Office-based Buprenorphine Treatment

Buprenorphine Enhanced Medication Assisted Recovery and Treatment (BESMART) Program

BESMART was developed in 2019 to be a specialized provider network focused on contracting with high quality medications for opioid use disorder (MOUD) providers to provide comprehensive care to TennCare members with opioid use disorder (OUD).

1. Must be a TennCare provider.
2. Must have a specific contract with each Managed Care Organization (MCO) for BESMART.
3. Must complete the BESMART attestation, attesting to the BESMART program description.

Not yet a TennCare provider? Visit Provider Registration to learn more.

BESMART Program Description

The following are benefits for providers in the BESMART program:

• Clinical and care coordination support from MCOs
• Increased data on quality and health outcomes
• Enhanced reimbursement from the MCOs for defined BESMART services
• Access to monoproduct buprenorphine
• Shortened Prior Authorization Form

Buprenorphine Prior Authorization Form

Note: The Prior Authorization Form can be submitted via fax or electronically. It cannot be submitted over the phone.

Please contact OptumRx with questions or feedback.

OptumRx Call Center

• Members can access increased buprenorphine treatment dosage options through BESMART providers

TennCare members who receive OUD treatment by a BESMART Provider will be eligible to receive buprenorphine product coverage with the following daily dosage limits:

• Up to 16mg of buprenorphine products per day throughout induction, stabilization, and maintenance phases as medically necessary
• If specific clinical criteria are met, may receive a maximum daily dosage of 24mg of buprenorphine products for the defined length of time established in in the clinical criteria

Deep Dive: 16 mg buprenorphine

• Follow best practice guidelines about tapering down or off treatment
• Follow best practice guidelines about utilizing lowest effective dose of Medications for Opioid Use Disorder (MOUD)
• Attest to the requirements of the BESMART Program Description

• Members can receive up to 16 mg buprenorphine containing products daily

Deep Dive: 24 mg buprenorphine

• Can prescribe maximum daily dosage of 24 mg of buprenorphine for specific populations
• Cannot exceed one year in duration for 24 mg

Eligible TennCare Member Populations

• Pregnant participants confirmed by provider attestation
• Postpartum participants for a period of 12 months from delivery date as shown by medical records or insurance claim
• Recent intravenous drug users confirmed by prescriber attestation and a positive urine drug screen
• Current users receiving greater than 50mg of methadone for OUD treatment transitioning to buprenorphine agonist therapy
• Current users of 16mg-24mg per day of buprenorphine demonstrated by paid claims data from the participants previous health insurer

The following describe the steps to become a BESMART provider:

• Understand the program description and evaluate your current care model

BESMART Program Description

• Identify any potential gaps or areas for increased support from MCOs
• Obtain a Medicaid Provider ID (if needed)
• Indicate interest in joining BESMART and ability to meet program standard

For contracting questions:

• Contract as a BESMART provider with appropriate MCO(s) to join network
• Continue to provide high-quality MOUD care to TennCare members

As outlined in Public Chapter Nos. 761 and 771, Nurse Practitioners (NPs) and Physician Assistants (PAs) must participate in at least one MCO’s network of BESMART providers in order to be reimbursed for the prescription of buprenorphine.

To be eligible to contract with TennCare as a BESMART Provider, a NP or PA must also meet the following criteria:

• Contracted in the BESMART Program
• Has a supervising physician that is contract within the MCO’s BESMART Program
• Specializes in family, adult, or psychiatric medicine
• Part of an Office-based Opioid Treatment center (OBOT), Community Mental Health - Center (CMHC), or Federally Qualified Health Center (FQHC)
• Follows member limits according to the legislation

NP & PA Prescribing Guidance Webinar (August 2020)

• CMHC & FQHC Guidance
• OBOT Guidance