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Substance Use Disorder (SUD) 1115 Waiver UpdateMay 9, 2019 9:00 AM – 12:00 PM

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Objectives

Receive updates on the

State Plan Amendment

(SPA)

Understand Chapter 15 Regulations

Changes

Become informed of

Partner Portal and MMIS

System Changes

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Review of December MCO Meeting

Medication Assisted Treatment (MAT) Bundling

Waiver of Institution for Mental Disease (IMD)(IMD)

Regulation Changes

SPA Changes

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State Plan Amendment (SPA) Updates

Providers will be required to utilize the current edition of “The American Society of Addiction Medicine (ASAM) Criteria” for recipients receiving SUD treatment:

• Assessments should utilize a multi-dimensional assessment tool

• Intensive Outpatient Programs and Partial Hospitalization Programs should meet service criteria outlined in the current edition of the “ASAM Criteria”

• Individuals should be assessed and meet the dimensional admission criteria utilizing the “ASAM Criteria” for appropriate level of care residential placement

o Care coordination requirements outlined o Removal of short term and long term length of stay

• Added description for Withdrawal Management (WDM)

Attachment 3.1 submitted to CMS on April 5, 2019 with request of effective date for July 1, 2019

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State Plan Amendment (SPA) Updates Cont.

• Peer Supports should be identified in a recipient treatment plan, except for Peer Supports engaging recipients into SUD treatment through ED Bridge Clinicso Peer Support led groups are limited to a maximum of 8

individuals at a timeo Peer Support Specialist are permitted a maximum of

120 units of direct recipient contact per week.

• Service Planning extended to cover SUD services

• Adding coverage for methadone as a part of MAT for SUD treatment in a Narcotic Treatment Program (NTP)

• Screening and Brief Intervention that do not meet referral to treatment are subject to coverage

• Added Registered Behavioral Technician (RBT) as an allowable rendering professional

Regulation Changes

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Regulation Updates

Definitions • 907 KAR 15:005

Behavioral Health Service Organization (BHSO)• 907 KAR 15:020 • 907 KAR 15:025

Individual Practitioner, Practitioner Groups and Multi-Specialty Group (MSG)

• 907 KAR 15:010• 907 KAR 15:015

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Definition Regulation907 KAR 15:005

• “Approved Behavioral Health Practitioner” • “Approved Behavioral Health Practitioner under supervision” • “Behavioral Health Service Organization” • “Face-to-face”

Updated the following definitions:

Added the following definitions:

• “ASAM Criteria”• “Co-occurring Disorder” • “Medication Assisted Treatment”• “Registered Behavioral Technicians”• “Telehealth”• “Withdrawal Management”

BHSO Regulation “Redesign”

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BHSO Requirements

Requirements

Tier I –Mental Health

Tier II –Outpatient SUD(Including Co-occurring)

Tier III –Residential SUD (Including Co-Occurring)

• BHSO OIG License

• National Accreditation

• Psychiatric Specialty for Medical Professionals (MD, APRN)

• Outpatient Alcohol and Other Drug Entity (AODE) License

• National Accreditation

• Verification of Psychiatric or Addictionology Specialty for Medical Professionals (MD, APRN)

• DEA Waivered License number and issued date for Medical Professionals prescribing buprenorphine

• Residential Alcohol and Other Drug Entity (AODE) License

• National Accreditation

• Verification of Psychiatric or Addictionology Specialty for Medical Professionals (MD, APRN)

• DEA Waivered License number and issued date for Medical Professionals prescribing buprenorphine

• Level of Care Certification as of 1/1/2020

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Changes Per Tier

Tier I –Mental Health

Tier II –Outpatient SUD(Including Co-Occurring)

Tier III –Residential SUD(Including Co-Occurring)

• Added Partial Hospitalization

• Added minimum of 6 hours per week for adolescents in IOP

• Additional Therapeutic Rehabilitation Program (TRP) components

• Added (RBT) as allowable professionals

• Assessments for SUD should utilize a multidimensional assessment tool

• IOPs should meet service criteria outlined in the “ASAM Criteria”

• Added minimum of 6 hours per week for adolescents in IOP

• Added Partial Hospitalization and programs should meet the service criteria outlined in the “ASAM Criteria”

• Added MAT and WDM as appropriate in outpatient settings

• Individuals should be assessed and meet the dimensional admission criteria utilizing the “ASAM Criteria” for appropriate level of care residential placement

• MAT and WDM services may be included in residential as appropriate

• Added Care Coordination requirements

• Removed short term and long term length of stay

Additional BHSO Changes

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BHSO Changes to ALL Tiers

• Added “Telehealth” as a means of service delivery for appropriate services

• Peer Support Specialist led groups are permitted a maximum of 8 individuals per event

• Peer Support Specialist are allowed a maximum of 120 units per week of direct recipient contact

• Limited laboratory services are reimbursable with appropriate CLIA certificate

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Tier II: Narcotic Treatment Programs (NTP)

• NTPs will enroll as a BHSO Tier II

• NTPs are permitted to have Medication Stations

• Addresses and Hours of Operation will be captured in enrollment

• Limited services are allowable in NTPs

With the addition of methadone coverage to the SPA and BHSO regulation changes, NTPs will be eligible to enroll with Medicaid as a BHSO provider type:

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Code Description

H0020* Methadone Medication Assisted Treatment Bundle

H0033* Methadone Induction

T2023 Targeted Case Management

H0038 Peer Support Services

*S9446 Peer Support, Group

H0015 Intensive Outpatient Programs

T1007 Alcohol and/or substance abuse services, treatment plan development and/or modification

*New codes added to the Behavioral Health & Substance Use Fee Schedule to be effective 7/1/2019**The Physician’s visit/assessment is billable outside of these codes and will be a new or established patient E&M code.

NTP Services

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BHSO Non-Permitted Practitioners

Non-Permitted Practitioners

Tier I –Mental Health

Tier II –Outpatient SUD (Including Co-Occurring)

Tier III –Residential SUD(Including Co-Occurring)

• A Licensed Clinical Alcohol and Drug Counselor (LCADC)

• A Licensed Clinical Alcohol and Drug Counselor (LCADCA)

• A Certified Alcohol and Drug Counselor (CADC)

• A Substance Use Disorder Peer Support Specialist

• Licensed Behavioral Analyst (LBA)

• Licensed Assistant Behavioral Analyst (LABA)

• Registered Behavioral Technician (RBT)

• Community Support Associate (CSA)

• Licensed Behavioral Analyst (LBA)

• Licensed Assistant Behavioral Analyst (LABA)

• Registered Behavioral Technician (RBT)

• Community Support Associate (CSA)

Individual Practitioner, Practitioner Group and MSG Regulation Changes

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Individual Practitioner, Practitioner Group and MSG Regulation Changes: 907 KAR 15:010

Outpatient AODE license is required IF providing SUD treatment

Assessments for SUD treatment should utilize a multidimensional assessment tool in accordance with the “ASAM Criteria”

IOPs should meet service criteria outlined in the “ASAM Criteria” level of care

Medication Assisted Treatment as appropriate

Withdrawal Management as appropriate

Added requirements specific to SUD treatment:

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Additional Individual Practitioner, Group and MSG Regulation Changes

• Psychiatric specialty required for Medical Professionals (MDs & APRNs) OR Addictionology specialty for Medical Professionals treating SUD

• Added “Telehealth” as a means of service delivery to appropriate services

• Additional Therapeutic Rehabilitation Program components

• Community Support Associate (CSA) are allowable professionals to preform Comprehensive Community Support Services

• Added Registered Behavioral Technicians (RBTs) as allowable professionals to perform applicable ABA services

• Limited laboratory services can be reimbursable with appropriate CLIA certificate

• Added minimum of 6 hours per week for adolescents in IOP

BREAK

Self Attestations and Residential Certification

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Residential Self Attestations

March 6th, 2019 March 25th, 2019 April 1st , 2019

Self Attestations were sent to residential facilities.

A list of all “Waived”

Providers was sent to MCOs.

The temporary waive of the IMD exclusion became

effective.

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January 1st, 2020

• The “ASAM Criteria” will be applied to Residential Level of Care (LOC). All providers will be required to be certified to the appropriate LOC.

Level 3.1 Level 3.3 Level 3.5

Providers will be required to complete a “maintenance” update in Partner Portal to identify appropriate LOC:

Residential Level of Care Certification

Partner Portal Changes

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BHSO (Provider Type 03) Partner Portal ChangesCurrent BHSOs will be required to complete a “maintenance” update prior to July 1st, 2019.

Providers will select appropriate “tiers” applicable to them:

Providers have the capability to select multiple

tiers

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NTP Tier II Portal Changes

If “Yes” is selected, a message will appear to “Please enroll Non-Methadone Clinic as a separate provider”

If “Yes” is selected, Screen 2 will appear

Screen 1

Screen 2

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Additional PT 03 Partner Portal Changes

Tier III Providers will be required to enter residential bed capacity

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MSG (Provider Type 66) Partner Portal Changes

• Provider will be asked, “Are you providing Substance Use Disorder Treatment (SUD)?”

◦ If “YES” an Outpatient AODE license is required to upload

• MSG’s linking a MD or APRN will be asked, “Is this provider licensed to prescribe buprenorphine?”

◦ If “YES” they will be required to enter XDEA License information

Current MSG providers will be required to complete a “maintenance” update prior to July 1st

MMIS Changes

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BHSO MMIS Changes New Codes Effective July 1, 2019

Code Description Rate

H0020 Methadone MAT Bundle

Bundle Includes: 80305, 80306, 80307, 90785, 90832, 90833, 90834, 90836, 90837, 99354, 99355, 90838, 90839, 90840, and 90853.

$105, Weekly

Sun – Sat

H0033 Methadone Induction

A MD, APRN, or PA to monitor the first-time administration of methadone to a recipient to ensure that the medication is not contraindicated

$200, Event

No more than 4 per calendar year

S9446 Peer Support, Group TBD

H0035 Partial Hospitalization $194.10, Per Diem

HF Modifier Required for ALL Claims in TIER II and TIER III

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Provider Master File ChangesContract Code, along with Effective and End Dates, will be added to the Provider Master file to enable MCOs to identify the provider’s “tier” enrollment.

Contract Code Tier Description

BHSO I Behavioral Health – Mental Health Only

NTP II Behavioral Health Outpatient Services with NTP

NONTP II Behavioral Health Outpatient Services Non-NTP

BHSO3 III Behavioral Health Residential Services

The Provider Master File is distributed to MCOs on a daily basis. This file includes:

• Active and recently end-dated providers• Contents include Provider Name, Address, Medicaid ID, Tax ID, NPI

(up to 30), Taxonomy (up to 50), etc.

The tier can be identified as indicated below:

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Provider Master File Changes

The Contract Code will be a five character field.

Up to 10 contracts may be submitted per provider.

The contract code will be added to the end of the Provider Master File.

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The Provider Master File:

Implementation Timeline

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Substance Use Disorder (SUD)

2019

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

SUD Phase 1 Release(7/1/19)

Legend:Dev.Design SIT UAT/

PIT

Provider Portal Requirements/Design Approved: 3/4/19 - 4/30/19

MMIS Development: 5/13/19 – 5/24/19 (Provider = 5/22 and Claims = 5/24)

Provider Portal UAT: 6/10/19 – 6/14/19

MMIS Requirements/Design Approved: 3/4/19- 5/10/19 (Provider = 5/6 and Claims = 5/10)

Provider Portal Development: 4/28/19 – 5/24/19

MMIS M&O SIT: 5/13/19 - 6/7/19 (Provider = 6/5 and Claims = 6/7)

MMIS and MCO PIT: 6/7/19 - 6/26/19 (Claims = 6/24 and Provider = 6/26)

Phase 1 Provider and Claims Policy Go Live: 7/1

Provider Portal SIT: 5/13/19 – 6/7/19

Phase 1 Provider System Go Live: 6/19

SUD 1115 Go Live Implementation Timeline

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Scheduling Upcoming MCO Meetings

DMS requests MCOs to provide feedback regarding upcoming topicsfor discussion

Feedback

DMS requests each MCO provide appropriate “Point of Contact(s)” for scheduling future meetings regarding changes related to SUD 1115.

Point of Contact(s)

Questions?

AKYPEC-2107-19 May 2019