Addiction Treatment Services

Addiction is a chronic disease, which causes individuals to seek “reward” from substance-use or other activities whether or not they may cause harm. Addiction treatment has been in the spotlight as payers, policymakers, and health systems struggle to address the opioid crisis and increasing substance-related mortality rates. As a result, the addiction treatment market is shifting—there is expanded coverage for residential treatment, a push towards greater integration and care coordination, and new competitors entering the market—creating new challenges and opportunities for organizations working in addiction treatment.

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Commercial Payers’ Negotiated Reimbursement Rates Vary Across All Levels Of Facility-Based Addiction Treatment Care

Negotiated reimbursement rates vary substantially across all American Society of Addiction Medicine (ASAM) Levels of Care for facility-based services—even after standardizing codes and removing outliers, according to a recent analysis released by the National Association of Addiction Treatment Providers (NAATP). The variation in reimbursement rates existed within and across payer networks, reflecting a fragmented and inequitable reimbursement environment rather than one driven by clinical outcomes, the report stated. The report outlines national commercial reimbursement patterns for Aetna, Blue Cross Blue Shield, Cigna, and United, including the Optum carrier networks.… Read

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