CMMI Payment Model Seeks to Increase Access to Opioid Use Disorder Treatment
To address the ongoing opioid crisis, CMS' Center for Medicare and Medicaid Innovation is preparing a 4-year demonstration project called Value in Opioid Use Disorder Treatment (Value in Treatment). The new program offers the opportunity for Medicare beneficiaries to receive opioid use disorder (OUD) care management in primary care settings.
The purpose of the demonstration project, as stated in the SUPPORT Act statute, is to “increase access of applicable beneficiaries to opioid use disorder treatment services, improve physical and mental health outcomes for such beneficiaries, and to the extent possible, reduce [Medicare program expenditures].” CMMI said it expects the Value in Treatment demonstration to be implemented by January 2021.
The statute stipulates that a maximum of 20,000 applicable beneficiaries may participate in Value in Treatment at any given time, and makes available $10 million from the Federal Supplementary Medical Insurance Trust Fund under section 1841 of the Act available each of fiscal years 2021-2024 for demonstration payments. The program will create two new payments for opioid use disorder (OUD) treatment services furnished to applicable beneficiaries participating in the demonstration program:
• A per-beneficiary, per-month care management fee (CMF), which the participant may use to “deliver additional services to applicable beneficiaries, including services not otherwise eligible for payment under [Title XVIII]”; and
• A performance-based incentive, that would be payable based on the participant’s performance with respect to criteria specified by CMS, which may include evidence-based medication-assisted treatment (MAT), as well as patient engagement and retention in treatment.
Services furnished under Value in Treatment must be based on an applicable beneficiary’s individualized OUD treatment plan, aligned with OUD treatment services defined in statute, and have a reasonable expectation of improving or maintaining the health or overall function of applicable beneficiaries.
The following types of individuals or entities are potential eligible participants:
• Physician
• Group practice comprised of at least one physician
• Hospital outpatient department
• Federally qualified health center
• Rural health clinic
• Community mental health center
• Clinic certified as a certified community behavioral health clinic pursuant to section 223 of the Protecting Access to Medicare Act of 2014
• Opioid treatment program (entity specified by the Secretary)
• Critical Access Hospital (entity specified by the Secretary)
Value in Treatment will test whether the demonstration reduces hospitalizations and emergency department visits; increases use of medication assisted treatment (MAT) for OUD; improves health outcomes for individuals with OUD, including reducing the incidence of infectious diseases such as Human Immunodeficiency Virus (HIV) and hepatitis C (HCV); reduces deaths from opioid overdose; reduces utilization of inpatient residential treatment; and reduces Medicare program expenditures to the extent possible.
CMMI is seeking public comments until July 28, 2020, to further inform demonstration design.
