From:  Maria Bruni, Acting Director
Division of Alcoholism and Substance Abuse

MEDICAID BILLING AND MEDICATION ASSISTED TREATMENT (METHADONE)

The Heroin Crisis Act (Public Act 099-0480, formerly HB 0001) contains many additions and revisions to existing statutes that will help to address the escalating problem of opioid use disorders and overdoses. Of particular relevance to DASA is the provision that will allow reimbursement of Methadone, through Medicaid fee-for-service and Medicaid Managed Care Organizations (MCOs), for Medicaid eligible patients assessed as medically appropriate for this service.

Over the past few months, DASA has been working on an implementation plan for this newly covered service with staff from the Illinois Department of Healthcare and Family Services (HFS). The first step in this process involves a change to the HFS Medicaid State Plan that, when adopted, will include Medication Assisted Treatment, including Methadone, as a covered service. The amendments to the current plan have been completed and submitted to federal Central Management Services (CMS) for review and approval. Once approval is received, implementation will proceed.

The projected target date for implementation is January of 2017 which would then allow any provider, licensed and Medicaid certified through DASA for Opioid Maintenance Treatment (OMT), to be reimbursed for these services through Medicaid. DASA staff is working now to implement changes so services reimbursed as fee-for-service can be accepted and forwarded on to HFS for Medicaid reimbursement. Additionally, the procedure for each provider to obtain the applicable Medicaid certification and enrollment for OMT is being identified. More information will be forwarded over the next few months as policy and implementation steps are finalized.

In the interim, a review of DASA Administrative Rules, Part 2060 and Part 2090, is strongly recommended for any provider that does not currently have DASA Medicaid certification or for any provider who will be adding OMT as a covered service to existing certification. This review will help to ensure that billed services are medically necessary and conducted in accordance with all facility and clinical standards.

Please direct any questions you have about the content of this Smart Alert to the DASA Help Desk at DHS.DASAHELP@ILLINOIS.GOV.