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Section 1006(b) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, Public Law 115-271 (The SUPPORT Act) provides for increased Medicaid access to medication-assisted treatment (MAT) for opioid use disorders (OUD). Specifically, this law requires that the USVI Medicaid Program provide for the coverage of certain drugs and biological products, related counseling services, and behavioral therapy during the period October 01, 2020 through September 30, 2025.
The VI Medicaid Program is required to cover all drugs and biologicals approved or licensed by the Federal Food and Drug Administration (FDA) used for MAT to treat OUD under this new mandatory benefit. Buprenorphine is already covered under the VI Medicaid program. Methadone and Naltrexone will be added to our drug coverage, along with the counseling programs associated with each drug regimen (see below).
In order to address the full scope of our VI Medicaid Program patient treatment needs we are required to cover under the MAT benefit counseling services and behavioral therapy related to the drugs and biologicals indicated above.
These services include the following:
- Individual/Group Therapy to help patients identify treatment goals and potential solutions to problems that cause emotional stress; seeks to restore communication and coping skills; strengthens self-esteem; and promote behavior change and optimal mental health.
- Peer Support Services in which a qualified peer support provider (also called a recovery coach or peer recovery support specialist) assists individuals with their recovery from substance use disorders, including OUD.
- Crisis Intervention Services to immediately reduce or eliminate the risk of physical or emotional harm. Services will include evaluation, triage, and access to services; and treatment to effect symptom reduction, harm reduction, and/or safe transition of individuals in acute crisis to the appropriate level of care for stabilization.
The VI Medicaid Program will reimburse for these drugs and related services in accordance with the reimbursement requirements in the approved VI Medicaid State Plan.
The Medicaid State Plan Amendment which describes this coverage is available for review at http://www.dhs.gov.vi/financial_programs/medical_assistance.html. It is also posted for review at the DHS District Offices on St. Thomas, St. Croix, and St. John.
