In 2020, Will There be Changes to Medicare’s Coverage of Opioid Treatment Programs?As a result of federal legislation, Medicare Part B covers opioid use disorder (OUD) treatment received at opioid treatment programs (OTPs) effective January 1, 2020. Medicare previously did not cover OTPs, and this expanded Medicare coverage is intended to address the opioid epidemic by providing beneficiaries with access to services.

OTPs, which are also known as methadone clinics, are certified by the Substance Abuse and Mental Health Services Administrations (SAMHSA) to provide methadone as part of medicationassisted treatment (MAT). Opioid treatment programs are the only places where you can receive methadone to treat opioid use disorder (if you are prescribed methadone for pain relief, you do not need to receive it from an OTP). Before 2020, Medicare did not cover methadone to treat opioid use disorder because of the way it is dispensed and administered. As a result, beneficiaries could not get Medicare coverage for methadone they received at an OTP.

Types of services provided by an OTP that Medicare now covers include:

  • FDA-approved opioid agonist and antagonist treatment medications
    • There are currently three FDA-approved medications: methadone, buprenorphine,
      and naltrexone
  • Dispensing and administering of such medication (if applicable)
  • Substance use counseling
  • Individual and group therapy
  • Toxicology testing
  • Intake activities
  • Periodic assessments

In order for OTPs to bill Medicare for medication-assisted treatment provided to Medicare beneficiaries, they must be certified by SAMHSA and enroll in the Medicare program. If you have Medicare and Medicaid, and Medicaid was previously paying for your OTP, Medicaid will continue to pay primary for treatment until the OTP is enrolled in Medicare.

At this time, once you meet your deductible, you will not owe any cost-sharing (coinsurance or copayment) for OTP. This is intended to minimize any barriers to accessing care.

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