Were you aware that as of 2018, close to one million adults 65 and older suffered from a substance abuse disorder? What’s more, according to the National Institute on Drug Abuse, the percentage of older adults admitted to a treatment facility for substance abuse grew from 3.4% in 2000 to 7% by 2012. In addition, while the population of adults 55 and up grew by 6% between 2013 and 2015, the percentage of people in that age group who sought treatment for an opioid use disorder (OUD) skyrocketed to 54%.
The Centers for Medicare and Medicaid Services are addressing the dangers opioids pose. While prescription opioids are effective for managing pain when used correctly, the potential for misuse cannot be ignored. Opioids killed more than 47,000 people in 2018 alone. And 32% of all opioid deaths involved a prescription medication. As one of the largest healthcare services payers in the U.S., CMS has focused on the following three OUD areas:
• Prevention – manage pain but rely less on prescription opioids
• Treatment – increase access to treatment for opioid use disorder
• Data – use analytics to target prevention and treatment efforts and combat fraud and abuse
What does Medicare cover?
Medication-assisted treatment, or MAT, is now included in all CMS programs. In January of 2020, Medicare began covering methadone for MAT and related services provided by Opioid Treatment Programs (OTP) under Part B (outpatient medical insurance). And on Jan. 21, 2020, Medicare expanded coverage to include acupuncture for certain beneficiaries with chronic low back pain. OTPs must enroll in Medicare to receive reimbursement when services are provided to Medicare patients.
Among the items covered under the Medicare OTP benefit:
• Food and Drug Administration approved opioid agonist and antagonist MAT medications
• Dispensing and administering MAT medications (if applicable)
• Substance abuse counseling
• Individual and group therapy
• Toxicology testing
Medicare covers OTP in 2022
In summary: OUD treatment options If you or someone you know enrolled in Medicare may have an opioid use disorder, you don’t have to pay for services if you receive them from an OTP enrolled in Medicare. However, a Part B deductible will apply. Medicare will pay doctors and other healthcare providers for office-based opioid use disorder treatment. This includes management, coordination of care, psychotherapy and counseling.
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