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

MEDICAID REIMBURSEMENT FOR OPIOID TREATMENT SERVICES

Illinois has received approval from the Center for Medicare and Medicaid Services (CMS) for the State Plan Amendment (SPA) to allow for Medicaid reimbursement for Opioid Treatment Services (OTS) (methadone maintenance) effective January 1, 2017.

The Division of Alcoholism and Substance Abuse (DASA) is working to assist OTS (methadone maintenance) providers in completing the necessary steps in order to bill Medicaid and the Medicaid Managed Care Organizations (MCOs) for these services. Immediate steps include obtaining a National Provider Identifier (NPI), submitting an application for Medicaid certification through DASA for this service, and enrolling in the IMPACT system with the Department of Healthcare and Family Services (HFS) in order to be able to be reimbursed for services, both through fee-for-service and MCOs.

DASA sent an informational bulletin to OTS (methadone maintenance) providers on June 28, 2017 explaining these steps in greater detail. In addition, DASA will hold a webinar for OTS (methadone maintenance) providers to review the requirements and timing of the transition for Medicaid reimbursement for these services. OTS (methadone maintenance) providers have been asked to send any questions regarding this process to the DASA Help Desk at DoIT.dasahelp@illinois.gov by July 10, 2017. This will help us shape the materials developed for the webinar and will be included in a FAQ resource for all OTS (methadone maintenance) providers.

We, at DASA, are extremely proud of our system of care for individuals with opioid use disorder (OUD), including our providers who use methadone as an adjunct to treatment. As we continue our efforts in fighting the opioid crisis in Illinois, both DASA and HFS are working to enhance all possible resources available for this cause. Our hope is that inclusion of these services in the Medicaid State Plan will improve access to care for individuals with OUD. We deeply appreciate our partnership with the OTS providers in Illinois and their ongoing commitment to this life-saving endeavor.