Informational Bulletin 
 
DATE:   July 11, 2014 
 
FROM:   Cindy Mann, Director  
Center for Medicaid and CHIP Services  
   
Thomas Frieden, M.D., M.P.H., Director 
Centers for Disease Control and Prevention  
 
Pamela S. Hyde, J.D., Administrator 
Substance Abuse and Mental Health Services Administration 
 
Nora D. Volkow, M.D., Director 
National Institute on Drug Abuse, National Institutes of Health 
 
George F. Koob, Ph.D., Director 
National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health 
 
SUBJECT: Medication Assisted Treatment for Substance Use Disorders 
 
The Center for Medicaid and CHIP Services (CMCS) has issued a series of Informational 
Bulletins on effective practices to identify and treat mental health and substance use disorders 
(SUDs) covered under Medicaid.1,2  Nearly 12 percent of Medicaid beneficiaries over 18 have a 
SUD, and CMCS is committed to helping States effectively serve these individuals.3 The 
purpose of this Bulletin is to highlight the use of FDA-approved medications in combination 
with evidence-based behavioral therapies, commonly referred to as Medication Assisted 
Treatment (MAT), to help persons with SUDs recover in a safe and cost-effective manner. 
Specifically, the Bulletin provides background information about MAT, examples of state-based 
initiatives, and useful resources to help ensure proper delivery of these services. 
 
Background 
SUDs impact the lives of millions of Americans in the general population, including individuals 
who are enrolled in the Medicaid program.  On average, 105 people die every day as result of a 
drug overdoses.4 Additionally, 6,748 individuals across the country seek treatment every day in 
                                                            
1 Additional Informational Bulletins on behavioral health can be found at http://www.medicaid.gov/Medicaid-CHIP-
Program-Information/By-Topics/Benefits/Mental-Health-Services-.html 
2 http://www.drugabuse.gov/drugs-abuse 
3 http://store.samhsa.gov/shin/content/SMA13-4757/SMA13-4757.pdf, p.10 
4 Centers for Disease Control and Prevention. Drug Overdose in the United States: Fact Sheet, Home and 
Recreational Safety, accessed on October 28, 2013 from 
http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html.  Informational Bulletin  Page 2 
the emergency department for misuse or abuse of drugs.5 In 2010, drug overdose was the leading 
cause of injury death6 and caused more deaths than motor vehicle accidents among individuals 
25-64 years old.7 The monetary costs and associated collateral impact to society due to SUDs are 
high.  In 2009, health insurance payers spent $24 billion for treating SUDs, of which Medicaid 
accounted for 21 percent of spending.8 9  Therefore, understanding how MAT could reduce the 
high rates of SUDs and associated costs of medical and SUD treatment is crucial.  The use of 
medications in combination with behavioral therapies to treat SUDs can help reestablish normal 
brain functioning, reduce cravings, and prevent relapse.10 The medications used can manage the 
symptoms of substance use withdrawal that often prompt relapse and allow individuals to utilize 
other treatments, such as behavioral therapy.  In addition, these medications and therapies can 
contribute to lowering a persons risk of contracting HIV or hepatitis C by reducing the potential 
for relapse.11   
Medication assisted treatment is the use of FDA-approved medications in combination with 
evidence-based behavioral therapies to provide a whole-patient approach to treating SUDs.  
There is strong evidence that use of MAT in managing SUDs provides substantial cost savings. 
For instance:   
  Persons with untreated alcohol use disorders use twice as much health care and cost twice as 
much as those with treated alcohol use disorders,12 and medications treating SUDs in 
pregnant women resulted in significantly shorter hospital stays for SUD treatment  than drug-
addicted pregnant women not receiving MAT (10.0 days vs. 17.5 days).13  
                                                            
5 Centers for Disease Control and Prevention. Drug Overdose in the United States: Fact Sheet, Home and 
Recreational Safety, accessed on October 28, 2013 from 
http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html. 
6 Injury deaths are those caused by acute exposure to physical agents, e.g., mechanical force or energy, heat, 
electricity, chemicals, and ionizing radiation, in amounts or at rates that exceed the threshold of human tolerance. 
From http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_10.pdf.   
7 Centers for Disease Control and Prevention. Drug Overdose in the United States: Fact Sheet, Home and 
Recreational Safety, accessed on October 28, 2013 from 
http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html. 
8 Substance Abuse and Mental Health Services Administration. National Expenditures for Mental Health Services 
and Substance Abuse Treatment, 19862009. HHS Publication No. SMA-13-4740. Rockville, MD: Substance 
Abuse and Mental Health Services Administration, 2013. 
9 Substance Abuse and Mental Health Services Administration. National Expenditures for Mental Health Services 
and Substance Abuse Treatment, 19862009. HHS Publication No. SMA-13-4740. Rockville, MD: Substance 
Abuse and Mental Health Services Administration, 2013. 
10 National Institute on Drug Abuse. (September 2009). InfoFacts: Treatment approaches for drug addiction. 
Retrieved from http://www.drugabuse.gov/sites/default/files/if_treatment_approaches_2009_to_nida_92209.pdf  
11 National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research Based Guide. Third 
Edition, December 2012, http://www.drugabuse.gov/sites/default/files/podat_1.pdf. 
12 Holder, HD. Costs Benefits of Substance Abuse Treatment: An Overview of Results from Alcohol and Drug Abuse.  
J. Mental Health Policy Econ, March, 1998. 
13 Jones HE, Kaltenbach K, Heil SH, et al:Neonatal abstinence syndrome aftermethadone or buprenorphine 
exposure. New England Journal of Medicine 363:23202331, 2010  Informational Bulletin  Page 3 
  For individuals with alcohol dependence, MAT was associated with fewer inpatient 
admissions.  Total healthcare costs were 30 percent less for individuals receiving MAT than 
for individuals not receiving MAT.14 
  Medical costs decreased by 33 percent for Medicaid patients over three years following their 
engagement in treatment. This included a decline in expenditures in all types of health care 
settings including hospitals, emergency departments, and outpatient centers.15   
Studies have shown that prior to alcoholism treatment initiation, total monthly health care costs 
increased and costs substantially increased during the 612 months prior to treatment. Following 
treatment initiation, monthly total medical care costs declined and the overall trend was 
downward. Early intervention in the cycle of addiction for younger individuals with SUDs can 
bring costs down as they have lower pre-treatment costs than older adults with SUDs.16 
 
Medication Assisted Treatment 
This section provides an overview of the medications and therapies that comprise MAT.  These 
medications fall into two larger categories: medications to treat opioid use disorders and 
medications to treat alcohol use disorders.   
Several medications have been found effective in treating addiction to opioids, alcohol, and 
nicotine in adults.17 There are currently no FDA-approved medications to treat addiction to 
cannabis, cocaine, or methamphetamine.  
 
Medications to Treat Opioid Use Disorders 
Three medications have received FDA-approval for treating opioid use disorders: 
  Methadone prevents opioid withdrawal symptoms and reduces craving by activating opioid 
receptors in the brain.  It has a long history of use in treatment of opioid dependence in 
adults, and is available in specially licensed methadone treatment programs.  In some States, 
opioid-dependent adolescents between the ages of 16 and 18 may be eligible for methadone 
treatment, provided they have two documented failed treatments of opioid detoxification or 
drug-free treatment and have a written consent for methadone signed by a parent or legal 
guardian.18  
  Buprenorphine reduces or eliminates opioid withdrawal symptoms, including drug cravings, 
without producing the euphoria or dangerous side effects of heroin and other opioids. It does 
                                                            
14 Baser, o., Chalk, M. Rawson, R. etal. (2001) Alcohol treatment dependence: comprehensive healthcare costs, 
utilization outcomes, and pharmacotherapy persistence.  The American Journal of Managed Care, 178(8), S222-
234. 
15 Walter, L. et al (2006). Medicaid Chemical Dependency Patients in a Commercial Health Plan, Robert Wood 
Johnson Foundation, Princeton, New Jersey. 
16 Holder, HD. Costs Benefits of Substance Abuse Treatment: An Overview of Results from Alcohol and Drug Abuse.  
J. Mental Health Policy Econ, March, 1998. 
17 This Bulletin will only focus on medications for treating opioid and alcohol disorders. See 
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Tobacco.html for detailed 
information about treating nicotine disorders. 
18 Marsch, L.A. Treatment of adolescents. In Strain, E.C.; and Stitzer, M.L. (eds.) The Treatment of Opioid 
Dependence. Baltimore, MD: Johns Hopkins University Press, pp. 497507, 2005.  Informational Bulletin  Page 4 
this by both activating and blocking opioid receptors in the brain. It is available for 
sublingual (under-the-tongue) administration both in a stand-alone formulation and in 
combination with another agent called naloxone. The naloxone in the combined formulation 
is included to deter diversion or abuse of the medication by causing a withdrawal reaction if 
it is intravenously injected by individuals physically dependent on opioids.19  Physicians with 
special certification may provide office-based buprenorphine treatment for detoxification 
and/or maintenance therapy.20  It is sometimes prescribed to older adolescents on the basis of 
two research studies indicating its efficacy for this population,21,22 and has proven efficacy to 
treat those 16 years and older.  More information can be found here and here. 
  Naltrexone is approved for the prevention of relapse in adult patients following complete 
detoxification from opioids. It acts by blocking the brains opioid receptors, preventing 
opioid drugs from acting on them and thus blocking the euphoria the user would normally 
feel and/or causing withdrawal if recent opioid use has occurred. It can be taken orally in 
tablets or as a once-monthly injection given in a doctors office.23 
In addition to the above medications for opioid use disorder treatment, naloxone is a medication 
used to prevent opioid overdose deaths. The medication binds to opioid receptors and can rapidly 
reverse or block the effects of other opioids.  In doing so, naloxone can very quickly restore 
normal respiration to a person whose breathing has slowed or stopped as a result of heroin use or 
the misuse of prescription opioids. 
 
Medications to Treat Alcohol Use Disorders 
Three medications have received FDA-approval for treating alcohol use disorders:  
  Acamprosate reduces symptoms of protracted withdrawal (i.e., insomnia, anxiety, 
restlessness, and dysphoria) by normalizing brain systems disrupted by chronic alcohol 
consumption in adults.  It is thought to be more effective in patients with severe alcohol use 
disorders.24 
  Disulfiram inhibits an enzyme involved in the metabolism of alcohol, causing an unpleasant 
                                                            
19 Subramaniam, G.A.; Warden, D.; Minhajuddin, A.; Fishman, M.J.; Stitzer, M.L.; Adinoff, B.; Trivedi, M.; Weiss, 
R.; Potter, J.; Poole, S.A.; and Woody, G.E. Predictors of abstinence: National Institute on Drug Abuse multisite 
buprenorphine/naloxone treatment trial in opioid-dependent youth. Journal of the American Academy of Child and 
Adolescent Psychiatry 50(11):11201128, 2011. 
20 Substance Abuse and Mental Health Services Administration. Physician Waiver Qualifications. Available at: 
http://buprenorphine.samhsa.gov/waiver_qualifications.html 
21 Woody, G.E.; Poole, S.A.; Subramaniam, G.; Dugosh, K.; Bogenschutz, M.; Abbott, P.; Patkar, A.; Publicker, M.; 
McCain, K.; Potter, J.S.; Forman, R.; Vetter, V.;, McNicholas, L.; Blaine, J.; Lynch, K.G.; and Fudala, P. Extended 
vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial. Journal of the 
American Medical Association 300(17):20032011, 2008. Erratum in Journal of the American Medical Association 
301(8):830, 2009. 
22 Marsch, L.A.; Bickel, W.K.; Badger, G.J.; Stothart, M.E.; Quesnel, K.J.; Stanger, C.; and Brooklyn, J. 
Comparison of pharmacological treatments for opioid-dependent adolescents: A randomized controlled trial. 
Archives of General Psychiatry 62(10):11571164, 2005. 
23 Fishman, M.J.; Winstanley, E.L.; Curran, E.; Garrett, S.; and Subramaniam, G. Treatment of opioid dependence in 
adolescents and young adults with extended release naltrexone: Preliminary case-series and feasibility. Addiction 
105(9):16691676, 2010. 
24 http://www.ncbi.nlm.nih.gov/books/NBK64035/  Informational Bulletin  Page 5 
reaction (i.e., flushing, nausea, and heart palpitations) if alcohol is consumed after taking the 
medication.25  Compliance can be a problem, but among motivated patients this can be very 
effective. 
  Naltrexone blocks receptors involved in the rewarding effects of drinking and in the craving 
for alcohol similarly to how it blocks the effects of opioids.  It reduces relapse of heavy 
drinking behavior and is highly effective in some but not all patients, where varied outcomes 
could be due to genetic factors.  Naltrexone is available in both oral tablet and long-acting 
injectable preparations.26 
 
Behavioral Therapies 
To improve outcomes, the medications discussed above are recommended to be combined with 
behavioral therapies. Research shows that when treating SUDs, a combination of medication and 
behavioral therapies is the most effective.  Behavioral therapies help patients engage in the 
treatment process, modify their attitudes and behaviors related to drug and alcohol abuse, and 
increase healthy life skills. These treatments can also enhance the effectiveness of medications 
and help people stay in treatment longer.  Treatment programs that combine pharmacological and 
behavioral therapy services increase the likelihood of cessation relative to programs without 
these services.27  There are a number of treatment strategies that can be used in combination with 
medications to successfully address SUDs.  These include:   
  Individual therapy, group counseling, and family behavior therapy each provide different 
types of support for individuals in recovery from SUDs:  
  Individual therapy can help people learn new skills to maintain a substance-free life, 
o
address co-occurring mental health issues, address the benefits of utilizing 
prescription medication in treatment, and support individuals to pursue meaningful 
work, school and family goals.  
  Group counseling can help reduce a persons sense of isolation, provide peer support 
o
and feedback, and develop social and problem-solving skills.  
  Family behavior therapy provides education, allows family members to express their 
o
feelings and concerns, and helps secure the familys support for the person in 
recovery. More information on family behavior therapy can be found here.  
  Cognitive-behavioral therapy seeks to help patients recognize, avoid, and cope with the 
situations in which they are most likely to abuse drugs.  More information on cognitive-
behavioral therapy can be found here.  
  Motivational enhancement capitalizes on the readiness of individuals to change their 
behavior and enter treatment.  More information on motivational enhancement can be found 
at here. 
                                                            
25 Niederhofer, H.; and Staffen, W. Comparison of disulfiram and placebo in treatment of alcohol dependence of 
adolescents. Drug and Alcohol Review 22(3):295297, 2003. 
26 http://www.ncbi.nlm.nih.gov/books/NBK64042/ 
27 Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment 
Programs. Treatment Improvement Protocol (TIP) Series 43. HHS Publication No. (SMA) 12-4214. Rockville, MD: 
Substance Abuse and Mental Health Services Administration, 2005.  Informational Bulletin  Page 6 
  Motivational incentives (contingency management) use positive reinforcement to encourage 
abstinence from drugs.  More information on motivational incentives can be found here. 
Information on other behavioral therapies that can be effective when combined with medications 
for SUD can be found here. 
 
Additional Services  
Screening and Management of Co-occurring Physical Health Issues   
A significant number of individuals receiving MAT for SUDs also have physical health issues. 
Many suffer from serious chronic conditions including: diabetes, asthma, HIV/AIDS, Hepatitis 
C, chronic obstructive pulmonary disease, and severe dental problems. SUDs can cause or 
exacerbate these chronic conditions; many of the health problems associated with substance use 
could be managed alongside MAT programs. Providers offering substance use treatment can 
screen for chronic physical health conditions and provide services onsite (with appropriate 
primary care supports in place) or make referrals to community providers. Studies have found 
that integrating care for individuals with a chronic SUD condition with MAT is cost-effective 
and improves patient care.28  
 
Screening and Management of Co-occurring Mental Health Issues  
A significant number of individuals with a SUD also suffer from a co-occurring mental health 
issue; of 21 million adults aged 18 or older in 2012 with a past year SUD, 40.6 percent also had a 
mental illness.29  Understanding SUDs and mental health issues interact with each other is 
important as a co-occurring disorder can complicate recovery if it is not adequately addressed.  
Rapidly identifying and addressing a co-occurring mental health issue can help improve MAT 
outcomes.  Similar to screening and management of co-occurring physical health issues, 
providers offering substance use treatment can screen for mental health issues and provide 
services onsite (with appropriate mental health professional supports in place), along with 
referrals to community provider depending on the illness severity and onsite mental health 
capacity.  Screening tools can include the PHQ-9 (Patient Health Questionnaire), the GAD-7 
(Generalized Anxiety Disorder), and the Columbia-Suicide Severity Rating Scale (C-SSRS).  For 
more information about screening tools, please visit here.    
 
Strategies for Managing Medication Assisted Treatment 
Many state Medicaid programs utilize processes to help manage the prescribing of addiction 
medications and delivery of evidence-based behavioral therapies.  States should ensure that these 
strategies are consistent with the Mental Health Parity and Addiction Equity Act, when 
                                                            
28 Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment 
Programs. Treatment Improvement Protocol (TIP) Series 43. HHS Publication No. (SMA) 12-4214. Rockville, MD: 
Substance Abuse and Mental Health Services Administration, 2005 
29 Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use 
and Health: Mental Health Findings, NSDUH Series H-47, HHS Publication No. (SMA) 13-4805. Rockville, MD: 
Substance Abuse and Mental Health Services Administration, 2013.  Informational Bulletin  Page 7 
appropriate.30  Medicaid programs may use the following strategies to support access to this 
benefit.    
  Preferred Drug List (PDL): A state Medicaid agency or contracted managed care 
organization (MCO) designates a medication as a preferred or non-preferred drug, indicating 
those drugs that providers are permitted to prescribe without seeking prior authorization for 
payment coverage.  If a drug is not included on the PDL, the provider must obtain approval 
from the state Medicaid agency before the drug will be paid for by the Medicaid agency or 
the agencys vendor. When a new drug enters the market, it typically has a non-preferred 
status until the drug can be reviewed by the Pharmacy and Therapeutics Committee. Before a 
drugs review and placement on a preferred drug list, a patients prescriber is able to 
prescribe a non-preferred drug through a states prior authorization process.  This allows 
prescriber flexibility to prescribe the most effective medication while ensuring appropriate 
systems measures are in place to manage the benefit.  
  Prior Authorization: In order for a Medicaid beneficiary to have prescribed medications paid 
for by the Medicaid agency or contracted MCO, the prescriber must obtain permission from 
Medicaid or the agencys vendor.  Each state Medicaid program has different policies in 
place for which medications require prior authorization.  Prior authorization criteria should 
reflect evidence-based standards for appropriate medical use of the pharmaceutical in 
question. 
  Documentation of Behavioral Therapy: A state Medicaid agency or contracted MCO may 
require evidence that the patient seeking an FDA-approved addiction medication is being 
referred to or has already started to receive behavioral therapy services along with their 
medication. Presently, 20 states and the District of Columbia require documentation of 
behavioral therapy with use of buprenorphine-naloxone and 18 states for the use of injectable 
naltrexone.31  Care should be used to avoid making such requirements unduly burdensome 
such that they effectively limit appropriate access to pharmacotherapy. 
  Quantity Limits: A state Medicaid agency or contracted MCO may impose quantity limits on 
certain medications as a way to ensure that it is not overprescribed. As many of these 
medications bind to the same receptors in the brain as other drugs, quantity limits exist to 
prevent overprescribing leading to abuse, overdose or diversion of the medications32. A state 
must have developed standards for applying these limits that are evidenced based and include 
the medical necessity criteria used for determining any limit.   A state must have developed 
standards for applying these limits that are evidenced based and include the medical 
necessity criteria used for determining any limit.     
  Duration Limits: A state Medicaid agency or contracted MCO may impose duration limits on 
certain medications as a way to ensure that it is not overprescribed. As many of these 
medications bind to the same receptors in the brain as other drugs, duration limits exist to 
prevent overprescribing leading to abuse, overdose or diversion of the medications.  Similar 
                                                            
30 http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-001.pdf 
31 Substance Abuse and Mental Health Services Administration. (2013). Medicaid Coverage And Financing Of 
Medications To Treat Substance Use Disorders.  Rockville, MD: Center for Substance Abuse Treatment, Substance 
Abuse and Mental Health Services Administration. 
32 Quantity limits should comport with MHPAEA requirements sets forth in statute and policies regarding CMS to 
ensure appropriate access to benefits.  Informational Bulletin  Page 8 
to quantity limits, states must have the necessary evidence and medical necessity criteria for 
imposing limits on the duration of these medications. Setting limits on the length of 
medication-assisted treatment can affect retention and outcomes. Medication-assisted 
treatment should be continued as long as the treatment is medically necessary and the 
individual participates in treatment as set forth in their treatment plan. 33 
  Provider Selection and Credentialing: Both state and federal regulations establish guidance 
regarding who can provide certain prescription medications and in what setting the 
medication can be administered.  Any additional stipulations imposed by state Medicaid 
agencies or contracted MCO should avoid excluding primary care providers and care sites 
where comorbid problems may be managed concurrently when otherwise established 
guidance regarding access and safety are satisfied. 
  Drug Utilization Reviews:  The drug utilization review (DUR) process occurs prospectively 
and retrospectively of a drug being dispensed. The prospective DUR, which occurs prior to a 
drug being dispensed, may involve a Medicaid agency or its claims processor reviewing 
documentation of claims against a clinical database containing an individuals prior 
pharmacy history to determine whether any problems or issues exist, including duplication of 
prescriptions and incompatibility with other prescriptions. If an issue is found, a review of 
the enrollees care, prescribers practice or pharmacy practice can occur, along with limits 
placed on a prescription being filled until the issue is resolved.  The retrospective DUR is a 
review process occurring after the drug has been dispensed. It may include a review of 
individual patient profiles for follow-up and intervention. It may also involve a review of the 
aggregate claims data to identify patterns in prescribing whether it be underutilization or 
overutilization, from which the Medicaid agency or its designee can make recommendations 
for future prescribing.  There is no established stepped approach to therapy with any of the 
pharmaceuticals discussed here. The pharmacotherapy must be matched to the needs of the 
individual at the time of the assessment. 
  Patient Review and Restriction Programs: If a Medicaid agency finds that a beneficiary has 
utilized Medicaid services at a frequency or amount that may not be medically necessary, as 
determined in accordance with utilization guidelines established by the State, the agency may 
restrict that beneficiary for a reasonable period of time to obtain Medicaid services from 
designated providers only.  Some States have implemented Patient Review and Restriction 
programs (PRRs) to address possible patient overuse of physician services and prescription 
drugs.    Medicaid programs may only impose restrictions if they give patients notice and an 
opportunity for a hearing, ensure that restricted patients still have reasonable access to 
Medicaid services, and exempt emergency services from the restriction. 
 
State-Based Initiatives 
MAT can be an effective strategy for addressing the needs of individuals who have a SUD.   
Policies regarding MAT and implementation practices that combine these medications with 
supportive counseling vary considerably across states.  Many states are experimenting with 
                                                            
33 Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville (MD): Substance 
Abuse and Mental Health Services Administration (US); 2005. Treatment Improvement Protocol (TIP) Series, No. 
43. http://www.ncbi.nlm.nih.gov/books/NBK64164/  Informational Bulletin  Page 9 
different strategies to encourage the implementation and availability of MAT.  States that have 
implemented strong evidence-based MAT programs tend to support financing and care 
provisions structures that provide pharmacological, medical, counseling and other supports 
within an integrated physical health and behavioral health system.  The examples below 
highlight select state-based efforts to implement MAT. 
 
Vermont 
In Vermont, MAT for opioid addiction was implemented for methadone and buprenorphine in 
2002.  Vermont incentivized implementation of buprenorphine by funding online training for 
physicians to obtain the additional DEA registration (also known as the X-number) to 
prescribe buprenorphine and other technical assistance to physicians. To improve the 
coordination of care for individuals struggling with opioid addiction issues and to facilitate MAT 
use, Vermont has developed a proposal for a health home model, called the Hub and Spoke 
model.   
The Hub and Spoke model consists of two levels of care, with the patients needs determining 
the appropriate level. Individuals with complex addictions and co-occurring substance abuse and 
mental health conditions will receive care through a Hub, or specialty treatment center 
responsible for coordinating care across the health and substance abuse treatment systems of 
care. Less clinically complex patients who require MAT but not methadone will receive 
treatment within the Spoke system. A Spoke is an integrated care system comprised of a 
prescribing physician and collaborating health and addictions professionals who provide 
assistance with obtaining a medical home, monitor adherence to treatment, coordinate access to 
recovery supports, and provide counseling, contingency management, and case management 
services.  This model is incorporated in Vermonts 1115 Waiver program and in their proposed 
2703 health home program. Additional information on Vermonts MAT approach can be found 
here and here. 
 
Rhode Island 
In Rhode Island, the state received approval for their 2703 person-centered health home 
provision focused on opioid dependent Medicaid beneficiaries who are currently receiving or 
who meet criteria for MAT.  Working with opioid treatment providers (OTPs) as the health home 
providers allows for heightened contact between medical and clinical professionals who have on-
going therapeutic relationships with patients. This will enable providers to use existing and 
enhanced resources to improve the health of patients and decrease inadequate/ineffective medical 
care.  Each individual is assigned to a team, which may be specialized to their specific healthcare 
needs. Patients have an assigned nurse and case manager to monitor their healthcare needs; assist 
with referral, scheduling, and transportation to medical and other appointments; develop a health 
plan; provide health promotion and wellness activities; facilitate transitions between levels of 
care; support recovery needs; and identify and provide resources that support wellness and 
recovery.   The Rhode Island health home model aims to provide a mechanism to support 
stronger, formalized relationships between OTPs and community healthcare providers. 
Additional information on Rhode Islands MAT approach can be found here. 
  Informational Bulletin  Page 10 
Texas 
Since February of 2011, qualified physicians and Chemical Dependency Treatment Facilities are 
able to bill the Texas Medicaid and Healthcare Partnership for MAT.  Texas legislation clearly 
articulated that medication should be available to manage withdrawal/intoxication from all 
classes of abusable drugs. To this end, the state has established procedure codes and modifiers 
that provide guidance to MAT providers.  Additional information regarding Texas approach to 
covering MAT in Medicaid can be found here and here.  
 
Ohio 
In July of 2012, the Ohio Medicaid program began to cover MAT as a component of its 
Medicaid program.  Similar to Texas, Ohios Medicaid program allows certain facilities and 
qualified practitioners to provide MAT.  In addition, the Ohio Department of Mental Health and 
Addiction Services developed protocols for MAT going beyond use of methadone, with specific 
standards of practice for buprenorphine and buprenorphine/naloxone products.   Additional 
information regarding Ohios coverage of MAT can be found here and here. 
 
Resources 
Opioid Treatment Program Directory 
http://dpt2.samhsa.gov/treatment/directory.aspx 
 
Medication-Assisted Treatment For Opioid Addiction in Opioid Treatment Programs Inservice 
Training 
Provides a training program for substance abuse treatment counselors and other clinicians on 
medication-assisted treatment for opioid addiction. Covers basic principles, best practices, 
history, and regulation. Includes scripted modules and handouts. 
http://store.samhsa.gov/product/Medication-Assisted-Treatment-for-Opioid-Addiction-in-Opioid-
Treatment-Programs/SMA09-4341 
 
Opioid Overdose Prevention Toolkit 
Equips communities and local governments with material to develop policies and practices to 
help prevent opioid-related overdoses and deaths. Addresses issues for first responders, treatment 
providers, and those recovering from opioid overdose. 
http://store.samhsa.gov/product/SMA13-4742?WT.mc_id=EB_20130828_SMA13-4742 
 
TAP 30: Buprenorphine: A Guide for Nurses 
Gives nurses information about buprenorphine for medication-assisted treatment of addiction to 
opioids and guidelines for working with physicians to provide office-based screening, 
assessment, supervised withdrawal (detoxification), and maintenance treatment.   Informational Bulletin  Page 11 
http://store.samhsa.gov/product/TAP-30-Buprenorphine-A-Guide-for-Nurses/SMA09-4376 
 
TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction 
Practice guidelines help physicians make decisions about using buprenorphine to treat opioid 
addiction. Includes information on patient assessment; protocols for opioid withdrawal; and the 
treatment of pregnant women, teens, and polysubstance users. 
http://store.samhsa.gov/product/TIP-40-Clinical-Guidelines-for-the-Use-of-Buprenorphine-in-the-
Treatment-of-Opioid-Addiction/SMA07-3939 
 
TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs 
Gives a detailed description of medication-assisted treatment for addiction to opioids, including 
comprehensive maintenance treatment, detoxification, and medically supervised withdrawal. 
Discusses screening, assessment, and administrative and ethical issues. 
http://store.samhsa.gov/product/TIP-43-Medication-Assisted-Treatment-for-Opioid-Addiction-in-Opioid-
Treatment-Programs/SMA12-4214 
 
TIP 49: Incorporating Alcohol Pharmacotherapies Into Medical Practice 
Provides clinical practice guidelines for using four medications in the medication-assisted 
treatment of alcoholism and alcohol abuse: acamprosate, disulfiram, oral naltrexone, and 
extended-release injectable naltrexone. Also discusses patient management. 
http://store.samhsa.gov/product/TIP-49-Incorporating-Alcohol-Pharmacotherapies-Into-Medical-
Practice/SMA13-4380 
 
General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-
Occurring Mental and Substance Use Disorders 
Offers general principles to assist in the planning, delivery, and evaluation of pharmacologic 
approaches to support the recovery of individuals with co-occurring disorders. Covers 
engagement, screening, assessment, treatment planning, and continuity of care. 
http://store.samhsa.gov/product/General-Principles-for-the-Use-of-Pharmacological-Agents-to-Treat-
Individuals-with-Co-Occurring-Mental-and-Substance-Use-Disorders/SMA12-
4689?WT.ac=EB_20120607_SMA12-4689 
 
Principles of Drug Addiction Treatment: A Research-based Guide (3rd Edition) 
Presents research-based principles of addiction treatment for a variety of drugs, including 
nicotine, alcohol, and illicit and prescription drugs, that can inform drug treatment programs and 
services. 
http://www.drugabuse.gov/publications/principles-drug-addiction-treatment 
  Informational Bulletin  Page 12 
Principles of Adolescent Substance Use Disorders: A Research-Based Guide 
Presents research-based principles of adolescent SUD treatment; covers treatment for a variety of 
drugs including, illicit and prescription drugs, alcohol, and tobacco; presents settings and 
evidence-based approaches unique to treating adolescents. 
http://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-
based-guide