Office Based Addiction Treatment (OBAT) Program

The Division of Medical Assistance and Health Services, in collaboration with the Division of Mental Health and Addiction Services, launched a program to cover and support Medication Assisted Treatment (MAT) and Office Based Addiction Treatment (OBAT). This program coordinates the delivery of multiple reimbursable services provided by primary care providers and community behavioral health specialists to NJ FamilyCare members with an addiction diagnosis.

The program reimburses physicians for OBAT services through their managed care contracts. Any contracted provider who is Data 2000 waivered for prescribing buprenorphine may participate. To participate, you must be Data 2000 certified. Contact your Provider Representative if would like to participate. If you would like to become certified, view the list of training programs.

For answers to OBAT frequently asked questions (FAQ), view the OBAT FAQ. For more information on the OBAT program, please contact your Provider Representative or Provider Services at 1-800-682-9091.

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Questions and answers: Office Based Addictions Treatment



Products are provided by Horizon NJ Health. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross? and Blue Shield? names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon? name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. ? 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. EC003106 (updated 0619)


March 21, 2019


The Division of Medical Assistance and Health Services (DMAHS), in collaboration with the
Division of Mental Health and Addiction Services (DMHAS) launched a new program to cover
and support Medication Assisted Treatment (MAT) and Office Based Addictions Treatment
(OBAT). This program allows for the delivery and coordination of multiple reimbursable
services provided by Primary Care Providers (PCP) and community behavioral health specialists
to NJ FamilyCare members with an addiction diagnosis.

Below are answers to frequently asked questions about OBAT.

Q1. How was this program developed?
A1. The New Jersey model is a hybrid of other state models including elements of the Hub
and Spoke model in Vermont, the Office-Based Opioid Treatment model in Virginia and
utilization of Centers for Excellence in Pennsylvania and Rhode Island. The New Jersey
system will be called the MATrx system.

Q2. What are the goals of the program?

A2. The goals of the MATrx program are to:
? Increase statewide capacity for the provision of MAT to patients with substance use

disorder
? Increase provider capacity
? Increase quality through continuing education, training and consultation
? Connect OBAT providers with behavioral health supports
? Improve treatment retention through the use of peer support and care coordination

?Navigator? services

Q3. How will I be reimbursed for these services?
A3. Since the majority of NJ FamilyCare recipients are covered under managed care plans
and receive their primary care through contracted physician practices, NJ FamilyCare has
designed the program to reimburse physicians for OBAT services through their managed care
contracts.

Q4. What qualifications do you need to be a part of the MATrx system?
A4. The MATrx consists of three types of providers.

1. OBAT providers: PCPs, advanced practice nurses and physicians assistants with a
Data 2000 Waiver, who meet established standards for participation. OBAT providers
must employ Navigators (registered nurse, licensed practical nurse, social worker,
bachelor?s degree with two years live experience or an Associate?s degree with four
years live experience).






Questions and answers: Office Based Addictions Treatment



Products are provided by Horizon NJ Health. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross? and Blue Shield? names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon? name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. ? 2019 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. EC003106 (updated 0619)

2. Premier providers: independent clinics or Department of Health licensed physician
practices capable of providing fully integrated care (MAT, counseling and primary
medical care). Fully integrated care providers are not eligible for the use of a
Navigator to coordinate counseling with medical services, but may utilize peers to
assist beneficiaries and obtain community services to ameliorate substance use related
psychosocial needs.

3. Centers of Excellence (COE): a state contracted provider capable of providing
mentorships, provider peer services and developing future office based MAT providers
through provider training. COEs must provide MAT and medical services directly or
may contract with a physician practice or premier provider capable of providing MAT.
If the COE or its contracted MAT provider does not provide counseling services, they
may utilize Navigators. If the COE is fully integrated, they may utilize peers to assist
clients obtaining community services that will assist them with their sobriety. COEs
are required to provide clinical advice for complex medical cases or cases with
multiple failed attempts. For beneficiaries who needs are beyond the competency of
their current provider, the COE will accept primary responsibility for the beneficiaries
SUD care.


Q5. What if I am not Data 2000 waivered for prescribing buprenorphine?
A5. You can take advantage of DMHAS? training opportunities to become Data 2000

waivered and participate in this OBAT model when you receive your Data 2000 waiver status.


Q6. Is prior authorization needed for MAT treatment, OBAT services or prescriptions?
A6. Effective April 1, 2019, no prior authorization shall be allowed for medications and/or

bundled services that include administering medication for the treatment of opioid use disorder.
Safety edits, posted as a result of prospective drug utilization review, are allowed. For claims
billed through the pharmacy program, formulary preferences may be utilized.






Q1. How was this program developed?
Q4. What qualifications do you need to be a part of the MATrx system?
Q6. Is prior authorization needed for MAT treatment, OBAT services or prescriptions?