For several decades, patients were required to visit a federally certified clinic or Opioid Treatment Program (OTP) to receive methadone maintenance treatment for opioid use disorder. They typically received their daily dose onsite, with very limited take-home medication. The COVID-19 pandemic, however, ushered in significant regulatory changes, which support more expansive and flexible methadone take-home doses. Despite this change, payment models for OTPs typically reflect the needs of onsite medication administration without accounting for take-home doses.
In March 2020, NYS Medicaid introduced a bundled payment model for OTPs. In contrast to a per-service payment, a bundled payment provides a set fee to cover a defined range of services within a given payment episode, typically weekly.
A study by Dr. Yuhua Bao, professor of population health sciences, and colleagues from the University of Connecticut, NYU Langone Health, and the NYS Office of Addiction Services and Supports in the Journal of Substance Use and Addiction Treatment reports on OTP organizations' experience with the bundled payment model in New York State. Researchers interviewed 25 individuals from 12 organizations who provided perspectives on NYS Medicaid payment changes as an alternative to the pre-existing, per-service payment model.
The study provided insights into how continued payment policy changes can better support flexible take-home medication. Among other results, interviewees recognized that the bundled payment model protected revenue when OTPs had to pivot to increase take-home doses for patients. In addition, they believed that increased take-home doses and federal regulatory changes had significant implications for the counseling workforce for OTPs. Findings also provided insights for fine-tuning the designs of the bundled payment for OTPs. Researchers recommend the need for more studies to understand the roles of financing strategies in supporting clinical practice changes in substance use disorder treatment.
- Highlights