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.

September 2020 Update

Coming soon: Residential SUD Provider Manual and revisions to Coding Standards

The Department will soon make available a new Residential SUD Provider Manual, which will cover: 

member eligibility, provider requirements, provider enrollment procedures, SUD benefit policies, and the roles of MSOs and RAEs in benefit management. Additionally, the upcoming revision of the Uniform Service Coding Standards Manual will include pages outlining the new SUD residential and inpatient treatment and withdrawal management services that will be billable starting in January 2021.


Information for Providers

New SUD licensure rules

The State Board of Human Services adopted new licensure rules for Substance Use Disorder Treatment Providers, which will align Office of Behavioral Health licensing standards more closely with the American Society of Addiction Medicine (ASAM) Criteria.  Visit the Colorado Department of Human Services webpage and expand the “Laws & Rules Updates” menu for additional information regarding the new SUD licensure rules.  Providers seeking Medicaid reimbursement for SUD services must be licensed according to the newly adopted rules.

Residential SUD Provider Training - October 22 and 29  (Please Register)
The Department will host two training sessions focusing on the upcoming residential and inpatient SUD service benefit. Two sessions, both covering the same content, will be offered on Thursday, October 22, 2020, 1:00-5:00 and Thursday, October 29, 2020, 9:00-1:00. The training will cover topics including: an overview of the SUD benefit expansion, enrollment with Health First Colorado as a residential/inpatient SUD treatment provider, billing procedures for the new services, ASAM Criteria documentation of medical necessity, utilization management, provider licensure requirements, and content provided by RAEs and MSOs for treatment providers. Click here to register for the training, and visit the Department’s SUD webpage, Ensuring a Full Continuum of SUD Benefits, for additional information. 

Reminder for providers: contact your RAEs and MSOs
The Department strongly encourages treatment providers to contact Regional Accountable Entities (RAEs) and Managed Services Organizations (MSOs) to ensure contracting and credentialing processes are in place before the Substance Use Disorder (SUD) residential/inpatient benefit is in place on January 1, 2021. Providers must be contracted with RAEs to receive Medicaid reimbursement for residential and inpatient SUD services, and with MSOs, which oversee the reimbursement process for SUD room and board charges.