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.

SUD Stakeholders Update - December 28, 2020

Health First Colorado (Colorado’s Medicaid Program) is pleased to begin covering residential, inpatient, and withdrawal management substance use disorder (SUD) services starting January 1, 2021. Here are a few reminders for members and providers in preparation for the launch of the new benefit.

What Health First Colorado Members Can Expect

Members should expect few, if any changes, in the ways they access SUD treatment. Members will continue to work with their existing providers and the Regional Accountable Entities (RAEs) to identify and coordinate access to the most appropriate treatment options. The primary change is that now the RAEs will offer greater support coordinating care for members receiving inpatient and residential treatment. Under Medicaid, the RAEs are responsible for administering the new services and paying providers for care delivered.

Information for Providers

New Processes for Providers

For a few weeks, the Department has been offering guidance regarding Medicaid provider enrollment so providers can be eligible for Medicaid reimbursement for the new inpatient and residential SUD services. (See the below Provider Enrollment Reminders for more details). Here are some more details about specific changes to provider processes.

Beginning on Jan. 1, 2021, inpatient and residential SUD providers will need to:

  • Submit a continued stay authorization request to the RAE for any member who initiated treatment prior to January 1, 2021

  • Determine a member’s appropriateness for admission based on ASAM criteria and the determination of medical necessity.

  • Submit a prior authorization request to the RAE for any member that seeks to begin inpatient or residential treatment on or following January 1, 2021.

  • Participate in continued stay reviews by the RAE throughout a member’s residency.

  • Partner with the RAEs on the discharge of members and the transition to less intensive levels of care.

  • Submit requests for reimbursement to the RAEs for all members approved for treatment.

  • For members in residential treatment, providers will also need to submit claims to their Managed Service Organization for reimbursement of room and board. Medicaid cannot cover room and board expenses for members in residential treatment.

Provider Enrollment Reminders

All residential and inpatient SUD providers must be enrolled with Medicaid in order to be eligible for reimbursement for services delivered to Medicaid members. While some providers may have initiated contracts with a RAE, the RAE cannot reimburse a provider until they are officially enrolled as a Colorado Medicaid provider. For information about provider enrollment, visit the Find Your Provider Type web page.

Current Medicaid providers need to ensure their ASAM level of care has been added to their Medicaid provider enrollment record before they can receive reimbursement from the RAE. This requires that providers:

  • Add a Specialty Provider Type in the Provider Web Portal based on their ASAM level of care license.

    • New providers can add the Specialty Provider Type as part of provider enrollment.

    • Existing providers must submit a Provider Maintenance Request in the Provider Web Portal. For information, visit the Provider Maintenance Quick Guide.

  • Upload their Colorado Department of Human Services, Office of Behavioral Health License (specific to the ASAM level being enrolled) to the Provider Web Portal.

  • Contract with their RAE(s).

The Department is offering personalized assistance to help expedite the process (including provider enrollment support) and to answer questions: 

Wednesday, December 30, 2020

Noon - 1:00

Phone: 1-413-338-0354‬

PIN: ‪637 989 890‬# ‬‬‬‬‬‬

Meeting Link

For more information, please see the Required Action for All Substance Use Disorder Residential, Inpatient and Withdrawal Management Providers fact sheet.

Provider Office Hour

The Department of Health Care Policy and Financing, in conjunction with its partners at the Colorado Office of Behavioral Health, Regional Accountable Entities, and Managed Services Organizations, will host a series of 60-minute Provider Office Hour sessions, where residential and inpatient SUD treatment providers may ask questions and receive support on issues relating to the SUD benefit expansion. 

Providers may submit a question by:

  1. Using this Question Submission Form, or 

  2. Join one of the sessions listed below

Provider Office Hour dates, meeting link and call-in information are as follows:

FIRST Wednesday of the month

Meeting link: meet.google.com/ypv-vtau-kfp

Call-in number: (419) 812-2582‬

PIN: ‪931 626 035‬#

THIRD Wednesday of the month

Meeting link: meet.google.com/jsw-mjwf-khk

 Call-in number: (916) 836-2601‬

PIN: ‪951 467 943‬#

January 6, 10:30 - 11:30 a.m. January 20, 2:00 - 3:00 p.m.
February 3, 2:00 - 3:00 p.m. February 17, 2:00 - 3:00 p.m.
March 3, 2:00 - 3:00 p.m. March 17, 2:00 - 3:00 p.m.
 

REQUIRED ACTION for ALL Substance Use Disorder Residential, Inpatient and Withdrawal Management Providers

To receive Medicaid reimbursement from the RAEs for residential, inpatient and withdrawal management SUD services, providers must:

  • Add a Specialty Provider Type in the Provider Web Portal based on your ASAM level of care license.

  • Existing providers must submit a Provider Maintenance Request in the Provider Web Portal (for information, visit the Provider Maintenance Quick Guide).

  • New providers can add the Specialty Provider Type as part of provider enrollment.

  • Upload your Department of Human Services, Office of Behavioral Health License (specific to the ASAM level being enrolled) to the Provider Web Portal.

Providers should start this process immediately as it requires a manual approval process that may take several days. For more information, visit the Required Action for All Substance Use Disorder Residential, Inpatient and Withdrawal Management Providers fact sheet. For information about provider type/specialty details and submitting a Provider Maintenance Request, visit the Find Your Provider Type web page and the Provider Maintenance Quick Guide.

How to Get More Information

Members and family members should reach out to their RAE or current provider for information about and assistance accessing the most appropriate SUD treatment. Providers and other stakeholders can submit their questions using the following form: SUD Waiver Question Form.

Stay Informed        
We encourage you to sign up for updates on SUD Benefits.

Questions
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.