Blue Cross, BCN to support providers who offer comprehensive opioid treatment

This article was updated on Dec. 9, 2019, to show that for Blue Cross and BCN members, applicable member cost-sharing amounts will apply.

Blue Cross Blue Shield of Michigan and Blue Care Network will implement the Centers for Medicare & Medicaid Services program that encourages providers to offer the comprehensive range of opioid treatment services that many patients need. You can view the CMS final rule on this program, which was published in the Federal Register.**

What this means
Starting Jan. 1, 2020, Blue Cross and BCN will use bundled rates to reimburse providers who offer certified opioid treatment programs, or OTPs. The bundled payment includes both drug and non-drug components and may allow for intensity add-on codes to be used when needed.

This will apply to services for our Medicare Advantage members (Medicare Plus Blue^SM PPO and BCN Advantage^SM) and our Blue Cross and BCN commercial members.

Once this change goes into effect, certified OTPs may qualify for bundled reimbursement.

Here’s some additional information you need to know.

What’s an OTP?
OTPs provide medication-assisted treatment along with counseling and other services for people diagnosed with an opioid use disorder. The treatment of opioid dependence with medications is governed by the Certification of Opioid Treatment Programs, 42 Code of Federal Regulations 8. This regulation created a system to accredit and certify opioid treatment programs.

SAMHSA’s Division of Pharmacologic Therapies is responsible for overseeing the certification of OTPs.

For information on how to obtain OTP certification, visit SAMHSA’s Certification of Opioid Treatment Programs** webpage.

About the CMS program
Section 2005 of the SUPPORT for Patients and Communities Act*** established a new Medicare Part B benefit for opioid use disorder, or OUD, treatment services. The OUD treatment services include medications for medication-assisted treatment furnished by opioid treatment programs.

To meet this statutory requirement, CMS has finalized the following:

• Definitions of OTP and OUD treatment services
• Enrollment policies for OTPs
• Methodology and estimated bundled payment rates for OTPs that vary by the medication used to treat OUD and service intensity, and by full and partial weeks
• Adjustments to the bundled payment rates for geography and annual updates
• Flexibility to deliver the counseling and therapy services described in the bundled payments via two-way interactive audio-video communication technology as clinically appropriate
• Zero beneficiary copayment for a time-limited duration

Blue Cross and BCN will implement this program beginning Jan. 1, 2020, as required by the SUPPORT for Patients and Communities Act. However, for Blue Cross and BCN members, applicable member cost-sharing amounts will apply.

What’s next?
Look for updates in future issues of The Record and BCN Provider News, as well as web-DENIS messages and news items on our ereferrals.bcsbm.com website.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.
***SUPPORT stands for Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment.