Colorados Medicaid Section 1115 Substance Use Disorder Waiver - PowerPoint PPT Presentation

Colorado’s Medicaid Section 1115 Substance Use Disorder Waiver Application Presented by: Dr. Kim McConnell August 30, 2019 1

Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2

Today’s Agenda • Welcome • Background on waiver application • S ummary of Colorado’ s S ubstance Use Disorder (S UD) 1115 waiver application • S takeholder feedback on the application and waiver components • Discussion of next steps 3

Before We Get Started • Please silence cell phones. • S hare your unique perspective. • Honor the public space. • Please state your name first so that all participants, live and on the phone can participate. • Write down anything you were unable to say during the meeting and email to the addresses provided at the end of this presentation. 4

Background 5

Waiver Background • House Bill 18-1136 • Correspondence with the Centers for Medicare & Medicaid S ervices (CMS ) to determine path to coverage of residential and inpatient S UD services • Once approved, the state will utilize S tate Plan and 1115 waiver authority to open up these services for coverage 6

Medicaid Section 1115 Waivers • Opportunities to test new approaches in Medicaid programs • Recent initiative provides additional federal funding to expand S UD treatment services • Twenty-four states have received approval; four pending 7

Colorado 1115 Waiver 8

Waiver Goal The goal of the S ection 1115 waiver is to complete the Colorado continuum of S UD care in order to improve health outcomes, promote long-term recovery, and reduce overdose deaths 9

Waiver Objectives 1. Increase access to necessary levels of care, including withdrawal management 2. Ensure that members receive a comprehensive assessment and are placed in an appropriate level of care 3. Align the state’ s S UD treatment system with a nationally recognized S UD- specific standard 4. Increase provider capacity where needed 5. Improve the availability of medication assisted treatment (MAT) to promote long-term recovery 10

Eligibility for Waiver Services • Open to all full benefit Medicaid members • Requires eligible S UD diagnosis • S tatewide implementation 11

Proposed Expanded Services Services defined by the American Society of Addiction Medicine (ASAM) • ASAM Level 3.1: Clinically Managed Low-Intensity Residential S ervices • ASAM Level 3.3: Clinically Managed Population-S pecific High-Intensity Residential S ervices • ASAM Level 3.5: Clinically Managed High-Intensity Residential S ervices • ASAM Level 3.7: Medically Monitored Intensive Inpatient S ervices • ASAM Level 3.7 WM: Medically Managed Inpatient Withdrawal Management 12

Delivery System • Regional Accountable Entities (RAEs) will manage services • Costs in capitated payment rate • As with other services under the capitation, no cost sharing • RAE Responsibilities  Administer covered services  Utilization management  Care coordination  Transition support 13

Stakeholder Process 14

Colorado Public Comment The waiver application is posted online at: https://www.colorado.gov/pacific/sites/default/files/sud1115waiverap plication.pdf Two in-person meetings • Friday, August 30, Denver • Friday, S eptember 6: Grand Junction 15

Colorado Public Comment Comments must be received by S eptember 27: Email: hcpf_sudbenefits@ state.co.us Mail: Colorado Department of Health Care Policy & Financing 1570 Grant S treet Denver, CO 80203 ATTN: HPO Director – 1115 waiver 16

Next Steps 17

Waiver Process • S ubmit waiver in October 2019 • 30-day federal comment period • Conduct waiver negotiations with CMS • Develop and submit implementation, monitoring and evaluation plans • “ Go-live” with services in S ummer 2020 18

Implementation Planning • Develop and enact capacity building plans • Develop billing methodologies • Initiate rule changes if necessary • Training and support for providers and RAE staff • Revise RAE contracts Contract with 3 rd party evaluator • 19

Provider and RAE Support • Provider Capacity:  Plan for addressing gaps in the availability of S UD services across the continuum of care • Workforce Development:  Training to ensure consistency in application of AS AM criteria and billing procedures 20

Continued Opportunities for Stakeholder Input • HCPF will host regular, open, public stakeholder meetings beginning in October to address implementation issues • Monthly newsletter • Periodic updates to the Ensuring a Full Continuum of S UD Benefits webpage, at: https:/ / www.colorado.gov/ pacific/ hcpf/ ensuring-full- continuum-sud-benefits 21

Questions? 22

Contact Kim McConnell, PhD ACC SUD Administrator Kim.mcconnell@ state.co.us S takeholder webpage: https:/ / www.colorado.gov/ pacific/ hcpf/ ensuring-full-continuum- sud-benefits 23

Thank You! 24