2020-04: Reimbursement for Opioid Use Treatment Programs

Date: 02/03/20

Effective January 20, 2020, Louisiana Healthcare Connections added coverage of Methadone as an authorized medication for Opioid Use Disorder (OUD) treatment provided in Opioid Treatment Programs (OTP)s. OTPs treat persons 18 years of age or older who are diagnosed with OUD for at least one year. Reimbursement for Methadone for OUD treatment will only be made to OTPs.  OTPs must adhere to all policies, rules and regulations set forth by the LA Department of Health; Office of Behavioral Health, State Opioid Treatment Authority.  Services shall be provided in accordance with the standards set forth by SAMHSA, Health Standards Licensing, the US Department of Justice Drug Enforcement Administration (DEA), the LA Board of Pharmacy and all applicable SAMSHA approved accrediting bodies as accepted by the LA Department of Health.  A provider subspecialty code 8V has been established for the OTPs/Methadone clinics as sole source providers.
 
The 8V subspecialty has two bundled rate options for OTPs/Methadone clinics:

·         H0020 – will be used for a bundled rate reimbursement for Methadone treatment

·         H0047 – will be used for a bundled rate for Buprenorphine treatment, but excludes the ingredient cost of the medication.  Buprenorphine medication will be billed separately using the applicable J-codes (J0571-J0575) depending on dosage amounts.

 

Louisiana Healthcare Connections will not require prior authorization for these services and the Specialized Behavioral Health Fee Schedule has been updated on the Louisiana Medicaid website at https://www.lamedicaid.com to reflect these changes.

Providers may access the full HPA 20-3.