CMS orders demonstration of new payment model for opioid treatment


The Center for Medicare and Medicaid Services (CMS) announced last month that they will demonstrate a new voluntary payment model for opioid use disorder treatment.

The Alternative Payment Model (APM) is designed, the center said, to increase access to opioid use disorder treatment and services, improves the outcome for Medicare beneficiaries with OUD from both a mental and physical standpoint, and decrease, where possible, Medicare expenditures.

The Value in Opioid Use Disorder Treatment Demonstration has two components, the center said. One, a care management fee, provides healthcare facilities and community behavioral health providers with a quarterly fee equivalent to $125 per patient per month. The new care management fee can be used in addition to the existing coverage to address non-medical aspects of treatment such as child care, transportation, housing, and job training.

The second component would provide OUD treatment centers with a performance-based incentive equal to a 5 percent withholding in the first year, and a 10 percent withholding every year thereafter. CMS had not yet specified what the quality measures tied to the performance initiative would be.

The demonstration is open to physician groups, hospital outpatient departments, and a wide range of other community providers, except those in the Comprehensive Primary Care+ Model, Primary Care First, and the Maryland Primary Care Program. Those applicants in counties and states with a high prevalence of OUD will be given the highest priority.

The demonstration begins on Jan. 1, 2021, and will run through Dec. 31, 2024. Applications for the program are due Sept. 30, 2020.