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.

March 2019 Update

The Department continues to work toward providing the full continuum of substance use disorder benefits to Health First Colorado enrollees.  To support these efforts, HCPF has hired two staff members who are focused on pursuing the 1115 waiver that will allow the Department to offer an inpatient and residential Substance Use Disorder (SUD) benefit.  The Department currently has an open solicitation for a contractor to assist with the development of the waiver application.  Numerous states have engaged contractors with expertise in the SUD waiver to ensure that the application is consistent with CMS requirements and to avoid unnecessary delays once the application is submitted.

The Department has also developed contracts with two experts who have familiarity with the SUD services in the State of Colorado.  These contractors will be assisting with system mapping and capacity issues.  Finally, HCPF has engaged a contractor who will assist with developing a robust plan for stakeholder communication and engagement.  A series of stakeholder meetings are being planned for Spring 2019.  Please stay tuned for more updates that will announce the dates and locations of those events.  In those meetings, we will be updating stakeholders on the work discussed above and inviting feedback from the community.

The Department is also engaged in biweekly calls with the Centers for Medicare & Medicaid Services (CMS).  The meetings are currently focused on the development of the 1115 waiver demonstration application.  The Department is working with CMS to prepare for the implementation, monitoring and evaluation components of the waiver process.  Additional information about CMS requirements and guidance is available here. 

In addition to its engagement with CMS, the Department is working with the State of Colorado Office of Behavioral Health to map the current system of SUD treatment providers and to assess the capacity of those providers.  While the 1115 waiver provides a funding opportunity for inpatient and residential treatment services, the focus of the initiative is broader in that it asks states to examine their existing SUD services across the continuum.  The waiver process requires that states demonstrate that provider qualifications, patient placement criteria and use of evidence-based practices in treatment programs meet nationally recognized standards.  Additionally, the Department will be examining the availability of care coordination and transition services throughout the state.

Additional Information

• Inpatient and Residential Benefit for SUD Concept Paper
• SUD Stakeholder Meeting Summary October 26, 2018
• SUD Stakeholder Meeting Presentation October 26, 2018
• Letter Signed by Governor John Hickenlooper June 5, 2018
• Colorado Health Institute Report to the General Assembly November 2017
• Legislative Bill
• CMS 115 SUD Demonstrations

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