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Opioid treatment services now covered by Medicare

New Medicare policy creates options for interdisciplinary senior services

By CARF International

Roughly two million people in the United States struggle with opioid use disorder (OUD) on a daily basis, although many are able to live productive and satisfying lives by receiving ongoing treatment. Some rely on private insurance to cover the cost of treatment while many pay out of pocket.

Although private and state insurance sometimes cover opioid addiction treatment, Medicare historically has not. However, on October 3, Congress passed the SUPPORT for Patients and Communities Act, which expanded Medicare coverage to include opioid treatment programs. The new law should provide access for persons served and opportunities for providers that were previously unavailable.

What the expansion of Medicare for OUD means
The age at which Americans become eligible for Medicare (65) is also an age when many begin needing age-related services (assisted living or community services) and/or face other health and social barriers. The comprehensive services provided in an opioid treatment program address recovery in a way that treats the whole person. This can be especially important now as opioid-related hospitalizations increased by 34% from 2010 to 2015 in individuals over 65.

The new Medicare rules take aim at an increasingly scrutinized barrier to comprehensive treatment for patients who struggle with OUD. National advocacy groups, such as the American Association for the Treatment of Opioid Dependence (AATOD) and the National Council for Behavioral Health (National Council) have long highlighted the potential for disruption of OUD treatment when a person reaches Medicare age. The issue has gained more importance as policymakers explore value-based solutions to one of the nation’s most pressing healthcare issues.

As Mark Parrino, President of AATOD, stated in late 2017, “This is a cradle-to-grave issue. People start abusing drugs when they’re very young. I don’t think the spigot turns off when they turn 65.”

How to learn more
The expansion of Medicare coverage for opioid treatment programs gives providers and doctors more options for treatment and referrals and could affect existing or new care plans in various ways.

 Learn more about the effects of the new rules:

More information should become available in the weeks and months ahead. If you have questions, connect with some of the associations that have been advocating this expansion, such as AATOD, National Council, and the American Psychiatric Association.

10/23/2018
(Aging Services,Behavioral Health,Opioid Treatment and Recovery)


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Liz, thank you for reading the blog and contacting CARF. You can find out more about reimbursement for OTPs by visiting the Centers for Medicare & Medicaid Services' website at www.cms.gov/Center/Provider-Type/Opioid-Treatment-Program-Center.

Posted by: CARF International at 12/5/2019 3:37:54 PM



Liz, thank you for reading the blog and contacting CARF. You can find out more about reimbursement for OTPs by visiting the Centers for Medicare & Medicaid Services' website at www.cms.gov/Center/Provider-Type/Opioid-Treatment-Program-Center.

Posted by: CARF International at 12/5/2019 9:49:55 AM



I am a patient advocate (P.A.A.G.) at Aegis Treatment Centers Ontario and when I had insurance, my insurance (Kaiser) paid my bill. That was until I turned 65 (in June 2018) and went to Medicare. Then I had to start paying out of my pocket which was financially difficult. My clinic manager told me a few months ago that Medicare was going to start paying after the first of the year!!!
I have said on more than one occasion during talks about Medicare not paying " did they think that seniors don't have addiction problems?? They most certainly do!!"
I've been clean almost 26 yrs because of methadone and I am beyond happy that other senior addicts are now getting the help they want and need.

Posted by: Debi McGregor at 11/29/2019 5:06:34 PM



I would love to know more regarding Medicare reimbursing for OTP.

Posted by: Liz Blair at 10/7/2019 10:26:11 AM

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