Policy Priorities - Advocates for Opioid Addiction Treatment

We are a community of opioid treatment programs (OTP) professionals, patients, and advocates united by the shared belief that access to medication-assisted treatment (MAT) saves lives.

Federal reforms introduced during the COVID-19 pandemic, now finalized by the Substance Abuse and Mental Health Services Administration (SAMHSA), are transforming how opioid use disorder (OUD) treatment is delivered—ushering in new opportunities to expand access to lifesaving care.

Together, we call on lawmakers and state regulators to continue to build on this momentum by adopting thoughtful, evidence-based policies that improve access to comprehensive MAT for people with OUD in communities that need it most.

Our priorities include cutting unnecessary red tape, increasing reimbursement for MAT services to align with other reimbursement models, and expanding OTP availability in rural and underserved communities.

We urge lawmakers to act now on these critical issues to increase access to lifesaving MAT.

Work requirements in Medicaid create unnecessary barriers to care, particularly for individuals with opioid use disorder (OUD) who rely on medication-assisted treatment (MAT) through opioid treatment programs (OTPs). Research has shown that Medicaid is the single largest payer for OUD treatment, covering 40% of all nonelderly adults with OUD. Implementing work requirements could strip coverage from thousands of individuals, leading to treatment disruptions, higher rates of overdose, and increased healthcare costs due to preventable hospitalizations and emergency care.

Work requirements create additional bureaucratic hurdles, disproportionately impacting people in treatment and recovery. Data from states that attempted to impose work requirements show that they primarily lead to coverage losses rather than increased employment.

To ensure continued access to lifesaving care, policymakers should reject Medicaid work requirements that create red tape and jeopardize treatment continuity.

In many states, Medicaid reimbursement for OTP services falls below 100% of the Medicare bundle, leaving programs underfunded. This funding gap creates disparities in care and undermines OTPs’ ability to provide high-quality treatment to patients. Reimbursement in some states has not changed since the SAMHSA rules have passed, which limits capacity to fully leverage reforms such as telehealth and take-home dosing.

To protect access to MAT, states should ensure their Medicaid reimbursement rates fully align with Medicare standards to enable OTPs to sustain their operations and continue serving patients effectively. Additionally, Medicaid programs should review their reimbursement structures to allow providers to fully personalize treatment by using telehealth and dosing flexibilities.

Medicare Advantage plans often impose excessive barriers that restrict access to medications for OUD, including co-pay requirements, prior authorization, and primary care referral mandates. These restrictions create financial hardships for patients, delay access to critical care, and increase administrative burden on healthcare providers.

PNAP calls on Congress to remove these restrictions and allow patients to access OTP services without unnecessary costs or delays.

Remote patient monitoring (RPM) and advanced dispensing tools enhance treatment adherence, provide real-time insights into patient health, and reduce logistical challenges for both patients and providers.

Despite their proven value, funding for RPM and dispensing tools remains insufficient. Congress should prioritize funding for RPM systems and innovative dispensing tools, ensuring OTPs can leverage technology to monitor patient progress, protect public safety, reduce relapse rates, and enhance treatment flexibility.

Current regulations prevent correctional facilities and skilled nursing facilities (SNFs) from dispensing methadone without an OTP license, leaving some of America’s most vulnerable populations without access to treatment. These facilities already have strong controls to ensure medication is administered safely and prevent diversion, which compromises public safety.

Congress should waive the requirement for an OTP license in these settings, allowing correctional facilities and SNFs to dispense methadone under the supervision of trained healthcare professionals or in coordination with a local OTP.

Mobile and satellite units can reduce barriers such as transportation challenges and limited proximity to care, particularly for patients in rural and underserved communities. However, these units require substantial capital investment, are costly to operate, and often face regulatory obstacles at the state and local levels.

Federal and state funding as well as regulatory exceptions are needed to expand and sustain these units, ensuring they meet safety standards, comply with OTP service guidelines, and effectively increase access to care.

Lawmakers should allocate funds to facilitate the development and operation of OTP mobile and satellite units, and create incentives for states to develop such units in rural communities, enabling their nationwide expansion and impact.