This regulation eliminates Medicaid beneficiary cost-sharing (the one-dollar pharmacy copay) for prescriptions associated with Medication Assisted Treatment (MAT) under a Medicaid demonstration program. To offset the waived cost-sharing, DHCF increases fee-for-service pharmacy provider reimbursement rates by the equivalent cost-sharing amount, effective January 1, 2020. Facility operators and MAT providers should ensure no cost-sharing is collected from beneficiaries for MAT-related prescriptions.
View official source8613 MEDICATION ASSISTED TREATMENT BENEFICIARY COST SHARING 8613.1 Medicaid amount, duration and scope requirements, as set forth under § 1902(a)(10)(B) of the SSA, and comparability requirements, as set forth under §§ 1902(a)(10) and 1902(a)(17), are waived under this demonstration program to enable the DHCF to exempt beneficiaries receiving SUD treatment under this demonstration from one-dollar ($1) pharmacy cost-sharing requirements when they are receiving prescriptions associated with MAT. 8613.2 There shall be no Medicaid beneficiary cost-sharing for prescriptions associated with the provision of MAT services. 8613.3 Medicaid reimbursement for prescriptions associated with the provision of MAT services shall increase by the cost-sharing amount set forth in the District of Columbia Medicaid State Plan fee-for-service pharmacy services. 8613.4 Effective January 1, 2020, DHCF shall increase fee-for-service pharmacy provider reimbursement rates for prescriptions associated with provision of MAT services by the cost-sharing amount identified in § 8613.3. SOURCE: Final Rulemaking published at 68 DCR 5406 (May 21, 2021). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 8613