Opioid Treatment Program

Opioid Treatment Programs (OTPs) provide medication-assisted treatment for people diagnosed with an OUD. OTPs must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by an independent, SAMHSA-approved accrediting body. For SAMHSA certification, OTPs must comply with all pertinent state laws and regulations and all regulations enforced by the Drug Enforcement Administration.

Enrollment Eligibly

Before you begin the application process, make sure you have all the necessary information and documentation you need, including:

  • OTPs require full certification by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accreditation by a SAMHSA-approved accrediting body.
  • Copies of legal records regarding any convictions, exclusions, revocations, and suspensions associated with the OTP

Effective Date

  • You must update any changes in ownership and/or adverse legal action history within 30 days of the change.
  • You must make all other changes within 90 days of the change.

Report a Change

  • You must update any changes in ownership and/or adverse legal action history within 30 days of the change.
  • You must make all other changes within 90 days of the change.

Application Completion

If completing application via PECOS, select Create Initial Enrollment Application, select the state in which services are rendered, and lastly, select Supplier Service type

  • Ensure the application questionnaire is answered correctly
  • A CMS-855B with an EFT application will populate. See additional information below on what must be completed
  • If completing application via paper, the following must be submitted:
    • CMS-855B
    • As an OTP provider, you only need to fill out sections 1-6, 8, 13, 15, 16 (optional) and 17 of the application
    • CMS-588 (EFT)

Identifying Information

  • Names, contact information, and Tax Identification Numbers (TINs) and/or Social Security Numbers (SSNs) for all individuals or organizations with managing control and/or ownership interest in the OTP
  • Addresses and phone numbers for all practice locations of the OTP
  • Organization with ownership interest and/or managing control
    • Any organization that exercises operational or managerial control over supplier, or conducts day-to-day operations of supplier, is a managing organization and must be reported
    • ALL organizations that have any of the following must be listed organization with ownership interest and/or managing control section/topic:
      • Five percent (5%) or greater direct or indirect ownership interest in the supplier
      • Interest must be equal to or more than 5% of property and assets
      • A partnership interest regardless of percentage of ownership, or whether partner is a general partner or limited partner
      • Managing control of supplier. Any organization that exercises operational or managerial control over supplier, or conducts day-to-day operations of supplier, is a managing organization and must be reported. The organization need not have an ownership interest in supplier in order to qualify as a managing organization. For instance, it could be a management services organization under contract with supplier to furnish management services for business
      • Owning and managing organizations generally fall into one of the following categories: corporations (including non-profit), partnerships and limited partnerships, limited liability companies, charitable and religious organizations, governmental/tribal organizations
    • Supply any Final Adverse Legal Actions sustained by Organization with ownership interest and/or managing control
      • If completing via PECOS, select yes or no to final adverse legal action topic
      • If completing via paper, ensure section 5B is completed for each organization added in this section
      • Submit final outcome documents or current status of final adverse legal action
  • A detailed organizational chart (like the one you used for your SAMHSA certification)
  • Individuals with ownership interest and/or managing control
    • All individuals with ownership or managing control in enrolling organization must be listed in this section/topic
    • Individuals must be listed in this section/topic if they are one of the following:
      • A 5% or greater ownership in supplier
      • Authorized Official (AO)
      • Authorized Officials must be:
        • 5% direct owner of provider or supplier
        • Have ownership interest or control of provider or supplier as:
          • President
          • General partner
          • Chairman of the board
          • Chief financial officer
          • Chief executive officer
      • Delegated Official (DO)
        • Delegated Officials must be:
        • Having ownership of control interest
        • W-2 managing employee. They can be the following:
          • General Manager
          • Business Manager
          • Administrator
          • Operational or Managerial control over operations
      • Managing Employee
      • Director
      • CEO/CFO
      • Sole Owner
    • Interest must be equal to or more than 5% of property and assets
    • Directors/Officers (Members of the Board)
    • A partnership interest regardless of percentage of ownership, or whether partner is a general partner or limited partner
    • Managing control of supplier
    • At least one managing employee must be indicated on application. Managing employee can be a W2 or Contracted Managing Employee
    • Supply any Final Adverse Legal Actions sustained by individual with ownership interest and/or managing control
      • If completing via PECOS, select yes or no to final adverse legal action topic
      • If completing via paper, ensure section 6B is completed for each person added in this section
      • Submit final outcome documents or current status of final adverse legal action

Supporting Documentation

  • A voided check or signed bank letter is necessary documentation for EFT portion of application
    • Must include legal business name (LBN) of OTP, routing and account number and practice address
  • Submit application fee
    • Fee is required for application. Can be paid on PECOS website
    • Select pay application fee on right-hand side under Helpful Links
  • A Form CMS-1561 Provider Agreement signed and dated by an authorized or delegated official of the OTP. The signature must be handwritten or digitally signed
  • Noridian may ask you to submit fingerprints for individuals who have a 5% or greater direct/indirect ownership, as a partner of an OTP provider when:
    • Initially enrolling
    • Substance Abuse and Mental Health Services Administration (SAMHSA) certified after October 23, 2018.

Resources

 

Last Updated May 28 , 2021