Sec. 2109. Demonstration testing coverage of certain services furnished by opioid treatment programs
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Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by inserting after section 1866E the following: The Secretary shall conduct a demonstration (in this section referred to as the demonstration ) to test coverage of and payment for opioid use disorder treatment services (as defined in paragraph (2)(B)) furnished by opioid treatment programs (as defined in paragraph (2)(A)) to individuals under part B using a bundled payment as described in paragraph (3).
In this section: The term opioid treatment program means an entity that is an opioid treatment program (as defined in section 8.2 of title 42 of the Code of Federal Regulations, or any successor regulation) that— is selected for participation in the demonstration; has in effect a certification by the Substance Abuse and Mental Health Services Administration for such a program; is accredited by an accrediting body approved by the Substance Abuse and Mental Health Services Administration; submits to the Secretary data and information needed to monitor the quality of services furnished and conduct the evaluation described in subsection (c); and meets such additional requirements as the Secretary may find necessary.
The term opioid use disorder treatment services means items and services that are furnished by an opioid treatment program for the treatment of opioid use disorder, including— opioid agonist and antagonist treatment medications (including oral, injected, or implanted versions) that are approved by the Food and Drug Administration under section 505 of the Federal Food, Drug and Cosmetic Act for use in the treatment of opioid use disorder; dispensing and administration of such medications, if applicable; substance use counseling by a professional to the extent authorized under State law to furnish such services; individual and group therapy with a physician or psychologist (or other mental health professional to the extent authorized under State law); toxicology testing; and other items and services that the Secretary determines are appropriate (but in no case to include meals or transportation).
The Secretary shall pay, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, to an opioid treatment program participating in the demonstration a bundled payment as determined by the Secretary for opioid use disorder treatment services that are furnished by such treatment program to an individual under part B during an episode of care (as defined by the Secretary). The Secretary may implement this paragraph through one or more bundles based on the type of medication provided (such as buprenorphine, methadone, naltrexone, or a new innovative drug), the frequency of services furnished, the scope of services furnished, characteristics of the individuals furnished such services, or other factors as the Secretary determines appropriate.
In developing such bundles, the Secretary may consider payment rates paid to opioid treatment programs for comparable services under State plans under title XIX or under the TRICARE program under chapter 55 of title 10 of the United States Code. The demonstration shall be conducted for a period of 5 years, beginning not later than January 1, 2021. In carrying out the demonstration, the Secretary shall limit the number of beneficiaries that may participate at any one time in the demonstration to 2,000.
The Secretary may waive such provisions of this title and title XI as the Secretary determines necessary in order to implement the demonstration. Chapter 35 of title 44, United States Code, shall not apply to this section. The Secretary shall conduct an evaluation of the demonstration. Such evaluation shall include analyses of— the impact of the demonstration on— utilization of health care items and services related to opioid use disorder, including hospitalizations and emergency department visits; beneficiary health outcomes related to opioid use disorder, including opioid overdose deaths; and overall expenditures under this title; and the performance of opioid treatment programs participating in the demonstration with respect to applicable quality and cost metrics, including whether any additional quality measures related to opioid use disorder treatment are needed with respect to such programs under this title.
Not later than 2 years after the completion of the demonstration, the Secretary shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate. For purposes of administering and carrying out the demonstration, in addition to funds otherwise appropriated, there shall be transferred to the Secretary for the Center for Medicare & Medicaid Services Program Management Account from the Federal Supplementary Medical Insurance Trust Fund under section 1841 $5,000,000, to remain available until expended. .
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Sec. 2109
Demonstration testing coverage of certain services furnished by opioid treatment programs
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