Wellcare CalViva Health Dual Align (HMO D-SNP): Opioid Treatment Program Services (OTP)
Treatment for opioid use disorder (OUD). Tolerance and dependence are physical, addiction is psychological, and both need support to overcome.
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Contact the Member Services at 1-800-431-9007. (TTY users should call 711) for additional questions
Mental health services provided by a state licensed psychiatrist or doctor, clinical psychologist, clinical social Members of our plan with opioid use disorder (OUD) can receive coverage of services to treat OUD through an Opioid Treatment Program (OTP) which includes the follow ing services:
U.S. Food and Drug Administration (FDA) approved opioid agonist and antagonist medication-assisted treatment (MAT) medications
Dispensing and administration of MAT medications (if applicable)
Substance use counseling
Individual and group therapy
Toxicology testing
Intake activities
Periodic assessments
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Opioid use disorder (OUD) comprises:
An overpowering desire to use opioids
Increased opioid tolerance (it takes more and more of the drug to achieve the desired effect)
Withdrawal syndrome when stopped (mood swings, flu-like symptoms, sweating, shaking, nausea and vomiting, diarrhea, and full body aches and pain, as well as more severe symptoms).
OUD can occur in older adults, especially those who use opioids for chronic pain control.
OUD treatment includes the following services:
FDA-approved opioid agonist and antagonist medication-assisted treatment (MAT), which are methadone, buprenorphine, or naltrexone.
Dispensing and administration of MAT medications (if applicable)
Substance use counseling
Individual and group therapy
Toxicology testing
Intake activities
Periodic assessments
OUD programs are conducted at both inpatient and outpatient hospital-based and sometimes university-based treatment sites and rehabilitation centers, and may be delivered in conjunction with drug therapy at independent MAT clinics (once commonly referred to as “methadone clinics” or “drug depots”). In more rural settings, outpatient counseling may be delivered in more community-based settings such as activity centers, churches, and legion-type facilities (VFW, Elk’s Club, etc.).
Not all OUD programs are medication-assisted. There are also programs (commonly called “detox”) that rely on abstinence-based treatment wherein there is no medication transition, though these are typically inpatient programs lasting from 21-28 days or residential programs lasting more than 30 days. However, there are inpatient and residential programs that are also MAT. Be sure to ask about the facility’s approach (abstinence or MAT) before intake and admission.
Outpatient programs, which are generally MAT, may vary in intensity and duration, but typically last anywhere between 3 months and a year.
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