Medicare Coverage for Opioid Use Disorder Treatment

As a friendly reminder, we are still fighting for full coverage for opioid use disorder treatment.

However, thanks in part to your advocacy efforts, H.R.6, the SUPPORT for Patients and Communities Act, commonly referred to as “The SUPPORT Act,” was signed into law October 2018. This landmark legislation includes critical provisions to increase and strengthen our workforce; standardize the delivery of addiction medicine; cover addiction medicine; and expand access to high-quality, evidence-based mental health care. The SUPPORT Act also expands the definition of allowable mental health care services under provision B to include LPCs operating within certified Opioid Treatment Programs (OTP) for the purpose of Opioid Use Disorder (OUD) treatment.

The Centers for Medicare and Medicaid Services (CMS) retained language within the SUPPORT Act that would benefit LPCs in a proposed rule related to Medicare payments. Specifically, the language would enable any LPCs or Licensed Mental Health Counselors (LMHC) working in an Opioid Treatment Program (OTP), with clients suffering from opioid use disorder, to provide counseling services without any disruption to the bundled payments received by the OTP since January 1, 2020.

Due to the passage of H.R.6, Medicare offers new bundled payment options to help you treat patients with Opioid Use Disorder (OUD):

• Office-based OUD treatment, including management, care coordination, psychotherapy, and counseling activities. Learn about treatment billing.
• Treatment provided by enrolled Opioid Treatment Programs (OTPs). Services include medication (like methadone and buprenorphine), counseling, drug testing, and individual and group therapy. We cover counseling and therapy services in person and virtually. Refer your patients to Medicare-enrolled OTPs to get started.

Learn more about our efforts to combat the opioid epidemic. 

Although this is a step forward toward Medicare coverage, ACA is still fighting for the full inclusion of professional counselors as behavioral health providers under Medicare. If you would like to become involved in ACA’s advocacy efforts, you can contact the ACA Government Affairs and Public Policy team at advocacy@counseling.org