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

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

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Colorados 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

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Colorado’s Medicaid Section 1115 Substance Use Disorder Waiver Application

Presented by: Dr. Kim McConnell August 30, 2019

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Our Mission

Improving health care access and

  • utcomes for the people we serve

while demonstrating sound stewardship of financial resources

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  • 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

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Today’s Agenda

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  • 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.

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Before We Get Started

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Background

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  • 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

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Waiver Background

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  • 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

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Medicaid Section 1115 Waivers

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Colorado 1115 Waiver

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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

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Waiver Goal

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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

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  • Open to all full benefit Medicaid members
  • Requires eligible S

UD diagnosis

  • S

tatewide implementation

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Eligibility for Waiver Services

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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

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Proposed Expanded Services

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  • 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

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Delivery System

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Stakeholder Process

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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

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Colorado Public Comment

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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

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Colorado Public Comment

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Next Steps

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  • 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

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Waiver Process

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  • 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 3rd party evaluator

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Implementation Planning

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  • 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

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Provider and RAE Support

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  • 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

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Continued Opportunities for Stakeholder Input

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Questions?

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Contact

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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

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Thank You!

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