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February 2020
Update: Blue Cross, BCN support providers who offer comprehensive opioid treatment
 In the December 2019 Record, we published an article on this topic. We have updated the article with some additional information and clarifications. Please use the following as your reference for information about the Centers for Medicare & Medicaid Services program that encourages providers to offer the comprehensive range of opioid treatment services that many patients need.
Blue Cross Blue Shield of Michigan and Blue Care Network have implemented the CMS 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, Medicare Plus BlueSM and BCN AdvantageSM are using 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.
Only providers who are certified through the Substance Abuse and Mental Health Services Administration, or SAMHSA, to provide OTP services are eligible to receive bundled reimbursement.
Additional information you need to know
- This applies to Medicare Plus Blue and BCN Advantage members only — not to our commercial members (BCN HMOSM and Blue Cross’ PPO).
- Member cost sharing applies for these services.
- The bundled OTP reimbursement is for professional services only:
- The reimbursement doesn’t include drug costs. You’ll need to bill these as pharmaceutical services using standard billing practices.
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 treatment services. The opioid use disorder 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 opioid use disorder treatment services.
- Enrollment policies for OTPs.
- Methodology and estimated bundled payment rates for OTPs that vary by the medication used to treat opioid use disorder 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 implemented 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 apply.
What’s next?
In the future, we may offer bundled rates to reimburse OTP services for our commercial members, in addition to our Medicare Advantage members.
Look for updates on this and on related topics 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. |
