Medicare Coverage for Residential Substance Use Disorder Treatment for Seniors.
This bill expands Medicare coverage to include residential treatment services for substance use disorders for seniors. It ensures that beneficiaries have access to various levels of residential care—from low-intensity to medically managed programs—in accredited facilities. This change aims to significantly improve access to comprehensive addiction treatment for older adults covered by Medicare, including covering room and board costs.
Key points
Medicare Part A will cover residential substance use disorder services, including room, board, and clinical treatment, which was previously not standard coverage.
Coverage includes three defined levels of care: clinically managed low-intensity, clinically managed high-intensity, and medically managed residential services.
Facilities must meet strict accreditation standards and regularly review the patient's need for continued care (every 10 or 30 days, depending on the intensity).
A new prospective payment system for these services is scheduled for implementation starting October 1, 2025.
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