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Value in Opioid Use Disorder Treatment Demonstration Model

Sponsor
Centers for Medicare and Medicaid Services
Deadlines
Jan 3, 2021
Purpose

Value in Opioid Use Disorder Treatment is a 4-year demonstration program designed to increase access to opioid use disorder (OUD) treatment services, improve physical and mental health outcomes for beneficiaries, and reduce Medicare program expenditures.

The model will test whether the demonstration:

  • Reduces hospitalizations and emergency department visits
  • Increases use of medication assisted treatment for OUD
  • Improves health outcomes for individuals with OUD, including reducing the incidence of infectious diseases such as Human Immunodeficiency Virus and hepatitis C
  • Reduces deaths from opioid overdose
  • Reduces utilization of inpatient residential treatment
  • Reduces Medicare program expenditures to the extent possible
Eligibility

Eligible participants:

  • Physicians
  • Group practices comprised of at least one physician
  • Hospital outpatient departments
  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Community mental health centers
  • Clinics certified as a certified community behavioral health clinic pursuant to section 223 of the Protecting Access to Medicare Act of 2014
  • Opioid treatment programs
  • Critical Access Hospitals

Applicable beneficiaries are individuals who:

  • Are entitled to, or enrolled for, benefits under Medicare Part A and enrolled for benefits under Medicare Part B
  • Are not enrolled in a Medicare Advantage plan under Medicare Part C
  • Have a current diagnosis for an opioid use disorder
Geographic coverage
Nationwide
Amount of funding

The model will have 2 new payments for OUD treatment services furnished to applicable beneficiaries participating in the demonstration program:

  • A per beneficiary per month care management fee, which the participant may use to deliver additional services to applicable beneficiaries
  • 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, as well as patient engagement and retention in treatment
Application process

Links to additional guidance and application instructions are available on the program website.

Email completed applications to ValueinTreatment@cms.hhs.gov.

Tagged as
Critical Access Hospitals · Federally Qualified Health Centers · HIV and AIDS · Illicit drug use · Infectious diseases · Mental health · Mortality · Prescription drug misuse · Reimbursement and payment models · Rural Health Clinics · Substance use and misuse



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