Federal Policies
Office of Inspector General
CM is subject to federal regulations, especially when delivered in the context of federally funded programs. The following list includes links to relevant federal laws that may apply to Contingency Management.
Please note that CM programs with federal approval via a Medicaid 1115 waiver or an Office of Inspector General opinion may be subject to a different set of rules. Consult your compliance team and/or your CM funder to understand how the following federal rules and regulations impact your CM program.
Office of Inspector General (OIG), Department of Health and Human Services (HHS). (2020). Medicare and State Health Care Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements. Federal Register. https://www.federalregister.gov/documents/2020/12/02/2020-26072/medicare-and-state-health-care-programs-fraud-and-abuse-revisions-to-safe-harbors-under-the
This document, issued by the Health and Human Services Department of the United States federal government is a summary of the “final rule” regarding the proposed revisions to the Anti-Kickback and related regulations.
Use Ctrl+F/Cmd+F and search for “contingency management” to see where it is discussed.
U.S. Department of Health and Human Services. (2023). Contingency Management for the Treatment of Substance Use Disorders: Enhancing Access, Quality, and Program Integrity for an Evidence-Based Intervention. ASPE. https://aspe.hhs.gov/reports/contingency-management-treatment-suds
Navigating Federal Regulations
The above federal resources are lengthy and may contain unfamiliar legal language. The following resources help interpret how these regulations pertain to CM.
McDonell, M. G., Hirchak, K. A., McCrady, E., Clark, H. W., Rawson, R. (2024). Federal Policy Changes Must Occur To Provide A Lifesaving Stimulant Drug Intervention. Health Affairs Forefront. https://doi.org/10.1377/forefront.20240209.728693
Rawson, R. A., Erath, T. G., Chalk, M., Clark, H. W., McDaid, C., Wattenberg, S. A., Roll, J. M., McDonell, M. G., Parent, S., & Freese, T. E. (2023). Contingency Management for Stimulant Use Disorder: Progress, Challenges, and Recommendations. The Journal of ambulatory care management, 46(2), 152–159. https://doi.org/10.1097/JAC.0000000000000450
Policy Considerations for Tribal Sovereignty
Federally recognized Tribes are sovereign nations with a government-to-government relationship with the US government. The trust responsibility began in 1787 and is based on Article I, Section 8 of the Constitution. The government-to-government relationship has continued through numerous treaties and laws. Therefore, US government programs and federal funding are legal mandates obligated to federally recognized Tribes. Tribal membership is therefore more akin to nationality than race/ethnicity status, with each Tribal Nation setting their own policies and laws around citizenship.
Each federally recognized Tribe has their own governance. Many Tribal programs are operated under Tribal laws and guidelines. However, the federal government does require implementation of CM to be in accordance with the US Health and Human Services Office of the Inspector General (OIG). The biggest barrier to CM implementation has been funding, including the legal barriers to using rewards or incentives in health care.