The health care authority (HCA) previously published its intent to submit medicaid SPA 18-0033 for a rate enhancement designed to increase access to MAT for opioid disorders. Notice appeared on HCA's web site on August 23, 2018, and will appear in the Washington State Register on September 19, 2018, under WSR 18-18-001.

HCA is amending that notice to clarify information regarding counseling and behavior therapies. Amended information is in italics below. The remainder of the information in this notice remains the same as in the previously published notice.

MAT is defined as the use of the Food and Drug Administration (FDA) approved medications, in combination with counseling and behavioral therapies, to provide a "whole-patient" approach to the treatment of substance use disorders. Health care providers licensed to prescribe Schedule II drugs may receive a waiver to prescribe MAT for opioid use disorder per the Drug Addiction Treatment Act 2000 (DATA 2000).

As one piece of Washington's response to the opioid crisis, the state legislature provided funds to pay medicare rates for MAT in order to encourage more providers to use medication to treat patients with opioid use disorder. The state proposes to pay medicare rates for selected evaluation and management (E&M) codes when all of the following conditions apply:


•	The provider is DATA-waived to write prescriptions for buprenorphine or any new FDA-approved products requiring a waiver;
•	Assessment for and treatment with counseling and behavioral therapies to address accompanying psychosocial conditions is part of the visit. If these services are not available onsite, the prescriber must document the plan to obtain them;
•	The claim is not from a mobile treatment unit or a setting where opioid treatment is already compensated under another payment methodology; and
•	The client has a qualifying diagnosis.

•

The provider is DATA-waived to write prescriptions for buprenorphine or any new FDA-approved products requiring a waiver;

•

Assessment for and treatment with counseling and behavioral therapies to address accompanying psychosocial conditions is part of the visit. If these services are not available onsite, the prescriber must document the plan to obtain them;

•

The claim is not from a mobile treatment unit or a setting where opioid treatment is already compensated under another payment methodology; and

•

The client has a qualifying diagnosis.

SPA 18-0033 is expected to increase the annual aggregate payments for MAT services. Eligible providers will receive the medicare rate for select E&M codes, resulting in an overall increase of about $6 million for the first year.

SPA 18-0033 is in the development process; therefore a copy is not yet available for review. HCA would appreciate any input or concerns regarding this SPA. To request a copy when it becomes available, you may contact the agency in your county listed in the table or the person named below. To submit comments, please contact the person named below (please note that all comments are subject to public review and disclosure, as are the names of those who comment).

Contact Christy Vaughn, Financial Services, 626 8th Avenue S.E., Olympia, WA 98501, phone 360-725-0468, TRS 711, email Christy.vaughn@hca.wa.gov.