Reimburse for contingency management

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Congress should require Medicare and state Medicaid programs to reimburse for Contingency Management.


Contingency Management is a highly effective approach to treat individuals with substance use disorders (SUDs). It provides small tangible reinforcements such as prizes, vouchers, or small amounts of money to motivate and sustain objectively measured positive changes in behavior (e.g., abstinence or decreased drug use). It takes advantage of the brain’s reward response – the same response that fuels substance use. While Contingency Management treats many SUDs, there is a particularly urgent need to increase its use to treat stimulant use disorder, which lacks other proven effective treatments. One meta-analysis[1][2] found that Contingency Management “has an extraordinarily strong evidence base and is a demonstrably cost-effective technique that has been used for decades to promote abstinence from benzodiazepines, cocaine, tobacco, opiates, alcohol, marijuana, and methamphetamine.”

In addition to Congress requiring Medicare and state Medicaid programs to reimburse Contingency Management, the Centers for Medicare & Medicaid Services (CMS) should educate state Medicaid programs that Contingency Management is THE treatment-of-choice for the nation's stimulant use disorder epidemic. CMS should also establish billing codes and rates for full-value, Office of Inspector General-approved, cash-equivalent, evidence-based Contingency Management, which is the only approach proven to be effective for stimulant use disorder.


1. McPherson, Sterling M., Ekaterina Burduli, Crystal Lederhos Smith, Jalene Herron, Oladunni Oluwoye, Katherine Hirchak, Michael F Orr, Michael G McDonell, John M Roll. “A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies.” National Institutes of Health, National Library of Medicine, National Center for Biotechnology Information. Last Updated August 13, 2018.

2. Pfund, R. A., Ginley, M. K., Boness, C. L., Rash, C. J., Zajac, K., & Witkiewitz, K. “Contingency management for drug use disorders: Meta-analysis and application of Tolin’s criteria.” American Psychological Association, APA PsycArticles: Journal Article. Last Updated 2022.