Minnesota Medicaid SPA 25-0036: MAT Services Recovery Peers

Table of Contents State/Territory Name: MinnesotaState Plan Amendment (SPA) #: 25-0036This file contains the following documents in the order listed: 1) Approval Letter2) CMS 179 Form/Summary Form (with 179-like data)3) Approved SPA Pages

DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 601 E. 12th St., Room 355 Kansas City, Missouri 64106 Medicaid and CHIP Operations Group March 10, 2026 John Connolly Assistant Commissioner and State Medicaid Director Minnesota Department of Human Services 540 Cedar Street P.O. Box 64983 St. Paul, MN 55164-0983 Re: Minnesota State Plan Amendment (SPA) 25-0036 Dear State Medicaid Director Connolly: The Centers for Medicare & Medicaid Services (CMS) reviewed your Medicaid State Plan Amendment (SPA) submitted in the CMS template under transmittal number (TN) 25-0036. The SPA removes the end date for the Medication Assisted Treatment (MAT) services in accordance with the Consolidated Appropriations Act of 2023 and adds recovery peers and treatment coordinators as qualified providers. We conducted our review of your submittal according to statutory requirements in 6HFWLRQ 1905(a)(29) of the Social Security Act and implementing regulations. This letter informs you that Minnesota’s Medicaid SPA 25-0036 was approved on March 10, 2026, with an effective date of October 1, 2025. Enclosed are copies of Form CMS-179 and approved SPA pages to be incorporated into the Minnesota State Plan. If you have any questions, please contact Sandra Porter at (312) 353-8310, or via email at Sandra.Porter@cms.hhs.gov. Sincerely, Wendy E. Hill Petras Acting Director, Division of Program Operations Enclosures cc: Patrick Hultman Alexandra Zoellner Leah Montgomery CENTERS FOR MEDICARE & MEDICAID SERVICES CENTER FOR MEDICAID & CHIP SERVICES

DEPARTMENT OF HEAL TH ANDHUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES TRANSMITTAL AND NOTICE OF APPROVAL OF STATE PLAN MATERIAL FOR: CENTERS FOR MEDICARE & MEDICAID SERVICES TO: CENTER DIRECTOR CENTERS FOR MEDICAID & C HIP SERVICES DEPARTMENT OF HEAL TH AND HUMAN SERVICES 1. TRANSMITTAL NUMBER 2.STATE 2 5 _ Q 0 3 6 MN --------3. PROGRAM IDENTIFICATION: TITLE OF THE SOCIAL SECURITY ACT (e) XIX (J XXI 4. PROPOSED EFFECTIVE DA TE October 1, 2025 FORM APPROV ED 0MB No. 0933-01 93 5. FEDERAL STATUTE/REGULATION CITATI ON 6. FEDERAL BUDGET IMPACT (Amounts in WHOLE do llars) C FR § and Title 1905( a )(29) of the Social Security Act a FFY $ 0 b. FFY $ 0 7. PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT 8. PAGE NUMBER OF THE SUPERSEDED PLAN SECTION Attachment 3.1-A Supplement 7 Page 1 (21 -10), Page 2 (21-10), OR ATTACHMENT ( If Applicable) Page (21-10), Page 4 (21-10), Page 5 (21-10) NEW Attachment 3.1-A Supplement Page 1 (21-10), Page Attachment 3.1-B Supplement 7 Page 1 (21 -10), Page 2 (21-10), (21-10), Page 3 (21 -10), Page 4 (21-10), P.age-6-f~~-~~ Page 3 (21 -10), Page 4 (21-10), Page 5 (21 -10) NEW Attachment 3.1-B Supplement Page 1 (21-10), Page (21-10), Page 3 (21 -10), Page 4 (21-10), Psge--5-~-2-r•49) 9. SUBJECT OF AMENDMENT Impl ements the Assisted Treatment template in accordance with SMD letter 24-0004. . GOVERNOR'S REVIEW (Check One) (!} GOVERNOR'S OFFICE REPORTED NO COMMENT 0 COMMENTS OF GOVERNOR'S OFFICE ENCLOSED 0 OTHER, AS SPECIFIED: NO REPLY RECEIV ED WITHIN 45 DAYS OF SUBMITTAL 11. SIGNATURE OF STATE AGENCY OFFICIAL 15. RETURN TO Patrick Hultman ---__ TYPED-NAME _______________ Minnesota Department of Human Services Patrick Hultman Federal Relations Unit -------------------------t Cedar Street, PO Box 64983 . TITLE Saint Paul, MN 55164 Deputy Medicaid Director 14. DATE SUBMITT ED 2/24/16. DATE RECEIVED December 24 2025 FOR CMS USE ONLY 17. DATE APPROVED March PLAN APPROVED - ONE COPY ATTACHED 18. EFFECTIVE DATE OF APPROVED MATERIAL 11 9. SIGNATURE OF APPROVING OFFICIAL Oct ober 1 2025 20. TYPED NAME OF APPROVING OFFICIAL Wend E. Hill Petras . REMARKS 21. TITLE OF APPROVING OFFICIAL Actin Director, Division of Pro MN State Medicaid Agency authorized CMS to make the following pen/ink changes to Box 7 and 8 Box 7: Add the word "NEW" after Attachment 3.1-A and 3.1-B Supplement 7 Page 5 (21-10) Box 8: Delete (strike through) the references to Attachment 3.1-A and 3.1-B Supplement 7 Page 5 (21-10) S. Porter, CMS 03/06/2026 FORM CMS-179 (09/24) Instructions on Back erations

Attachment 3. 1-A Supplement 7 Page 1 State Plan under Title XIX of the Social Security Act Citation: 3.1-A Amount, Duration, and Scope of Services [Please check the box below to indicate if this benefit is provided for the categorically needy (3.1-A) or medically needy only (3.1-B)] @1905(a)(29) MAT as descri bed and limited in Supplement 7 to Attachment 3.1-A. PRA Disclosure Statement- This use of this fotm is mandatory and the information is being collected to assist the Centers for Medicare & Medicaid Setvices in implementing section §1905(a)(29) of the Social Security Act. Under the Privacy Act of 197 4, any personally identifying info1mation obtained will be kept private to the extent of the law. An agency may not conduct or sponsor, and a person is not required to respond to a collection of infonnation unless it displays a cun-ently valid Office of Management and Budget (0MB) control number. The 0MB control munber for this project is 0938-1148 (CMS-10398 #68). Public bmden for all of the collection of information requirements under this control nlllllber is estimated to take about 25 hours per response. Send comments regarding this bmden estimate or any other aspect of this collection ofinfonnation, including suggestions for reducing this bmden, to CMS, 7500 Security Boulevard, Attn: Papetwork Reduction Act Repotis Clearance Officer, Mail Stop C4--05, Baltimore, Matyland Transmittal Number: MN-Supersedes Transmittal Number: MN-21-10 Approval Date: March 9, 2026 Effective Date: October 1, 2025

Supplement 7 Page 2 General Assurances [Select all three checkboxes below.] ܈MAT is covered under the Medicaid state plan for all Medicaid beneficiaries who meet themedical necessity criteria for receipt of the service for the period beginning October 1, 2020.܈The state assures coverage of Naltrexone, Buprenorphine, and Methadone and all of theforms of these drugs for MAT that are approved under section 505 of the Federal Food, Drug,and Cosmetic Act (21 U.S.C. 355) and all biological products licensed under section 351 of thePublic Health Service Act (42 U.S.C. 262).܈The state assures that Methadone for MAT is provided by Opioid Treatment Programs thatmeet the requirements in 42 C.F.R. Part 8.Service Package The state covers the following counseling services and behavioral health therapies as part of MAT: [Please describe in the text fields as indicated below.] Please set forth each service and components of each service (if applicable), along with a description of each service and component service. Opioid Treatment Program (OTP): Individual and group therapy services assist the beneficiary with achieving the goals developed in an individual opioid use disorder treatment plan. With the establishment of an individual treatment plan by identifying problems and implementing strategies to address, minimize, or reduce the inappropriate use and effects of chemicals through a combination of skills therapy, counseling, and treatment coordination. Therapy may also include consultation with relatives, guardians, close friends, and other treatment providers. Participation of non-Medicaid eligible persons is for the direct benefit of the beneficiary. The service must actively involve the beneficiary in the sense of being tailored to the beneficiary’s individual needs. There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of the service, but remains the focus of the service. Office Based Opioid Treatment (OBOT): Additional counseling services and behavioral health therapies may be provided in office-base settings by physician and non-physician practitioners.

Supplement 7 Page 3 Please include each practitioner and provider entity that furnishes each service and component service. Click or tap here to enter text. Opioid Treatment Program Services Credentials Therapy Licensed alcohol and drug counselors; counselor supervisors of licensed alcohol and drug counselors; licensed social workers; licensed marriage and family therapists; and licensed professional counselors. Peer Services Recovery Peers management Licensed practitioners, including nursing staff Treatment coordination Treatment coordinators Office-Based Opioid Treatment Services Credentials management Licensed practitioners

Supplement 7 Page 4 Please include a brief summary of the qualifications for each practitioner or provider entity that the state requires. Include any licensure, certification, registration, education, experience, training and supervisory arrangements that the state requires. OTP- Provider entity Must be licensed under State of Minnesota DHS and meet State Licensing requirements Monitored by: DEA Registration, Accreditation body(ex. CARF, JCAHO), certification by Division of Pharmacological Therapy/SAMHSA Counselors working with an OTP are required to be licensed as an alcohol and drug counselor or meet one of the following: Counselor supervisors of licensed alcohol and drug counselors must have three years of work experience as a licensed alcohol and drug counselor. Licensed professional counselors must have a master’s degree which included 120 hours of a specified course of study in addition studies with 440 hours of post-degree supervised experience in the provision of alcohol and drug counseling. All counseling and behavioral health therapies delivered as part of medication assisted treatment services are provided according to an individual recipient’s treatment plan. Additional training requirements for ongoing education and applicable statutory training must be met. OBOT/Licensed practitioners Have to have current license and DEA registration. Recovery Peers Provider qualifications are described in section 13.d. Rehabilitative Services, Page 54q.4. Treatment Coordinators Provider qualifications are described in section 13.d. Rehabilitative Services, Page 54q.4

Supplement 7 Page 5 Utilization Controls [Select all applicable checkboxes below.] ܈The state has drug utilization controls in place. (Check each of the following that apply)܈Generic first policy܈Preferred drug lists܈Clinical criteria܈Quantity limits܆The state does not have drug utilization controls in place.Limitations [Describe the state’s limitations on amount, duration, and scope of MAT drugs, biologicals, and counseling and behavioral therapies related to MAT.] For OTPs: No more than 30 weekly nondrug bundle charges are eligible for coverage in the first calendar year that an enrollee is being treated by an opioid treatment provider and no more than 15 weekly nondrug bundle charges are eligible for coverage in subsequent calendar years. For OBOT: Pre-Authorization is required. Buprenorphine is subject to quantity limits, and certain products and brands are included on the state’s Preferred Drug List. Injectable and implantable buprenorphine are covered through the medical benefit with prior authorization. 6XSHUVHGHV 7UDQVPLWWDO 1XPEHU 1(:

Attachment 3.1-B Supplement 7 Page 1 Citation: 3.1-A Amount, Duration, and Scope of Services [Please check the box below to indicate if this benefit is provided for the categorically needy (3.1-A) or medically needy only (3.1-B)] ;1905(a)(29) MAT as described and limited in Supplement 7 to Attachment 3.1-B.I

Supplement 7 Page 2 General Assurances [Select all three checkboxes below.] ܈MAT is covered under the Medicaid state plan for all Medicaid beneficiaries who meet themedical necessity criteria for receipt of the service for the period beginning October 1, 2020.܈The state assures coverage of Naltrexone, Buprenorphine, and Methadone and all of theforms of these drugs for MAT that are approved under section 505 of the Federal Food, Drug,and Cosmetic Act (21 U.S.C. 355) and all biological products licensed under section 351 of thePublic Health Service Act (42 U.S.C. 262).܈The state assures that Methadone for MAT is provided by Opioid Treatment Programs thatmeet the requirements in 42 C.F.R. Part 8.Service Package The state covers the following counseling services and behavioral health therapies as part of MAT: [Please describe in the text fields as indicated below.] Please set forth each service and components of each service (if applicable), along with a description of each service and component service. Opioid Treatment Program (OTP): Individual and group therapy services assist the beneficiary with achieving the goals developed in an individual opioid use disorder treatment plan. With the establishment of an individual treatment plan by identifying problems and implementing strategies to address, minimize, or reduce the inappropriate use and effects of chemicals through a combination of skills therapy, counseling, and treatment coordination. Therapy may also include consultation with relatives, guardians, close friends, and other treatment providers. Participation of non-Medicaid eligible persons is for the direct benefit of the beneficiary. The service must actively involve the beneficiary in the sense of being tailored to the beneficiary’s individual needs. There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of the service, but remains the focus of the service. Office Based Opioid Treatment (OBOT): Additional counseling services and behavioral health therapies may be provided in office-base settings by physician and non-physician practitioners.

Supplement 7 Page 3 Please include each practitioner and provider entity that furnishes each service and component service. Click or tap here to enter text. Opioid Treatment Program Services Credentials Therapy Licensed alcohol and drug counselors; counselor supervisors of licensed alcohol and drug counselors; licensed social workers; licensed marriage and family therapists; and licensed professional counselors. Peer Services Recovery Peers management Licensed practitioners, including nursing staff Treatment coordination Treatment coordinators Office-Based Opioid Treatment Services Credentials management Licensed practitioners

Supplement 7 Page 4 Please include a brief summary of the qualifications for each practitioner or provider entity that the state requires. Include any licensure, certification, registration, education, experience, training and supervisory arrangements that the state requires. OTP- Provider entity Must be licensed under State of Minnesota DHS and meet State Licensing requirements Monitored by: DEA Registration, Accreditation body(ex. CARF, JCAHO), certification by Division of Pharmacological Therapy/SAMHSA Counselors working with an OTP are required to be licensed as an alcohol and drug counselor or meet one of the following: Counselor supervisors of licensed alcohol and drug counselors must have three years of work experience as a licensed alcohol and drug counselor. Licensed professional counselors must have a master’s degree which included 120 hours of a specified course of study in addition studies with 440 hours of post-degree supervised experience in the provision of alcohol and drug counseling. All counseling and behavioral health therapies delivered as part of medication assisted treatment services are provided according to an individual recipient’s treatment plan. Additional training requirements for ongoing education and applicable statutory training must be met. OBOT/Licensed practitioners Have to have current license and DEA registration. Recovery Peers Provider qualifications are described in section 13.d. Rehabilitative Services, Page 53q.4. Treatment Coordinators Provider qualifications are described in section 13.d. Rehabilitative Services, Page 53q.4

Supplement 7 Page 5 Utilization Controls [Select all applicable checkboxes below.] ܈The state has drug utilization controls in place. (Check each of the following that apply)܈Generic first policy܈Preferred drug lists܈Clinical criteria܈Quantity limits܆The state does not have drug utilization controls in place.Limitations [Describe the state’s limitations on amount, duration, and scope of MAT drugs, biologicals, and counseling and behavioral therapies related to MAT.] For OTPs: No more than 30 weekly nondrug bundle charges are eligible for coverage in the first calendar year that an enrollee is being treated by an opioid treatment provider and no more than 15 weekly nondrug bundle charges are eligible for coverage in subsequent calendar years. For OBOT: Pre-Authorization is required. Buprenorphine is subject to quantity limits, and certain products and brands are included on the state’s Preferred Drug List. Injectable and implantable buprenorphine are covered through the medical benefit with prior authorization. 6XSHUVHGHV 7UDQVPLWWDO 1XPEHU 1(: