Regulation text
9109 MEDICATION ASSISTED TREATMENT
Medication Assisted Treatment (MAT) is the use of pharmacotherapy as long-term treatment for opiate or other forms of dependence. MAT shall include medication dosing used in conjunction with substance abuse counseling.
Beneficiaries enrolled in MAT shall also be enrolled in substance abuse counseling.
A unit of MAT shall be one (1) dose of medication per day.
MAT shall be prior authorized, subject to the beneficiary’s level of care and meet the following requirements:
Beneficiaries receiving MAT shall require two (2) prior authorizations before long-term maintenance can be authorized;
A beneficiary new to ASARS treatment shall have an initial authorization of up to ninety (90) units of daily medications; and
The provider may then request prior authorization for an additional ninety (90) units, if appropriate, after which the patient may receive authorization for long-term MAT up to one hundred eighty (180) units.
Additional limitations for MAT are as follows:
MAT shall not exceed three hundred sixty-five (365) units per twelve (12) month period;
Except for MAT covering the administration of buprenorphine, MAT shall be provided in substance abuse treatment facilities or programs certified by APRA, or other community-based settings approved or designated by APRA; and
MAT that includes the administration of buprenorphine shall be limited to private practice offices of individuals authorized to prescribe buprenorphine according to their licensure pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01, et seq. (2007 Repl. & 2012 Supp.)).
MAT shall be delivered by the following qualified practitioners:
A physician; or
An advance practice registered nurse or physician assistant who is supervised by qualified physicians.
SOURCE: Final Rulemaking published at 59 DCR 11144 (September 28, 2012).