Ensuring a Full Continuum of SUD Benefits

In accordance with House Bill 18-1136, the Department of Health Care Policy and Financing (Department) will be working to provide the full continuum of Substance Use Disorder (SUD) benefits to Health First Colorado (Colorado’s Medicaid program) members. The Department will be adding the inpatient and residential components, including withdrawal management, to the continuum of outpatient SUD services currently available. The Department’s objective is to make these services available for individuals who meet nationally-recognized evidence-based level of care criteria without shifting care from outpatient settings when they are more appropriate.

June 2019 Update

Stakeholder Meetings

The Department hosted a series of three meetings on June 19th and 20th.  During the meetings, staff presented the basic elements of the waiver application.  Staff announced the services which will be covered under the waiver, if approved by the Centers for Medicare and Medicaid Services (CMS).  These services include ASAM levels 3.1, 3.3, 3.5, 3.7 and 3.7 Withdrawal Management.  Meeting slides and a summary of the waiver components are available below:

Two meetings are planned for the public notice period in August.  The meetings will take place in Grand Junction and the Denver metro area.  The dates and locations of those meetings will be announced in July.  The Department is also developing a plan for further stakeholder engagement to take place after the public notice period.  Those meetings will focus on the implementation of waiver services. 

Waiver Application

A first draft of the waiver application is complete.  The Department is currently focused on the budget neutrality calculations that are included in the application.  The waiver is planned for submission to CMS during the month of October.

SUD system and benefit implementation planning

Departmental staff have begun to identify billing codes for the new services and are planning for the changes that will be necessary in the Interchange system when the services are introduced.  The Department is exploring requirements that will pertain to assessment practices for determining appropriate levels of care.  Staff are also working with OBH to align licensure requirements with ASAM criteria.  Statewide training needs for partners involved in providing the services are also being assessed.

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If you have questions regarding the 1115 SUD Waiver, Substance Use Disorder benefits for inpatient/residential treatment, or any other topic relating to the SUD Waiver, please complete our SUD Waiver Question Form.