Naugatuck Valley Overdose Prevention & Education
OTPs are defined by Medicare law as those who:
• are enrolled in Medicare
• are certified by the Substance Abuse and Mental Health Services Administration (SAMHSA)
• are accredited by a SAMHSA approved entity
• meet additional conditions to ensure the health and safety of individuals being furnished services under these programs and the effective and efficient furnishing of such services
• Have in effect a provider agreement with CMS
• As an OTP, you are a Part B provider.
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3 Approved medications to treat opioid addiction:
*Because of buprenorphine’s opioid effects, it can be misused, particularly by people who do not have an opioid dependency.
*Naloxone is added to buprenorphine to decrease the likelihood of diversion and misuse of the combination drug product.
Medication-assisted treatment (MAT) is the use of medications with counseling and behavioral therapies to treat substance use disorders and prevent opioid overdose. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery. The Food and Drug Administration (FDA) has approved several different medications to treat opioid addiction and alcohol dependence.
"MAT is primarily used for the treatment of addiction to opioids such as heroin and prescription pain relievers that contain opiates. The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug. Medications used in MAT are approved by the Food and Drug Administration (FDA), and MAT programs are clinically driven and tailored to meet each patient’s needs. Combining medications used in MAT with anxiety treatment medications can be fatal. Types of anxiety treatment medications include derivatives of Benzodiazepine, such as Xanax or valium." - SAMHSA
Healthcare Provider Resources
Medication-Assisted Treatment (MAT) | SAMHSA - Substance Abuse and Mental Health Services Administration
The Substance Abuse and Mental Health Services Administration
SAMHSA: "This Treatment Improvement Protocol (TIP) reviews the use of the three Food and Drug Administration (FDA)-approved medications used to treat opioid use disorder (OUD)—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support recovery for people with OUD."
You can download it for free at https://store.samhsa.gov/product/SMA18-5063FULLDOC
Medication-Assisted Treatment (MAT)
Beginning January 1, 2020, Medicare will pay Medicare-enrolled Opioid Treatment Programs (OTPs) to deliver opioid use disorder (OUD) treatment services to Medicare beneficiaries. For more information on how to enroll as an OTP provider, review the Opioid Treatment Programs (OTPs) Medicare Enrollment Fact Sheet.
This fact sheet has information about:
● covered opioid use disorder (OUD) Treatment Services
● who can provide OTP services
● enrolling in Medicare Electronic Data Interchange (EDI)
● checking Medicare beneficiary eligibility
● coding and submitting claims for OTP services
● payment and remittance advice (RA)
● issues with payment
● how to check claims status
● helpful resources
For more information on this new Part B benefit for Medicare beneficiaries with OUD, visit the CMS Opioid Treatment Programs webpage.
Covered opioid use disorder treatment services include:
● FDA-approved opioid agonist and antagonist treatment medications
● dispensing and administering medications (if applicable)
● substance use disorder counseling
● individual and group therapy
● toxicology testing
● intake activities
● periodic assessments
Who Can Provide OTP Services?
OTP providers must be:
● enrolled in Medicare
● fully certified by SAMHSA
● accredited by an accrediting body approved by SAMHSA
● able to meet such additional conditions as the Secretary may find necessary to ensure the health and
safety of individuals being provided services
Professionals who can provide the substance use counseling and individual and group therapy included in the bundled payment may include:
● licensed clinical social workers
● licensed professional counselors
● licensed clinical alcohol and drug counselors
● certified peer specialists who are permitted to furnish this type of therapy or counseling by state law and scope of practice
● others who are permitted to furnish this type of therapy or counseling by state law and scope of practice
If the individuals furnishing therapy or counseling services are not authorized under state law to furnish such services, the therapy or counseling services provided by these professionals would not be covered as OUD treatment services.