Spotlight: Final CMS Changes to Medicare Physician Payment and Opioid Use Disorder Benefits for Calendar Year 2020 Could Have Implications for State Medicaid Programs

November 2019

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates policies for services furnished under the Medicare Physician Fee Schedule and for Opioid Use Disorder (OUD) services in calendar year (CY) 2020 and thereafter.

The changes may have implications for states that:

  • Cover currently, or will be covering in 2020 Medicaid services for OUD;
    • Note that the SUPPORT Act of 2018 (Public Law 115-271) requires in Section 1006(b) that state Medicaid programs must cover medication-assisted treatment (MAT) for OUD by October 2020.
  • Base Medicaid physician payments on the Medicare Resource-Based Relative Value System (RBRVS); and/or
  • Are interested in coordinating Medicare and Medicaid physician care management services and care plans for their dually eligible beneficiaries.

In addition, CMS updated requirements for the Medicaid Promoting Interoperability Program, which requires provider reporting on electronic clinical quality measures. A fact sheet on the Medicare Physician Fee Schedule final rule and a news release on changes to Medicare payment to Opioid Treatment Programs provide additional information