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OIG Issues Favorable Opinion on Contingency Management
In recently published opinion, the Office of Inspector General (OIG) within the Department of Health and Human Services (HHS) has concluded that an app-based contingency management program will not incur a risk of sanctions under the federal Anti-Kickback Statute and Beneficiary Inducement Prohibition.
The opinion is the first to be issued by the OIG regarding a nationally accessible contingency management program that offers direct monetary rewards for healthy behaviors in addiction recovery, including demonstrated abstinence and retention in treatment programs.
The contingency management program covered in the opinion is an app-based solution developed by DynamiCare Health.
The National Council for Mental Wellbeing noted in a news release that contingency management has been shown to be an effective recovery tool in more than 100 randomized controlled trials, doubling abstinence rates for opioids, alcohol, tobacco, and nicotine, as well as stimulant addiction, for which there are no medications approved by the FDA to use in treatment. Advancing the use of contingency management was also identified as a first-year drug policy priority for the Biden administration.
“With no FDA-approved medication for methamphetamine or cocaine use disorder, organizations that provide substance use treatment need to be able to adopt contingency management, which represents the most effective evidence-based approach available,” National Council President and CEO Chuck Ingoglia said in the release. “We are pleased with HHS-OIG’s advisory opinion, and we’re proud to have played a role in breaking down this barrier to evidence-based care.”
Addiction treatment providers have been somewhat reluctant to adopt contingency management programs, largely amid concerns that monetary incentives of more than $75 per patient per year could violate the federal anti-kickback and beneficiary inducement laws. HHS had applied the $75 limit to State Opioid Response grantees. The DynamiCare program approved by the OIG, meanwhile, allows up to $599 in monetary incentives.
“Providers, Medicaid managed care vendors and even public health administrators often have the misconception that federal rules always prohibit contingency management. This advisory opinion puts that myth to rest,” Eric Gastfriend, CEO of DynamiCare Health, said in the National Council release. “Contingency management is not a kickback – it’s a foundation for treatment. We can now say with confidence that DynamiCare’s rigorous, research-based contingency management protocol, which includes accountable and protective measures, fits squarely within federal healthcare regulations.”
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