Comple mpleting t ng the he Subst Substanc ance Use se Di Diso sorde der C r Continuum nuum of C f Car are Health First Colorado Jalyn I n Inga ngalls a s and nd S Sara Schmi hmitt Stakeh ehold lder er M Meet eeting June 2019
Toda oday’s A Age genda nda • Welcome • Review of work to date and previous stakeholder communications • Summary of Substance Use Disorder (SUD) Waiver Proposal • Next Steps for Stakeholder Engagement
Goa oals for T or Toda oday’s Meeting ng • Provide background on the waiver and work to date. • Review and discuss content of the waiver application. • Identify next steps in the waiver submission process.
Bef efore W e We e Get et Star arted ed • Please silence cell phones. • Share your unique perspective. • Honor the public space. • State your headline first so that everyone can participate. • Write down anything that you were unable to say during the meeting. (Email to CHI.)
Waiver r reca cap • HB18-1136 • Previous stakeholder meetings: November 2018 and May 2019 • Waiver components: application, implementation plan, monitoring and evaluation • Implementation milestones • First draft of waiver complete
Waiver Timeline 6
Waiver Demonstration Milestones 1. Access to critical levels of care 2. Evidence-based, S UD-specific patient placement criteria 3. Use of nationally recognized standards to set provider qualifications 4. S ufficient provider capacity, including medication assisted treatment 5. Treatment and prevention strategies to address opioid abuse 6. Improved care coordination and transitions 7
Colorado’s Medicaid Section 1115 Substance Use Disorder Waiver Proposal Presented by: Kim McConnell, PhD ACC S UD Administrator June 2019 8
Medicaid Section 1115 Waivers • S ection 1115 waiver demonstrations provide states with opportunities to test new approaches in Medicaid programs • S UD waiver initiative is a response to opioid epidemic • Twenty-two states have approved S UD waivers; six more pending 9
Waiver Goal Complete the Colorado S UD continuum of care in order to improve health outcomes, promote long- term recovery, and reduce overdose deaths. 10
Waiver Objectives Add inpatient and residential S UD treatment, including WM services, for Medicaid members who need this level of care Ensure that members receive a comprehensive assessment and are placed in the appropriate level of care Improve the availability of MAT to promote long-term recovery 11
Eligibility for Waiver Services New services will be open to all Medicaid members with a covered S UD diagnosis and who meet medical necessity 12
ASAM Level of Care Designations
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 14
Delivery System The S UD continuum of services will be managed by the RAE’ s. RAE’ s will receive a capitation payment to provide these services. 15
Financing • CMS requires Section 1115 waivers to be “ budget neutral,” meaning that services provided under demonstration can cost no more to the federal government that what would have been spent absent the waiver • For Colorado, budget neutrality will be demonstrated by proving that reductions in ED visits and repeated inpatient hospitalizations will offset the cost of new services 16
Next Steps in Waiver Submission Process • The department is drafting and refining the waiver application and developing budget proj ections • Prior to CMS submission, the Department will: • Conduct a series of stakeholder meetings, including two formal public hearings • Conduct Tribal consultation • Post full application for 30-day public review and comment • Goal is to submit waiver proposal to CMS in Fall 2019 • Go live date for waivered services S ummer 2020 17
Post-submission waiver activities • Correspond with CMS during the waiver approval process • CMS will draft S pecial Terms and Conditions (S TC’ s) • S ubmission of the Implementation Plan • Discussion and approval of implementation plan • Development and submission of the monitoring and evaluation plans Procurement of 3 rd party evaluation contractor • 18
Planned implementation activities • S UD treatment system capacity assessment and collaboration for expansion • Interchange system changes • Contract amendments • Collaboration with OBH to bring licensure requirements into alignment with AS AM criteria • Provider and RAE training to ensure consistency in utilization of AS AM criteria and patient placement decision making • Planning for improved care coordination and transitions between levels of care 19
Questions? 20
Contact Kim McConnell, PhD ACC S UD Administrator Kim.mcconnell@ state.co.us S hingo Ishida ACC S UD Benefit S pecialist S hingo.Ishida@ state.co.us 21
Disc iscussio ssion Qu Questio stions • What are your thoughts on the waiver services that will be introduced? • What considerations would you like us to have in mind as we move into implementation of the waiver next year?
Thank You! 23
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