Primary healthcare providers will be reimbursed for substance use disorder (SUD) treatments that are provided in an office-based primary care setting effective Jan. 1, 2024. This applies to providers who do not have a specialty SUD benefit services contract with a Prepaid Inpatient Health Plan (PIHP).
Reimbursement will occur through the Medicaid Fee-for-Service program or through a Medicaid Health Plan, depending upon the beneficiary’s program enrollment status.
Primary healthcare providers include healthcare providers (physicians [MD/DO], nurse practitioners, physician assistants, clinical nurse specialists, clinical nurse midwives) in an office-based setting who are licensed or otherwise trained to provide SUD services and behavioral health providers (licensed psychologist [doctoral level], licensed social worker [master’s level], licensed marriage and family therapist [master’s or doctoral level], licensed professional counselor [master’s or doctoral level], limited licensed psychologist [master’s or doctoral Educational level] under the supervision of an enrolled, fully licensed psychologist [except as noted in Section 333.18223 of the Public Health Code]) who are associated with them, and who do not have a specialty SUD benefit services contract with a PIHP.
Please refer to MMP 23-61 for more information including reimbursable services, care coordination, use of medication assisted treatment and other program requirements.
Members with questions may contact Kelsey Ostergren with the MHA.