Systems and Policies
Policies that limit patient incentives and community stigma may be barriers to implementation of Contingency Management, but collaboration with researchers and growing awareness of the seriousness of the overdose crisis facilitate adoption.
Barriers
Policies and laws that limit the ability to reward treatment attendance or cap patient payments can hinder Contingency Management (CM) implementation. Specifically, concerns that programs might face penalties under the federal anti-kickback statute and, until 2025, a $75 per-patient limit on federal funds that can be allocated towards CM incentives, have substantially curtailed the uptake of CM.
CM has historically not been a reimbursable service, which limits programs’ willingness to expend funds on incentives and toxicology screens.
Community stigma towards patients with opioid use disorders can lead to resistance to offering programs that reward patients for abstinence. Clinic leaders have expressed sentiments that a “not in my backyard” phenomenon exists, whereby community partners are supportive of programs like CM but don’t want such programs in their small neighborhood.
Facilitators
Clinics with better collaboration with researchers and larger health networks are more likely to adopt CM.
In recent years, national awareness of the overdose crisis has increased, as well as awareness about the increasing role of stimulants in driving overdose deaths. Because CM is the front-line treatment for stimulants, there has been increased interest nationally in making CM a reimbursable intervention.
The latest guidance from federal agencies is that federal dollars can now support incentives of up to $750 per patient. Guidance from legal experts also suggests that programs can mitigate their risk of audit or non-compliance with the anti-kickback statute by using well-documented, evidence-based CM protocols.