CurrentCareSourcePolicy N/A

Arkansas PASSE Administrative Policy Statement (MOUD/OTP credentialing)

Governs administrative requirements, credentialing criteria, and coverage conditions related to opioid use disorder treatment (including medication for OUD and opioid treatment programs) for CareSource in Arkansas PASSE; affects practitioners, OTPs, and participating/non-participating providers.

Policy Summary

PayerCareSource

PolicyArkansas PASSE Administrative Policy Statement (MOUD/OTP credentialing)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2025

Next Review DateN/A

Key ActionNon-participating providers must obtain prior authorization for services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

8 hoursrequired practitioner training on SUD/OUD under CAA 2023

Apr 2, 2024SAMHSA OTP final rule effective

Oct 2, 2024SAMHSA final rule compliance

1+credentialing routes for prescribers

Prior authnon-participating providers

Coverage Criteria and Provider Requirements

Coverage criteria and provider requirements

Credentialing, licensure, training, and operational conditions that must be met for providers to deliver medications for opioid use disorder (MOUD) and for operation of Opioid Treatment Programs (OTP).

ALL of the following

ONE of
- Certification by the American Board of Addiction Medicine.
- Subspecialty certification in addiction medicine by the American Board of Preventive Medicine.
- Certificate of added qualification in addiction medicine from the American Osteopathic Association.

Policy Summary

PayerCareSource

PolicyArkansas PASSE Administrative Policy Statement (MOUD/OTP credentialing)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2025

Next Review DateN/A

Key ActionNon-participating providers must obtain prior authorization for services.

SourceLink

On This Page

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Subspecialty certification in addiction psychiatry by the American Board of Psychiatry and Neurology.

Completion of an accredited residency or fellowship in addiction medicine or addiction psychiatry.

Unrestricted licensed Advanced Practice Registered Nurses (APRN) credential pathway: completion of the Nurse Practitioner Substance Use Disorder Medical Education Project (NP-SUDMedEd) training.

ALL of the following

Hold an unrestricted license appropriate to the practitioner type.
Be registered with the DEA to dispense/ prescribe applicable controlled substances (Schedules III–V) as required for buprenorphine treatment.
Practice in an office-based setting.
Have training or experience that demonstrates the ability to treat and manage opioid-dependent members.
When required by state license, be supervised by or employed in collaboration with a qualifying physician.

ALL of the following

Obtain accreditation/certification as an Opioid Treatment Program (OTP).
Register with the Drug Enforcement Administration (DEA).
Follow applicable state laws (e.g., state licensure) for OTP operation.
Document that other traditional outpatient behavioral health services have been offered or provided (for example: testing, assessment, evaluation, psychotherapy).

ALL of the following

ONE of
- Graduation within the prior 5 years from a U.S. medical, advanced practice nursing, or physician assistant program that included successful completion of an opioid/SUD curriculum of at least 8 hours.
- Board certification in addiction medicine or addiction psychiatry from the American Board (or certification recognized by the American Osteopathic Association).
- Completion of an accredited 8-hour training on opioid or other SUDs from groups named in the CAA 2023 for practitioners applying for or renewing DEA registration to prescribe Schedule II–V medications.

ALL of the following

All providers must comply with applicable federal and state regulations (including SAMHSA and DEA requirements) and with state-specific licensure and oversight for OTPs.
CareSource administrative policy does not guarantee authorization or payment; plan contract (Evidence of Coverage) controls where conflicts exist.

Actions Required by Providers

Prior Authorization

Prior Authorization Required for Non-Participating Providers

Non-participating providers must obtain prior authorization before delivering services to members. Prior authorization requests should be submitted in accordance with CareSource prior authorization procedures and timeframes. Failure to obtain prior authorization when required may result in denial of payment.

Applies to all non-participating (out-of-network) providers
Prior authorization must be obtained before scheduling or performing services
Submit requests via CareSource prior authorization portal or established submission method
Non-compliance may lead to claim denial or reimbursement delay

Key Definitions

Opioid Treatment Program (OTP)

DefinitionProgram/qualified practitioner accredited and certified by SAMHSA delivering opioid treatment with an opioid agonist medication.

ScopeDelivers medication for opioid use disorder (MOUD) using opioid agonist medications as part of a structured treatment program.

AccreditationMust be accredited and certified by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Opioid Use Disorder (OUD)

Diagnostic thresholdAt least 2 of 11 DSM-5-TR clinical criteria must be met within a 12-month period.

Severity levelsSeverity ranges from mild to severe depending on number and intensity of criteria met.

Included featuresDiagnostic features include tolerance and withdrawal among the listed criteria.

Practitioner

Primary definitionA doctor of medicine (MD) or a doctor of osteopathy (DO), or another licensed healthcare professional acting within their licensed scope of practice.

Facility inclusionCan also refer to a healthcare facility licensed in the state where it is located to provide healthcare services.

Scope requirementPractitioners must act within their professional licensed scope of practice when providing services under this policy.