Title Arial Bold 34pt font Counseling Workforce Subtitle Arial - - PowerPoint PPT Presentation

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Title Arial Bold – 34pt font

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Presenter’s Name Office or Department Name

Credentialing, Licensing, and Reimbursement of the SUD Counseling Workforce

Review of Policies and Practices Across the Nation

Presenter: Nilüfer İsvan, PhD Human Services Research Institute

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Co-authors & Funding

Rachael Gerber, MPH1 David Hughes, PhD1 Kristin Battis, MPH1 Judith G. Dey, PhD2 Kristina D. West, MS, LLM2 Evan Anderson, MA3

1 Human Services Research Institute 2 U.S. Department of Health and Human Services 3 Brandeis University

Research funded by the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services

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Presentation Outline

• Background & purpose
• Overview of methodology
• Review of licensing and credentialing policies
• Review of billing eligibility & reimbursement
• Conclusions and implications

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Background

• US experiencing workforce shortage in SUD treatment field
• SUD providers historically reimbursed by block grant funds
• Expanded insurance coverage through recent health reforms
• State-level system transformation
• Integration and parity
• However, workforce shortages and some barriers to insurance

network participation remain

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Purpose of the Study

• Identify state variation in policies regulating licensing and

credentialing of SUD treatment providers

• Identify state variation in billing eligibility and reimbursement

across public & private insurance plans

• Investigate barriers to and facilitators of increased treatment

capacity and identify innovative strategies to address these challenges

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Methodology Overview

1. Environmental scan

• Literature review
• Interviews with key informants

2. State review of licensing & credentialing policies 3. State review of billing eligibility & reimbursement 4. State case studies

• California
• New York
• North Carolina
• Texas

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Review of licensing/credentialing policies

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Defining the SUD workforce

• The SUD treatment workforce is broad, consisting of medical

providers, behavioral health counselors, social workers, etc.

• This study focuses on the SUD counseling workforce
• Lack of standardized credentials
• Wide variation in titles and credentials across states
• Uneven availability of licensure across states
• These factors likely impact billing/reimbursement eligibility

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Career ladder for SUD counseling

SAMHSA’s Model Scopes of Practice and Career Ladder

SAMHSA Category Category Title Minimum Degree Category 4 Independent Clinical SUD Counselor/Supervisor Master’s; licensed to practice independently Category 3 Clinical SUD Counselor Master’s; works under supervision Category 2 SUD Counselor Bachelor’s Category 1 Associate SUD Counselor Associate SUD Technician SUD Technician High school or equivalent + 2 additional categories: Peer Recovery Specialist Prevention Specialist

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State-level review: Data and methods

• Search domain: Publicly available information on states’ licensing

and certification boards websites

• Classified all SUD credentials into one of SAMHSA’s five

categories, plus peer recovery and prevention specialist

• Reviewed data for comparability within and across categories and

made adjustments; separated clinical supervisor category

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States with at least one treatment credential, by category

37 (73%) 40 (78%) 46 (90%) 32 (63%) 22 (43%) 47 (92%) 10 (20%) Category 4 Category 3 Category 2 Category 1 SUD Technician Peer Recovery At least 1 credential in each of the 6 categories

Number of States

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State variation in number of credentialing boards

19 (37%) 28 (55%) 4 (8%) Single Board Two Boards Three Boards Number of States

Includes boards for SUD counselors and SUD prevention specialists

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States with licensure for SUD counseling

• 31 states (61%)

have licensure

• 20 states (39%)

certification only

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Minimum degree required to attain the highest available SUD counseling credential in the state

 Master’s  Bachelor’s  Associate  High School  None

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Minimum practice hours required to attain the highest available SUD counseling credential in the state

 <1 year  1-2 years  3-4 years  5 years

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Key issues related to credentialing

Lack of national standard credentials, competency requirements, and reciprocity Low accessibility of information on credentialing and career advancement Low and inconsistent education requirements for practice Lack of standard education curricula Low salaries, low insurance coverage, low reimbursement rates Historical development

• utside of professional

clinical care Low desirability as a career choice Lack of state licensure statutes

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Addressing credentialing-related issues

• Efforts to establish uniform standards for credentialing, career

ladder, scopes of practice, and core competencies

• Within-state consolidation of certification boards
• Centralized information dissemination and technical assistance to

providers

• Degree programs linked to credentials, scholarships, loan

repayment

• State licensure statutes

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Review of billing eligibility and reimbursement

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State-level review: Data and methods

• Medicaid search domain: Publicly available documentation

from provider/billing manuals, fee schedules, enrollment docs

• Fee-for-service (FFS) Medicaid state plans
• Commercial insurance search domain: UnitedHealth/Optum

Provider Portal

• Determine SUD counselors’ eligibility to:
• Enroll in insurance plan as an “independent provider” type
• Be reimbursed for 8 pre-defined billing codes

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Billing codes

ASAM Level Billing Code (HCPCS) Billing Code Description 0.5 H0001 Alcohol and/or drug assessment 0.5 H0049 Alcohol and/or drug screening 0.5 H0050 Alcohol and/or drug services, brief intervention 1 H0004 Behavioral health counseling & therapy, 15 min 1 H0038 Self-help/peer services, per 15 min 1, 2.1 H0006 Alcohol and/or drug; case management 1, 2.1 H0007 Alcohol and/or drug; crisis intervention 2.1 H0015 Alcohol and/or drug; intensive outpatient 0.5 = early intervention 1 = outpatient services 2.1 = intensive outpatient services

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Billing eligibility under Medicaid

• SUD counselors

eligible in 11 states, all with licensure

• Not eligible in 32

states; must work in an accredited facility

• Could not

determine eligibility in 8 states

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Billing eligibility under Medicare

• Federal Medicare rules set eligible practitioner types
• SUD counselors not eligible
• Did not find evidence Medicare Advantage plans more flexible
• Medicare Special Needs Plans (SNPs)
• Dual Eligible Special Needs Plans (D-SNPs)
• Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs)
• These types of plans promising for expanded coverage and

reimbursement options

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Billing eligibility under Optum’s commercial plans

• SUD counselors

eligible in 13 states, all with licensure

• Optum requires a

state license and ability to practice independently w/o supervision

• Practitioner

eligibility based on “geographic and special needs”

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Alignment of licensure and billing eligibility

• Of 25 states with licensure and information on Medicaid billing

eligibility, 11 (44%) allow SUD counselors independent status

• SUD counselors eligible under Optum’s commercial plans in

42% of states with licensure

• Licensure facilitates, but does not guarantee, billing eligibility
• The 20 states without licensure are at a disadvantage for

independent practice and billing

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Key issues related to reimbursement

Lack of national standard credentials, competency requirements, and reciprocity Low accessibility of information on credentialing and career advancement Lack of state licensure statutes Low insurance billing eligibility Low insurance coverage, low reimbursement rates Historical development

• utside of professional

clinical care Low desirability as a career choice Lack of pathways to independent practice Administrative burdens related to network participation and billing

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Addressing billing-related issues

• Medicaid waivers, statewide system redesign
• Health homes and bundled services
• State licensure
• Infrastructural resource pooling
• State supports for joining insurance networks

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Conclusions and Implications

28 Lack of national standard credentials, competency requirements, and reciprocity Low accessibility of information on credentialing and career advancement Lack of standard education curricula Lack of state licensure statutes Low insurance billing eligibility Low salaries, low insurance coverage, low reimbursement rates Historical development

• utside of professional

clinical care Historical stigma and criminalization of SUDs Low desirability as a career choice Lack of pathways to independent practice Administrative burdens related to network participation and billing Low and inconsistent education requirements for practice

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The interconnected nature of the barriers implies systemic responses that simultaneously address multiple factors through consensus building among federal, state, and local stakeholders.

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Thank You!