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IMPORTANT UPDATES: New Resources on Residential, Inpatient and Withdrawal Management Services
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.
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:
Ensure their National Provider Identifier (NPI) is updated. For information, visit the Provider Web Portal Quick Guide: Provider Maintenance - Adding a National Provider Identifier (NPI)
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
PIN: 637 989 890#
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:
Using this Question Submission Form, or
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#
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).
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.
Information for Providers:
Guidance for Residential and Inpatient Substance Use Disorder (SUD) Treatment: Provider Reimbursement for Medicaid effective on January 1, 2021
The Accountable Care Collaborative (ACC) is the primary vehicle for delivering health care to Health First Colorado (Colorado's Medicaid program) members. To prepare members, providers, and stakeholders for the launch of these new SUD services, the Department will be sending out weekly communications with updated guidance and other information.
The Department has developed the following guidance for inpatient and residential SUD providers to facilitate a smooth transition to Health First Colorado reimbursement for Health First Colorado members already in residential or inpatient treatment when the new benefit begins on Jan. 1, 2021.
SUD residential treatment providers are asked to do the following:
Enroll as a provider with Health First Colorado.
Visit the Provider Enrollment webpage for more information about provider types.
Discuss with each RAE opportunities for establishing a contracting arrangement.
Generate a list of Health First Colorado members in treatment as of Dec. 11, 2020, using the Department's template. The list must contain the following information:
Health First Colorado ID
Treatment Provider (indicate whether Special Connections provider)
Date of Admission
Anticipated Date of Discharge
Contact information for provider staff person
Submit the member information from the numbered list above to the Managed Service Organizations by Dec. 14, 2020.
Coordinate with the individual RAEs as they reach out to discuss treatment plans, support transitions to community-based services for appropriate members, and arrange for stays that will extend beyond Jan. 1 to be reviewed for continued stay authorizations.
Beginning Dec. 28, 2020, submit continued stay authorization requests to the RAEs for all Health First Colorado members who will remain in inpatient or residential SUD treatment after Dec. 31, 2020.
All continued stay authorization requests must be received by the RAEs by Jan. 15, 2021, for members who began inpatient or residential SUD treatment prior to Jan. 1, 2021. Failure to submit continued stay authorization requests by Jan. 15, 2021, will jeopardize a provider’s ability to receive reimbursement back to Jan. 1, 2021, for eligible members.
Providers must be enrolled with Health First Colorado in order to be eligible for reimbursement for services provided to Health First Colorado members. Additional information will be posted within the next week to better support providers during this transition.
Approved: 1115 Substance Use Disorder (SUD) Demonstration
The Colorado Department of Health Care Policy and Financing is pleased to announce that on November 13, 2020 the Centers for Medicare and Medicaid Services (CMS) provided approval of Colorado’s Section 1115 SUD demonstration, titled “Expanding the Substance Use Disorder Continuum of Care.” You will find CMS Administrator Seema Verma's letter of approval, expenditure authority, and the Special Terms and Conditions for the demonstration above.
SUD Provider Manual
The Residential SUD Provider Manual is now available. The manual covers: member eligibility, provider requirements, provider enrollment procedures, SUD benefit policies, the roles of MSOs and RAEs in benefit management and coding pages for the new services. The document can be found below under the 'Additional Information' drop down. Additionally, the upcoming revision of the Uniform Service Coding Standards Manual released in January 2021 will include the coding pages outlining the new SUD residential and inpatient treatment and withdrawal management services that are found in the SUD Provider Manual.
The Department, in collaboration with the RAEs, MSOs, and OBH, hosted two provider-centered trainings on October 22 and 29 covering topics related to the implementation of the SUD benefit expansion. Recordings of the October 29 session will be posted on the Department’s SUD web page, Ensuring a Full Continuum of SUD Benefits, and can be found at the links below. The recordings are divided into three sections to make it easier to locate the content you are interested in. You can find the training here:
Part 1: Training Overview, SUD Benefit: Current and Future, ASAM Criteria and Medical Necessity, Utilization ManagementPart 2: Provider Requirements, OBH SUD Provider Licensure, Medicaid Provider Enrollment, RAE PresentationPart 3: MSO Presentation, Coding and Billing Procedures, Facilitation of Medication Assisted Treatment
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 treatment and withdrawal management services. In order to receive reimbursement for room and board, residential providers must also contract with the MSOs.
Provider Enrollment - Enrollment portal for the new SUD benefit available November 5
In order to bill for residential SUD treatment services starting January 1, residential providers will need to be enrolled with Health First Colorado as an SUD Clinic (Provider Type 64) and each specialty provider type associated with the ASAM level(s) of care for which they are licensed. As of November 5, providers are able to enroll as the new specialty types in the provider web portal. The codes by ASAM level are as follows:
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 MSOsThe 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.
Federal Authorities for expanded SUD service continuum
The Department is actively engaged with the Centers for Medicare and Medicaid Services (CMS) in discussions pertaining to the three federal authorities which apply to the SUD treatment benefits: the 1115 SUD demonstration waiver application, Medicaid State Plan amendments (SPA) and the 1915(b)(3) waiver. Progress toward approvals are currently on track for a January 2021 benefit expansion.
Preparation for benefit implementation
Rate Development for the SUD residential benefit portion of the Behavioral Health Capitation will be complete in September. System changes to allow for billing of new services in 2021 are underway and the provider portal will open for enrollment this Fall. Rule changes to reflect coverage of residential and inpatient SUD services are in process. The Department is also developing plans for monitoring the utilization of SUD services and evaluating their effectiveness.
Contact RAEs and MSOs
In order to receive Medicaid reimbursement for residential and inpatient SUD services in Colorado, providers must be contracted and credentialed with the Regional Accountable Entities (RAEs). The Department encourages treatment providers to contact the RAEs and Managed Services Organizations (MSOs) to initiate contracting at this time if they have not already done so. MSOs will oversee the reimbursement process for room and board charges associated with SUD services.
Resources and training opportunities for treatment providersProgram staff are finalizing a Provider Manual and revising the Uniform Service Coding Standards Manual to include coding pages for the new SUD residential and inpatient services that will be billable in 2021. The Department and RAEs will also be offering training opportunities for providers this Fall. These trainings will include information on how to enroll with Health First Colorado as a residential/inpatient SUD provider, how to bill for the new services, how to use the ASAM Criteria to document medical necessity and other topics. Please watch this space for announcements about upcoming training.
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.
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 #3Registration 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 email@example.com for additional information. Many thanks to the Colorado Office of Behavioral Health and Signal for collaborating with the Department to make this training available.
Federal Authority Approval
The Department continues to work with CMS toward obtaining federal approvals for coverage of residential and inpatient SUD services. Staff are working toward approval of the 1115 waiver, a state plan amendment (SPA) and the 1915(b)(3) waiver. All three authorities apply to the new services.
Collaboration with RAEs, MSOs and OBH
The Department continues its collaboration with the Regional Accountable Entities, Managed Service Organizations and the Colorado Office of Behavioral Health to prepare for the implementation of the new service coverage. The focus of recent collaboration has included discussion of utilization management and the transition of the Special Connections program to the RAEs. The Department will continue its planning with particular attention on serving individuals with co-occurring disorders and planning for the introduction of medical withdrawal management to the SUD benefit.
ASAM Training - Components #2 and #3 available in July
Starting next month, the second and third components of the free, one-time online American Society of Addiction Medicine (ASAM) training are scheduled to become available to treatment providers who successfully completed the first component. These components will benefit providers learning (or refreshing their knowledge of) the ASAM criteria, which will be utilized as the basis for managing SUD benefits covered by Health First Colorado starting in January 2021. The Colorado Department of Health Care Policy & Financing gratefully acknowledges the Colorado Office of Behavioral Health and Signal Behavioral Health Network for making this training available. If you have questions about the training, please contact Heather Dolan at firstname.lastname@example.org.
SUD Implementation Plan update
Program staff continue to collaborate with the Centers for Medicaid and Medicare Services (CMS) on the SUD waiver Implementation Plan. The Department submitted the draft Implementation Plan per CMS requirements and is currently awaiting additional guidance on the document from CMS. Program staff are also focusing efforts on creating and developing other waiver application components, such as the Health IT Plan and Monitoring Protocol.
Capacity Assessment and Expansion Plan
The Department and Capacity Expansion Plan Work Group is concluding its analysis of SUD treatment provider capacity across the state. In addition, plans for expanding capacity where needed are in development. This plan will highlight how available resources can be utilized to support and incentivize expansion where needed. While expansion of the provider network will be necessary to meet the expected demand for SUD services, the workgroup acknowledges that the current COVID-19 crisis presents a number of challenges to that process. The Department continues to assess the changing landscape for treatment providers.
Coming soon: MAT information for treatment providers, partners and stakeholders
Medicaid coverage for residential and inpatient services requires that providers facilitate access to MAT for its patients. In order to support providers in arranging for access, the Department’s program staff are developing a Medication Assisted Treatment (MAT) Toolkit. Stay tuned to future SUD Updates for this information.
Now available: Frequently Asked Questions about new SUD benefit expansion
A list of frequently asked questions (FAQ) regarding the Department’s SUD benefit expansion is now available.
Update on ASAM training for providers
In previous Substance Use Disorder (SUD) Updates, treatment providers were encouraged to acquaint, or reacquaint, their staff with the American Society of Addiction Medicine (ASAM) criteria, which will be utilized as the basis for the management of SUD benefits covered by Health First Colorado. As of this month, 260 individuals registered for the ASAM training. About one-half of registrants have completed the first training component. Components #2 and 3 will be offered in June. The Colorado Department of Health Care Policy & Financing gratefully acknowledges the cooperation and assistance from the Colorado Office of Behavioral Health and Signal Behavioral Health Network in making this free, one-time ASAM training available to providers.
In upcoming newsletters, we will be highlighting information relevant to SUD providers that plan to offer residential and inpatient SUD services in Colorado through Medicaid funding. Information on enrollment with the Department and billing and coding information will be featured along with other important information about the new service coverage. Please look for this feature in upcoming SUD updates and newsletters.
RAE CommunicationAt this time, we encourage providers interested in receiving Medicaid reimbursement for residential and inpatient SUD treatment and withdrawal management services to reach out to the Regional Accountable Entities (RAEs) and Managed Service Organizations (MSOs) to discuss the credentialing and contracting process. Contact information for each RAE can be found on the Department’s Accountable Care Collaborative Phase II webpage. Providers may choose to contact their local RAE or other RAEs throughout the state if they plan to serve populations state-wide. Please visit this webpage for MSO contact information. The MSOs contract with providers to serve the non-Medicaid, indigent population in Colorado. Providers receiving Medicaid funding for residential SUD services will need to contract with RAEs to receive payment for treatment services and MSOs to receive payment for room and board cost associated with those stays.
ASAM alignment and trainingProviders are also encouraged to acquaint, or reacquaint, their staff with the American Society of Addiction Medicine (ASAM) criteria. ASAM criteria will be utilized as the basis for the management of SUD benefits covered by Health First Colorado. Additionally, it is the foundation for the state’s SUD treatment program licensure rules. The Colorado Office of Behavioral Health (OBH) is in the process of aligning its licensure rules more closely with the ASAM criteria. Residential and inpatient providers are encouraged to review the ASAM criteria and consider how their programs are aligned with the criteria in anticipation of licensure changes. Provider agencies should also ensure that relevant staff are trained in the ASAM criteria. OBH partnered with Signal Behavioral Health to make ASAM training available at no cost for a limited number of staff in provider agencies. As of February, over 150 participants across the state have been registered in trainings. Training components #2 and #3 are scheduled to be offered in March. Providers are encouraged to enact plans to ensure that all staff needing ASAM training have completed relevant training by July 2020.
Prior to the opening of coverage for SUD residential and inpatient services, the state must receive approval from the Centers for Medicare and Medicaid Services (CMS) for three components that will authorize coverage for SUD services in residential and inpatient settings. Those authorities include the State Plan, 1115 waiver and 1915(b) waiver. Each item authorizes a component of the services or service delivery system. The State is engaged with CMS in discussion of each of those components and is working toward obtaining approval for all components in advance of the target benefit opening date of July 2020.
To date, the Department has completed 9 of 11 Regional SUD Capacity Stakeholder Meetings, scheduled through March 2020. At these public meetings, the Department is presenting information on SUD treatment capacity, hearing from community members about the needs in the local area, as well as collecting input from the public regarding the new benefits for residential and inpatient SUD treatment and withdrawal management services. The Department’s data analytics unit also continues to develop maps to reflect supply and demand of SUD services across the state. After capacity assessment activities are concluded, a capacity expansion plan will be developed in conjunction with the Office of Behavioral Health, RAEs, MSOs and external consultants. This plan will document gaps in the SUD service continuum and propose plans for the use of existing resources to address deficiencies. Presentation slides for these meetings are available here. Meeting minutes including participant input and feedback will be made available in the near future.
Section 1115 Substance Use Disorder (SUD) Waiver Demonstration Application
The Colorado Department of Health Care Policy and Financing is engaged with the Centers for Medicare and Medicaid Services (CMS) in discussion about the content of the State’s proposed Section 1115 Substance Use Disorder (SUD) waiver demonstration application. The Department is also in the process of amending the Colorado State Plan to include residential and inpatient SUD treatment and withdrawal management services. Tribal notice for the State Plan modifications concluded on January 15, 2020. The Department will submit the draft amendments during January.
Regional Capacity Stakeholder Meetings
The Department continues its series of Regional Capacity Meetings during January and February 2020. At these public meetings, the Department will be presenting information on SUD treatment capacity and hearing from community members about the needs in that local area. The regional meetings serve as opportunities for the public to provide input and ask questions about the implementation of coverage for residential and inpatient SUD treatment and withdrawal management services. Attendees may register for the regional meeting of their choice via the RSVP links provided on this webpage.
SUD Implementation Workgroup
The Department convened the SUD Implementation Workgroup on January 15, 2020. The Implementation Workgroup, comprised of representatives from Regional Accountable Entities (RAEs), Managed Services Organizations (MSOs), Colorado Office of Behavioral Health, and Department staff, will address various issues (utilization management, care coordination, provider enrollment/billing, capacity development, provider training and support, etc.) that need to be addressed prior to the introduction in July 2020 of Medicaid coverage for new SUD treatment benefits.
DenverMeeting SummaryAlamosaMeeting Summary
Colorado SpringsMeeting Summary
Fort CollinsMeeting Summary
Fort MorganMeeting Summary
Steamboat SpringsMeeting Summary
Regional Stakeholder Meeting Presentation Slides
Presentation SlidesWebinar Recording (Presentation begins at the 7:00 minute mark)
Stay Informed We encourage you to sign up for updates on SUD Benefits.
QuestionsIf 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.