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.

July 2020 Update

Approval of Federal Authorities

The Colorado Department of Health Care Policy & Financing continues to work with the Centers for Medicare and Medicaid Services (CMS) to obtain approvals for the three federal authorities which apply to the SUD treatment benefits: the 1115 SUD demonstration waiver application, Medicaid State Plan amendment (SPA) and the 1915(b)(3) waiver. 

RAEs, MSOs and OBH collaboration on UM policy and readiness assessment

The Department continues to collaborate with the Regional Accountable Entities, Managed Service Organizations and the Colorado Office of Behavioral Health to implement the SUD residential and inpatient treatment benefit. Department staff are developing policies and guidance around utilization management and supporting RAEs in their preparations to implement the new SUD treatment benefit for Health First Colorado members in their RAE regions.

Information for Providers

Contact RAEs and MSOs: contracting and credentialing

If you are a provider planning to bill Medicaid for residential services in January, now is the time to reach out to RAEs that you intend to work with to bill these services. To bill for services, you will send claims for treatment services through the RAEs and claims for Room and Board through the MSOs. Please reach out to MSOs to make arrangements for billing as well.

Coming soon - additional provider resources and training 

Programs staff are developing a Provider Manual and Coding Manual pages for the new SUD treatment benefit. Also, provider-specific training opportunities will be offered in the Fall on topics including: enrollment for new and existing treatment providers under new specialty provider types, submission of claims, and billing procedures. Please watch this webpage for announcements on those communications.

ASAM Training - Register now for components #2 and #3
Registration is ongoing for the American Society of Addiction Medicine (ASAM) criteria training for providers. If you have successfully completed the first component of the ASAM training, please register to complete the second and third components. Contact Heather Dolan at Signal Behavioral Health Network, at hdolan@signalbhn.org for additional information. Many thanks to the Colorado Office of Behavioral Health and Signal for collaborating with the Department to make this training available.