This Louisiana Medicaid rule establishes coverage, provider participation requirements, and reimbursement methodology for medication-assisted treatment (including methadone) delivered by Opioid Treatment Programs (OTPs) to Medicaid-eligible individuals with opioid use disorder. OTPs must contract with managed care organizations, maintain state and federal licensure (including SAMHSA and DEA compliance), and retain records for five years. Reimbursement is provided through a bundled rate on the Specialized Behavioral Health Fee Schedule.
View official sourceSubpart 16. Coverage for Treatment for Opioid Use Disorder in Opioid Treatment Programs Chapter 151.General Provisions §15101.Introduction A.The Medicaid Program hereby adopts provisions to provide coverage for medication-assisted treatment provided in Opioid Treatment Programs, including but not limited to, methadone treatment, to all Medicaid-eligible adults and children with opioid use disorder (OUD). AUTHORITY NOTE:Promulgated in accordance with R.S, 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 46:27 (January 2020). §15103.Recipient Qualifications A.Adults and children who meet Medicaid eligibility and clinical criteria shall qualify to receive medically necessary OUD services in Opioid Treatment Programs. B.Qualifying recipients must meet the following criteria: 1.are at least 18 years old, unless the recipient has consent from a parent or legal guardian, if applicable; and 2.meet the federal requirements regarding admission to the Opioid Treatment Program. AUTHORITY NOTE:Promulgated in accordance with R.S, 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 46:27 (January 2020). Chapter 153.Services §15301.General Provisions A.All treatment services must be medically necessary. AUTHORITY NOTE:Promulgated in accordance with R.S, 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 46:27 (January 2020). §15303.Covered Services A.The following services provided by Opioid Treatment Programs shall be reimbursed under the Medicaid Program: 1.the administration and dispensing of medications; and 2.treatment phases outlined in LAC 48:I.5725. AUTHORITY NOTE:Promulgated in accordance with R.S, 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 46:27 (January 2020). Chapter 155.Provider Participation §15501.Provider Responsibilities A.Each Opioid Treatment Program shall enter into a contract with the managed care organizations (MCOs) and the coordinated system of care (CSoC) contractor in order to receive reimbursement for Medicaid covered services. B.Opioid treatment programs shall deliver all services in accordance with federal and state laws and regulations, and the provisions of this Rule. C.Opioid Treatment Programs must be licensed in accordance with state laws and regulations, in addition to operating within their scope of practice license. D.Opioid Treatment Programs shall retain all records necessary to fully disclose the extent of services provided to recipients for five years from the date of service and furnish such records, and any payments claimed for services, to the Medicaid program upon request. E.Opioid Treatment Programs shall maintain compliance with state and federal regulatory authorities for operation, including but not limited to the Substance Abuse and Mental Health Services Administration (SAMHSA), the Drug Enforcement Administration (DEA), and the State Opioid Treatment Authority. AUTHORITY NOTE:Promulgated in accordance with R.S, 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 46:27 (January 2020). Chapter 157.Reimbursement §15701.Reimbursement Methodology A.Reimbursement rates for Opioid Treatment Programs shall be a bundled rate included in the Specialized Behavioral Health Fee Schedule as determined by the department. AUTHORITY NOTE:Promulgated in accordance with R.S, 36:254 and Title XIX of the Social Security Act. HISTORICAL NOTE:Promulgated by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 46:27 (January 2020).