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PDFWAC 182-531-2040

Enhanced reimbursementMedication assisted treatment for opioid use disorder.

(1) The medicaid agency pays an enhanced reimbursement using the medicare rate when medication assisted treatment (MAT) is part of the visit for selected evaluation and management (E/M) codes and the provider meets the criteria in this section.
(2) The purpose of this enhanced reimbursement is to encourage providers to obtain and use a Drug Addiction Treatment Act of 2000 waiver (DATA 2000 waiver) to increase client access to evidence-based treatment using medications for opioid use disorder.
(3) To receive the enhanced reimbursement for MAT, a provider must:
(a) Bill using the agency's expedited prior authorization process;
(b) Currently use a DATA 2000 waiver to prescribe MAT to clients with opioid use disorder;
(c) Bill for treating a client with a qualifying diagnosis for opioid use disorder; and
(d) Provide opioid-related counseling during the visit.
(4) The agency payment for MAT under this section is limited to one enhanced reimbursement, per client, per day.
(5) The agency does not pay an enhanced reimbursement for services a client receives for opioid use disorder through an opioid treatment program facility licensed by the department of health.
[Statutory Authority: RCW 41.05.021, 41.05.160, and 2018 c 299. WSR 19-09-052, § 182-531-2040, filed 4/12/19, effective 5/13/19.]
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