In accordance with the public notice requirements of 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act, the Indiana Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP) publishes this notice of proposed changes to the reimbursement of Opioid Treatment Programs (OTP). The public notice period will run 02/15/2023 to 03/17/2023.

OMPP is requesting a State Plan Amendment (SPA) specific to the reimbursement and coverage of OTP services. Currently, OTP services are reimbursed on a per diem basis using an OMPP-developed single bundled code. This SPA will replace the current per diem reimbursement bundles utilized by Indiana Medicaid, and instead will reimburse OTP providers according to Medicare's OTP code set, which uses a weekly reimbursement bundle structure.

This SPA will reduce provider confusion for submitting claims for these services, as there will then be one consistent code set to be used for both Medicaid and Medicare beneficiaries. These new reimbursement bundles will give providers the ability to more accurately code and be reimbursed for services provided to the beneficiary, considering Medicare's OTP bundle code set has multiple different bundled codes that allows the provider to more accurately bill for services dispensed, unlike the single broadly used code currently utilized by the Indiana Medicaid program. This code will broaden medication treatment options. By using the Medicare OTP bundle code set, providers will be able to utilize other treatment options and be reimbursed for those options compared to current practice which imposes barriers to accessing alternative treatments.

This SPA will therefore result in a change to Medicaid reimbursement for opioid treatment providers. The changes are estimated to have a minor fiscal impact on the Medicaid program. These changes are to be effective July 1, 2023.

A copy of this notice is now on file at the Indiana Government Center South, 402 West Washington Street, Room W451, Indianapolis, Indiana and is open for public inspection. Also, a copy of this notice is now available and may be inspected by contacting the local county Division of Family Resources office, except in Marion County, where public inspection may be made at 402 West Washington Street, Room W374, Indianapolis, Indiana.

There will be no public hearing. Written comments may be directed to FSSA, Office of Medicaid Policy and Planning, Attention: Madison May-Gruthusen, 402 West Washington Street, Room W382, P.O. Box 7083, Indianapolis, IN 46207-7083 or by email to spacomment@fssa.in.gov. Correspondence should be identified in the following manner: COMMENT RE: OPIOID TREATMENT PROGRAM BUNDLES. Written comments will be made available for public inspection at the address herein of the OMPP.

Dan Rusyniak, MD

Secretary

Office of the Secretary of Family and Social Services