The request-for-application period is now open for the recently announced Value in Opioid Use Disorder Treatment (ViT) Demonstration program.
Applications are due January 3, 2021.
Program Overview
The four-year demonstration starts April 1, 2021, and concludes December 31, 2024.
The ViT demonstration, as stated in the statute, intends to “increase access of applicable beneficiaries to opioid use disorder treatment services, improve physical and mental health outcomes for such beneficiaries, and to the extent possible, reduce [Medicare program expenditures].”
Eligible beneficiaries include any individual with a current diagnosis of opioid use disorder (OUD) enrolled in Medicare fee-for-service (FFS) or dually eligible for Medicare and Medicaid.
The demonstration will budget $10 million each fiscal year from 2021 through 2024. A maximum of 20,000 beneficiaries may participate at any given time. Therefore, the number of participants may be limited based on funding availability.
Demonstration Payments
Two new payments will be provided to model participants:
- Care Management Fee (CMF)
- Performance-based Payment
CMF
The participant must submit claims for a payment of $125 per beneficiary per month, paid quarterly by the Medicare Administrative Contractor (MAC).
Performance-Based Payment
CMF payments will be subject to a quality withhold, such that a certain percentage will be withheld from each quarterly payment.
The withholding amounts are as follows:
- 0% in performance year one
- 5% in performance year two
- 10% in each performance years three and four
Participants who meet quality criteria, to be specified in the participation agreement, during a given performance year will be eligible to earn back withheld monies.
Additional Benefits
CMS will waive beneficiaries’ cost sharing requirements for OUD related services as an additional benefit.
Participants in the model will be considered Merit-Based Incentive Payment System Alternative Payment Model (MIPS APM) participants for PY2021 and beyond.
Eligible Individuals and Entities
The model is open to of the following types of individuals or entities:
- Clinics certified as a certified community behavioral health clinic pursuant to section 223 of the Protecting Access to Medicare Act of 2014
- Community mental health centers
- Critical access hospitals
- Federally qualified health centers
- Group practices comprised of at least one physician
- Hospital outpatient departments
- Opioid treatment programs
- Physicians
- Rural health clinics
We’re Here to Help
Analyzing the risks, benefits, compliance requirements, and financial impact of any new value-based model is a crucial first step.
If you’re considering participating in the ViT demonstration, contact your Moss Adams professional for support with submitting an application and preparing to succeed in the model.