VIRGINIA MEDICAID ADDICTION AND RECOVERY TREATMENT SERVICES (ARTS) PROGRAM Katherine Neuhausen, MD, MPH, Chief Medical Officer Virginia Department of Medical Assistance Services November 2018
Virginia Medicaid Coverage of Substance Use Virginia Medicaid Coverage of Substance Use Disorder Services before ARTS Disorder Services before ARTS Incomplete Care Continuum Lack of Providers • Rates for substance use disorder Limited Coverage treatment had not been increased • Residential treatment was not covered since 2007. for non ‐ pregnant adults. Utilizing more • Providers were not reimbursed for expensive inpatient detox. the actual cost of providing care. • Fragmented System: Substance use • System severely limited the number disorder treatment was separated from of providers willing to provide mental and physical health services. services to Medicaid members. • Pregnant women lose eligibility and • Providers struggled to understand coverage for treatment 60 days after who to bill for services. Consumers delivery. did not know where to seek services. Limited Access to Services
Addiction and Recovery Treatment Services (ARTS) Benefit Changes to DMAS’ Substance Use Disorder (SUD) Services for Medicaid and FAMIS Members approved by General Assembly in Spring 2016 Expand short ‐ term SUD inpatient detox to all Medicaid /FAMIS members 1 Expand short ‐ term SUD residential treatment to all Medicaid members 2 Increase reimbursement for existing Medicaid/FAMIS SUD treatment services 3 Add Peer Support services for individuals with SUD and/or mental health conditions 4 Require SUD Care Coordinators at DMAS contracted Managed Care Plans 5 Organize Provider Education, Training, and Recruitment Activities 6 2
Addiction and Recovery Treatment Services (ARTS): Addiction and Recovery Treatment Services (ARTS): Transforming the Delivery System of Medicaid SUD Services Transforming the Delivery System of Medicaid SUD Services • All ARTS services are covered by Managed Care plans • Magellan continues to cover community ‐ based substance use disorder treatment services for fee ‐ for ‐ service members Intensive Opioid Outpatient Treatment Programs Program Office ‐ Based Partial Opioid Hospitalization Treatment Residential Case Treatment Management Peer Recovery Inpatient Detox Supports Effective July 1, 2017 Effective April 1, 2017 ARTS creates a fully integrated physical and behavioral health continuum of care 4
Increases in Addiction Treatment Providers Due to ARTS Increases in Addiction Treatment Providers Due to ARTS Over 400 new Addiction Treatment Provider Sites in Medicaid Addiction Provider Type # of Providers # of Providers % Increase in before ARTS after ARTS Providers Inpatient Detox Unknown 103 NEW (ASAM 4.0) Residential Treatment 4 94 ↑ 2250% (ASAM 3.1, 3.3, 3.5, 3.7) Partial Hospitalization 0 24 NEW Program (ASAM 2.5) Intensive Outpatient Program 49 136 ↑ 178% (ASAM 2.1) Opioid Treatment Program 6 39 ↑ 550% Preferred Office ‐ Based 0 100 NEW Opioid Treatment Provider 5
Preferred Office ‐ Based Opioid Treatment Providers Preferred Office ‐ Based Opioid Treatment Providers Required Core Team Members • Member • Buprenorphine‐Waivered Practitioner (physician, NP or PA) • Licensed Mental Health Professional (e.g., LCSW, LPC, licensed clinical psychologist, etc.) • Nurse Optional Team Members • Pharmacists • Peer Recovery Specialists • Substance Use Care Coordination • This can be designated team member whose only function is to perform care coordination or a team member such as the nurse or LCSW who performs dual roles in the clinic. 6
Payment Model for Preferred OBOTs Payment Model for Preferred OBOTs Rate/ Code Service Who Can Bill? Unit Unit Medication Assisted Buprenorphine Waivered Per H0014 Treatment (MAT) $140 Practitioner encounter induction Opioid Treatment – Credentialed Addiction 1 unit= H0004 individual and family $24 Treatment Professional 15 min therapy 1 unit = 15 Opioid Treatment – Credentialed Addiction H0005 min (per $7.25 group therapy Treatment Professional patient) Buprenorphine Waivered Substance Use Care Practitioner or Credentialed 1 unit = 1 G9012 $243 Coordination Addiction Treatment month Professional
Before ARTS Medicaid Provider Network Adequacy Before ARTS Medicaid Provider Network Adequacy Opioid Treatment Services Opioid Treatment Services Source : Department of Medical Assistance Services ‐ Provider Network data (April 16 2018). Circles # of Medicaid providers included in network adequacy access calculation. For a zip code to be considered accessible, there must be at least two providers within 30 miles (urban) or 60 miles (rural) driving distance. Driving distance is calculated by Google services based on the centroid of each zip code. Note: Before ARTS, only two of the six Opioid Treatment Programs enrolled with Medicaid were billing Medicaid to treat Medicaid members 5
After Medicaid Provider Network Adequacy After Medicaid Provider Network Adequacy Opioid Treatment Services Opioid Treatment Services Source : Department of Medical Assistance Services ‐ Provider Network data (April 16 2018). Circles # of Medicaid providers included in network adequacy access calculation. For a zip code to be considered accessible, there must be at least two providers within 30 miles (urban) or 60 miles (rural) driving distance. Driving distance is calculated by Google services based on the centroid of each zip code. Note: The map with results after the ARTS program began shows Opioid Treatment Services, which include Opioid Treatment Programs that existed prior to ARTS, and the addition of the Preferred Office‐Based Opioid Treatment Providers (which are an innovative new care delivery model supported by ARTS. 6
VCU Evaluation: Outcomes from First Year of ARTS VCU Evaluation: Outcomes from First Year of ARTS Characteristics of Members • More than 20,000 members have Opioid Use Disorder (OUD) • About 30,000 members have other Substance Use Disorder including Alcohol Use Disorder and other legal/illegal drugs • OUD diagnoses increased by 15% during first year • 2/3 members with OUD are female • Members with OUD are disproportionately white and ages 45 and older and more likely to have gained eligibility as an adult with a disability 7
VCU Evaluation: Outcomes From First Year of ARTS VCU Evaluation: Outcomes From First Year of ARTS More Medicaid members are receiving treatment for all Substance Use Disorders (SUD) and Opioid Use Disorder (OUD) After ARTS Before ARTS % Change (Apr 2017‐Mar 2018) (Apr 2016‐Mar 2017) Members with ↑ 57% SUD receiving treatment 15,703 24,615 Members with ↑ 48% OUD receiving treatment 10,092 14,917 11
VCU Evaluation: Outcomes from First Year of ARTS VCU Evaluation: Outcomes from First Year of ARTS ARTS Increased SUD Treatment in All Regions 9
VCU Evaluation: Outcomes From First Year of ARTS VCU Evaluation: Outcomes From First Year of ARTS Increase in total number of Substance Use Disorder Outpatient Providers After ARTS Before ARTS % Change (Apr 2017 ‐ Mar 2018 ) (Apr 2016 ‐ Mar 2017) Total number of ↑ 173% 1,087 2,965 SUD Outpatient Providers ↑ 502% Physicians 261 1,571 By Provider Type ↑ 652% 25 NP 188 ↑ 52% 300 Counselors and SW 457 ↑ 50% 501 749 Other 13
VCU Evaluation: Outcomes From First Year of ARTS VCU Evaluation: Outcomes From First Year of ARTS Increase in total number of Opioid Use Disorder Outpatient Providers Before ARTS After ARTS % Change (Apr 2016 ‐ Mar 2017) (Apr 2017 ‐ Mar 2018) Total number of ↑ 137% 570 1,352 OUD Outpatient Providers ↑ 358% Physicians 128 586 By Provider Type ↑ 408% 13 NP 66 ↑ 66% 142 Counselors and SW 236 ↑ 62% 287 464 Other 14
VCU Evaluation: Outcomes From First Ten Months of ARTS VCU Evaluation: Outcomes From First Ten Months of ARTS Fewer Emergency Department visits related to Substance Use Disorder (SUD) and Opioid Use Disorder (SUD) Before ARTS After ARTS % Change (Apr 2016‐Jan 2017) (Apr 2017‐Jan 2018) ED Visits Related ↓ 14% to SUD 24,962 21,445 ED Visits Related ↓ 25% to OUD 5,016 3,756 2 15
VCU Evaluation: Outcomes From First Ten Months of ARTS VCU Evaluation: Outcomes From First Ten Months of ARTS Fewer inpatient hospitalizations related to Substance Use Disorder (SUD) and Opioid Use Disorder (SUD) Before ARTS After ARTS % Change (Apr 2016‐Jan 2017) (Apr 2017‐Jan 2018) Hospitalizations ↓ 4% Related to SUD 13,182 12,650 Hospitalizations ↓ 6% Related to OUD 3,520 3,315 2 16
VCU Evaluation: Decrease in ED Visits Due to ARTS Program VCU Evaluation: Decrease in ED Visits Due to ARTS Program Probability of an Emergency Department Visit 40.0% Without 35.0% ARTS Members with OUD 30.0% 25.0% 20.0% Members without SUD 15.0% 10.0% 5.0% 0.0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 ARTS 16
VCU Evaluation: Decrease in Inpatient Hospitalizations Due VCU Evaluation: Decrease in Inpatient Hospitalizations Due to ARTS Program to ARTS Program Probability of an acute inpatient hospitalization 30.0% Without 25.0% ARTS Members with OUD 20.0% 15.0% 10.0% 5.0% Members without SUD 0.0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 ARTS 17
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