OMB control number

Value in Opioid Use Disorder Treatment Demonstration (CMS-10728)

OMB 0938-1388 · HHS/CMS.

OMB 0938-1388

Value in Opioid Use Disorder Treatment (Value in Treatment) is a 4-year demonstration program authorized under section 1866F of the Social Security Act (Act), which was added by section 6042 of the SUPPORT Act. The purpose of Value in Treatment is to “increase access of applicable beneficiaries to opioid use disorder treatment services, improve physical and mental health outcomes for such beneficiaries, and to the extent possible, reduce Medicare program expenditures.” As required by statute, Value in Treatment will be implemented no later than January 1, 2021. All Value in Treatment participants are required to cooperate with efforts to conduct the independent evaluation of the demonstration program. This may include but not limited to participation in surveys, interviews, site visits, focus groups, and other activities that CMS determines necessary to conduct a comprehensive evaluation. CMS anticipates all data collected from participants will be reported at an aggregate-level data so as to avoid the disclosure of private and sensitive data of specific participants. The evaluation will assess the extent that the demonstration program: a) Reduced hospitalizations and emergency department visits; b) Increased use of medication-assisted treatment for opioid use disorders; c) Improved health outcomes of individuals with OUD, including reducing the incidence of Hepatitis C and HIV; d) Did not increase the total spending on items and services; e) Reduced deaths from opioid overdose; and f) Reduced the utilization of inpatient residential treatment.

The latest form for Value in Opioid Use Disorder Treatment Demonstration (CMS-10728) expires 2026-09-30 and is listed under ICR 202305-0938-016.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10728 Patient Agreement	Form and Instruction
Form CMS-10728 Participation Agreement	Form and Instruction
Form CMS-10728 Financial Report	Form and Instruction
Form CMS-10728 Participant Survey	Form and Instruction
Form CMS-10728 Participant Survey	Form and Instruction
Form CMS-10728 Beneficiary Health Survey	Form and Instruction
Form CMS-10728 Beneficiary Survey	Form and Instruction
Form CMS-10728 Beneficiary Notification	Form and Instruction
Form CMS-10728 Beneficiary Notification	Form and Instruction
Form CMS-10728 Request for Application	Form and Instruction
Form CMS-10728 OUD Care Team Roster Guidance & Template	Form and Instruction
Form CMS-10728 Participant's OUD Care Team	Form and Instruction
Form CMS-10728 Request for Application	Form and Instruction
CMS-10728_OUD_Supporting Statement - Part A.docx	Supporting Statement A
Value in Treatment 2022 Amendment No. 1 Sequestration (003).pdf	Supplementary Document
ViT RFA Attachment 2 prevalence rates.xlsx	Supplementary Document
ViT_OUD_Diagnosis_Codes.pdf	Supplementary Document
ViT PA Final clean 3.25.2021.pdf	Supplementary Document
Participation Agreement	Form and Instruction
Participation Agreement	Form and Instruction
Participant Financial	Form and Instruction
Participant Financial	Instruction
Participant Compliance Audit	Instruction
Participant Survey	Form and Instruction
Participant Survey	Form and Instruction
Beneficiary Survey	Form and Instruction
Beneficiary Survey	Form and Instruction
Beneficiary Notification	Form and Instruction
Beneficiary Notification	Form and Instruction
Request for Application	Form and Instruction
Request for Application	Form and Instruction
Request for Application	Form and Instruction
Request for Application	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202305-0938-016	Extension without change of a currently approved collection	2023-05-31		Approved without change
202007-0938-012	New collection (Request for a new OMB Control Number)	2020-09-14		Approved with change

OMB Details

Request for Application

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form CMS-10728	Request for Application	Fillable Printable	Form and instruction
Form CMS-10728	Participant's OUD Care Team	Fillable Printable	Form and instruction
Form CMS-10728	OUD Care Team Roster Guidance & Template	Fillable Printable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.