Ensuring a Full Continuum of SUD Benefits (Unpublished) | Colorado Department of Health Care Policy & Financing

Provider Network Map

IMPORTANT UPDATES: Resources on Residential, Inpatient and Withdrawal Management Services

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CMS-Approval Documents and Reports

Colorado SUD Implementation Plan Approval and CMS
CMS Letter of Approval, Expenditure Authority, and the Special Terms and Conditions for 1115 SUD Demonstration Waiver

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.

April 2022 SUD Stakeholder Update

Quarterly SUD Provider Forum- Wednesday July 6, 2022 @ 2 p.m.

This quarterly SUD forum is open to providers and other stakeholders who would like to learn more about issues SUD providers are facing and initiatives designed to increase access to SUD services. Registration for this online Zoom forum is required and most easily be reached by going to the SUD webpage. Suggestions for future agenda topics are encouraged. Please email hcpf_sudbenefits@state.co.us with suggestions.

Webpage Makeover

The HCPF webpage titled "Ensuring a Full Continuum of SUD Benefits" is being updated. Some changes have already been made and more are on the way! We have added an interactive SUD Provider Network Map displaying locations of all SUD providers enrolled with Health First Colorado including address, ASAM Levels of Care the facility is licensed to provide, Facility Bed Capacity and the MCEs that the provider is currently contracted with. We are continuing to add more user friendly content and guidance and welcome suggestions about things you would like to see on the webpage. Please email hcpf_sudbenefits@state.co.us with ideas.

Update to the SUD Provider Manual

The SUD provider manual has been updated. This resource is designed to provide an overview of processes SUD providers (facilities and individuals) should be familiar with and links to additional resources for more detailed steps and most current versions of forms and tools.

Review: Residential and Inpatient Authorization processes and timelines

A guidance document has been posted on the webpage providing a review of how authorization processes for residential and inpatient treatment including a review of facility bed days are counted and examples of making determination for when continued or concurrent authorization should be sought. The following link will take you to the guidance document Residential and Inpatient Authorization.

2022 Updates

March 2022 SUD Stakeholder Update

Quarterly SUD Provider Forum- Wednesday April 6, 2022 @ 2 p.m.

Suggestions for future agenda topics are encouraged. Please email hcpf_sudbenefits@state.co.us with suggestions.

Topics for the April forum include:

-Counting Bed Days- Understanding when to submit Continuing Authorization or Concurrent Authorization requests
-Facility Bed Counts- what to count, why it matters, how to correct errors
-Provider Network Map- Information about map and data displayed
-Involuntary Commitment- Questions/Concerns about guidance
-Debunking Medicaid Myths- Medicaid does not require members to go to detox to enter a residential program and more
-Open for Questions

Quarterly Utilization Management Report posted

In accordance with HB21-137, data is collected from all MCEs quarterly and compiled into a utilization management report. The report for the third quarter of demonstration year one (covering the time period from July 1, 2021- Sept. 30, 2021) will be posted on April 1, 2022. This quarterly report and all previous quarterly reports are on the Regulatory Resource Center and a link to this page is on our webpage.

Webpage Makeover

The HCPF webpage titled Ensuring a Full Continuum of SUD Benefits is being updated. As of April 1, 2022, there will be a new look for the Provider Network list and there will be a new and interactive SUD Provider Network Map that displays the locations of all SUD providers enrolled with Health First Colorado displaying address, ASAM Levels of Care the facility is Licensed to provide, Facility Bed Capacity and the MCEs that the provider is currently contracted with. We are continuing to add more user friendly content and guidance and welcome suggestions about things you would like to see on the webpage. Please email hcpf_sudbenefits@state.co.us with ideas.

February 2022 SUD Stakeholder Update

As HCPF continues to work with the RAEs to support expansion of provider networks we ask that all providers ensure that their Medicaid enrollments are up to date. Please verify that you are enrolled for each specialty type (specialty types are the term for each ASAM level of care) that you are licensed to provide. Also, please ensure that your FACILITY level (based on unique street address location) correctly reflects the number of SUD treatment beds you have at that location. If you find that any of this information is outdated please update by completing a maintenance request. The link to complete a maintenance request is here. https://hcpf.colorado.gov/prov-maintenance

If you are new to providing services to Medicaid members please be sure to complete your initial enrollment here. https://hcpf.colorado.gov/provider-enrollment

HCPF will be posting a map of all providers on the SUD Webpage. This map will show the number of beds and ASAM levels of care the provider is enrolled for with Medicaid as well as displaying each provider location and indicate which RAEs the provider is working with.

Reminder:

Effective January 2022 standard pre-authorization timeframes for each residential ASAM level of care went into effect.

ASAM Level Initial Auth Timeframe

3.1, 3.3, 3.5: 14 days minimum

3.7: 7 days minimum

3.2WM: 5 days minimum before concurrent auth

3.7WM: 4 days minimum before concurrent auth

Reminder:

The SUD Provider Forum is hosted on Zoom and requires participants to register to attend. Meetings are quarterly on the first Wednesday of the month from 2:00 - 3:00pm. Meeting schedule and registration links for 2022 are below:

April 6th 2:00 - 3:00 pm

July 6th 2:00 - 3:00 pm Zoom Registration

October 5th 2:00 - 3:00 pm Zoom Registration

Reasonable accommodations will be provided upon request for persons with disabilities. Please notify the Department 504/ADA Coordinator, Emelie Esquivel, at hcpf504ada@state.co.us at least one week before the meeting to make arrangements.

2021 Updates

SUD Stakeholder Update - October/November 2021

SUD Provider Forum

Beginning in July, the Substance Use Disorder (SUD) Provider Forum transitioned to focus on implementation of legislative requirements outlined in SB 21-137. The Department was required to address some components of the legislation by Oct 1st, including drafting a quarterly report of Utilization Management metrics. The first report was made available on October 1, 2021.

The SUD Provider Forum is hosted on Zoom and requires participants to register to attend. Meetings will now be quarterly on the first Wednesday of the month from 2:00 - 3:00pm. Upcoming meeting information is as follows:

January 5th 2:00 - 3:00 pm

April 6th 2:00 - 3:00 pm

July 6th 2:00 - 3:00 pm

October 5th 2:00 - 3:00 pm

Reasonable accommodations will be provided upon request for persons with disabilities. Please notify the Department 504/ADA Coordinator, Emelie Esquivel, at hcpf504ada@state.co.us at least one week before the meeting to make arrangements.

Standardized Authorization Form

In accordance with requirements of SB 21-137, a single authorization form has been developed for use across all RAEs. This form is used for both prior and continued stay authorizations. Beginning December 1, 2021 this new standard authorization form will replace any previous version you may be using. If you have questions or comments regarding use of this new form please contact Jennifer Holcomb at jennifer.holcomb@state.co.us

Reminder: Bed Count Updates

Providers enrolled with Health First Colorado report their bed count numbers in their enrollment application to comply with federal reporting requirements. If there is a change in the number of beds at a provider location, please be sure to update the number of beds in the provider enrollment portal. Bed counts should reflect capacity without COVID-related capacity restrictions. Technical assistance for the portal is provided by Gainwell at the following telephone number: 1-(844)-235-2387.

Please reach out to hcpf_sudbenefits@state.co.us with any questions regarding this update.

August/September 2021 Update

SUD Provider Forums

Beginning in July, the Substance Use Disorder (SUD) Provider Forum transitioned to focus on implementation of legislative requirements outlined in SB 21-137. The Department was required to address some components of the legislation by Oct 1st, including drafting a quarterly report of Utilization Management metrics. This report will be posted on the Ensuring a Full Continuum of SUD Benefits website starting Oct 1, 2021for those who are interested.

October 6th 2:00 - 3:00pm

January 5th 2:00 - 3:00pm

Reasonable accommodations will be provided upon request for persons with disabilities. Please notify the Department 504/ADA Coordinator, Emelie Esquivel, at hcpf504ada@state.co.us or Victoria Laskey (victoria.laskey@state.co.us) at least one week before the meeting to make arrangements.

Recovering Out Loud with Tough as a Mother

When we recover loudly, we keep other mothers from struggling in silence.

Please join Tough as a Mother in celebrating National Recovery Month. We are elevating and honoring the stories of tough moms across Colorado who are recovering loudly, so that other moms don't have to struggle in silence. These stories remind us that people can, and do, recover every day. The following social media posts can be shared widely to help raise awareness and honor those who are recovering, wherever they are in their recovery journey. You can also visit our website to see more powerful stories from Tough Mothers across Colorado. Please encourage mothers in your community to tell their stories. Instructions for our easy-to-use platform can be found here.

Want to know more about Tough as a Mother’s history and founders? Click here to learn more about the campaign. Additional campaign materials and resources are available here.

Want to connect about the campaign? Contact us at outreach@toughasamother.org.

SUD Provider Network List

In collaboration with our Regional Accountable Entities (RAE) partners, the Colorado Department of Health Care Policy & Financing (Department) has published a Substance Use Disorder (SUD) Provider Network List. The list includes all residential and inpatient SUD treatment providers who are contracted with RAEs to provide SUD services. This list continues to be updated regularly and made available on the Department’s SUD webpage, Ensuring a Full Continuum of SUD Benefits under "IMPORTANT UPDATES." The list is available in two formats:

A Microsoft Excel spreadsheet that allows filtering of SUD providers by provider name, location, level of care provided, contracted RAEs, etc. (note: when opening the Excel spreadsheet, please select “Read Only.”) A print friendly PDF with SUD provider information formatted as a table

Providers enrolled with Health First Colorado report their bed count numbers in their enrollment application to comply with federal reporting requirements. If there is a change in the number of beds at a provider location, please be sure to update the number of beds in the provider enrollment portal. Bed counts should reflect capacity without COVID-related capacity restrictions. Technical assistance for the portal is provided by Gainwell at the following telephone number: 1-(844)-235-2387.

Please reach out to hcpf_sudbenefits@state.co.us with any questions regarding this update.

Reminder: Bed Count Updates

June/July 2021 Update

1115 SUD Demonstration Budget Neutrality Update

The Department of Health Care Policy & Financing is updating the budget neutrality calculations for the 1115 Substance Use Disorder (SUD) Demonstration. The updated calculations will reflect the changes in bed capacity and reimbursement rates. The increased capacity represents improved access to inpatient SUD services for Medicaid members ages 21 and under. The Department does not anticipate a significant policy or operational impact from the updated calculations. Stakeholders and the public are invited to provide feedback and comments regarding this change.

Comment Submission Page

SUD Provider Forum Update

In light of the recent passage of SB21-137 , the Department has decided to repurpose our bimonthly SUD Provider Forum meetings to address the mandates in this legislation. Providers are encouraged to reach out to the Regional Accountable Entity(ies) they work with for technical assistance. We will cancel the July 7th meeting and send out a detailed agenda/project plan for subsequent meetings to help organize our time and meet the deadlines called out in the bill. A summary of key tasks can be found below.

1) On or before October 1, 2021, the state Department shall consult with the Office of Behavioral Health in the Department of Human Services, residential treatment providers, and MCEs to develop standardized utilization management processes to determine medical necessity for residential and inpatient substance use disorder treatment.

2) Beginning October 1,2021, and quarterly thereafter, the state Department shall collaborate with the Office of Behavioral Health in the Department of Human Services, residential treatment providers, and MCEs to develop a report on the residential and inpatient substance use disorder utilization management statistics.

3) On or before January 1,2022, the state Department shall incorporate the standards developed pursuant to subsection (1) of this section into existing MCE contracts,

4) On or before January 1, 2022, each MCE's notice of an adverse benefit determination must demonstrate how each dimension of the most recent edition of "the ASAM criteria for addictive, substance-related, and co-occurring conditions" was considered when determining medical necessity.

5) No later than July 1, 2022, the state Department shall contract with an independent third-party vendor to audit thirty-three percent of all denials of authorization for inpatient and residential substance use disorder treatment for each MCE.

6) Beginning December 1, 2022, and each December 1 thereafter, the state Department shall submit the results of the audit conducted

7) No later than July 1, 2023, the state Department shall contract with one or more independent review organizations to conduct external medical reviews requested for review by a Medicaid provider when there is a denial or reduction for residential or inpatient substance use disorder treatment and Medicaid appeals processes have been exhausted.

The SUD Provider Forum is open to residential SUD providers, the Office of Behavioral Health, Regional Accountable Entities, and Managed Care Service Organizations. Please register in advance using the Zoom registration links for each date.

The Forums are scheduled as follows:

July 21st from 2:00 - 3:00 p.m.

August 4th from 2:00 - 3:00 p.m.

August 18th from 2:00 - 3:00 p.m.

September 1st 2:00 - 3:00 p.m.

RAE Network List Update

The June update to the RAE SUD Network List can be found on the Ensuring a Full Continuum of SUD Benefits web page. The list is available in two formats:

May 2021 Update

SUD Provider Network List

In collaboration with our Regional Accountable Entities (RAE) partners, the Colorado Department of Health Care Policy & Financing (Department) has published a Substance Use Disorder (SUD) Provider Network List. The list includes all residential and inpatient SUD treatment providers who are contracted with RAEs to provide SUD services. Due to ongoing contracting and credentialing, this list will be updated periodically and made available on the Department’s SUD webpage, Ensuring a Full Continuum of SUD Benefits under "IMPORTANT UPDATES." The list is available in two formats:

The Department is seeking candidates for employment opportunities in Behavioral Health. You can find current and upcoming positions can be found on the State of Colorado Job Opportunities Website. For additional information or questions regarding these positions, please contact Susanna Snyder or Melissa Eddleman through the SUD team.

SUD Provider Forums - Version Two

Thank you to SUD treatment providers and community partners who attended previous SUD Provider Forums. The Department has been hosting these in collaboration with the RAEs, Managed Services Organizations, and the Office of Behavioral Health (OBH) as a primarily "open forum" for issues that arose during early implementation. As we move into full operation of the benefit, we are redesigning these meetings. These will now be a partnership between the Department and OBH to host issue focused forums on SUD services in the state. We have cancelled our May 5th meeting to build out our future format but will begin on May 19th.

The Forums are scheduled as follows:

FIRST Wednesday of the month 2:00 - 3:00 p.m. Meeting link: meet.google.com/ypv-vtau-kfp Call-in number: (419) 812-2582 PIN: 931 626 035#	THIRD Wednesday of the month 2:00 - 3:00 p.m. Meeting link: meet.google.com/jsw-mjwf-khk Call-in number: (916) 836-2601 PIN: 951 467 943#
May 5th - Cancelled	May 19th
June 2nd - Cancelled	June 16th
July 7th	July 21st
August 4th	August 18th
September 1st	September 15th
October 6th	October 20th
November 3rd	November 17th
December 1st	December 15th

If you have questions or require additional information regarding the SUD Provider Forum, please contact Shingo Ishida.

Employment Opportunities in Behavioral Health at the Department

March 2021 Update

Provider Support - SUD Provider Forum

Thank you to all SUD treatment providers who attended previous Provider Office Hour sessions hosted by the Colorado Department of Health Care Policy and Financing, in collaboration with its partners at Regional Accountable Entities, Managed Services Organizations, and the Office of Behavioral Health at the Colorado Department of Human Services. The Department is pleased to announce that additional sessions - now called SUD Provider Forums - have been scheduled through the end of May. These Forum sessions will focus on topics of interest for providers based on responses collected from a recent Department survey.

The Forums are scheduled 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#

April 7, 2:00 - 3:00 p.m.

April 21, 2:00 - 3:00 p.m.

May 5, 2:00 - 3:00 p.m.

May 19, 2:00 - 3:00 p.m.

If you are a treatment provider and have questions or require additional information regarding the SUD Provider Forum, please contact Shingo Ishida.

Department welcomes feedback and questions on SUD benefit

The Department continues to monitor and actively refine processes relating to the SUD benefit expansion since its implementation on 1 January. We welcome question and comments regarding the benefit expansion, please contact the SUD team.

February 2021 Update

SUD Residential and Inpatient Benefit now open

Provider Support

The Colorado Department of Health Care Policy and Financing is actively refining processes related to the benefit and welcomes stakeholder feedback to make improvements. Please reach out with any questions to the SUD team at hcpf_sudbenefits@state.co.us. In addition to the support RAEs are providing to treatment providers, the Department is holding Provider Office Hours twice per month, on the first and third Wednesdays. Provider Office Hour dates, meeting link and call-in information are as follows, please bookmark this webpage for any updates.

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.
March3, 2:00 - 3:00 p.m.	March 17, 2:00 - 3:00 p.m

MAT Toolkit

The Centers for Medicare and Medicaid (CMS) Services requires that all providers receiving Medicaid reimbursement for residential and inpatient SUD services offer Medication Assisted Treatment (MAT) onsite or facilitate access to MAT offsite. The Department has partnered with the Office of Behavioral Health (OBH) at the Colorado Department of Human Services to develop a MAT Toolkit for providers incorporating MAT into their programs.

January 2021 Update

SUD Residential and Inpatient Benefit now open

On January 1, 2021, coverage for residential and inpatient substance use disorder (SUD) services became available to Medicaid members in Colorado. We continue to enroll providers, and the Regional Accountable Entities (RAEs) are contracting with treatment providers across all available levels of care. Since January 1, RAEs have approved over 208 authorizations for services, which include over 1,712 authorized days of treatment. The RAEs are working closely with providers to help them learn the authorization process.

Provider Support

The Colorado Department of Health Care Policy and Financing is actively refining processes related to the benefit and welcomes stakeholder feedback to make improvements. Please reach out with any questions to the SUD team at hcpf_sudbenefits@state.co.us. In addition to the support RAEs are providing to treatment providers, the Department is holding Provider Office Hours twice per month, on the first and third Wednesdays. Provider Office Hour dates, meeting link and call-in information are as follows, please bookmark this webpage for any updates.

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.
March3, 2:00 - 3:00 p.m.	March 17, 2:00 - 3:00 p.m.

PROVIDER ACTION NEEDED: Provider Bed Count Data Collection

In order to update rates for the SUD benefit for the coming year, the Department has begun the rate setting process. Obtaining accurate counts of the number of SUD treatment and withdrawal management beds across the state is a critical component of rate setting. The Department is requesting provider assistance in updating bed counts at each facility. Victoria Laskey reached out to all providers in January to request updated information on program capacity. If you have not completed the survey for your program, please complete the survey.

MAT Toolkit

The Centers for Medicare and Medicaid (CMS) Services requires that all providers receiving Medicaid reimbursement for residential and inpatient SUD services offer Medication Assisted Treatment (MAT) onsite or facilitate access to MAT offsite. The Department has partnered with the Office of Behavioral Health (OBH) at the Colorado Department of Human Services to develop a MAT Toolkit for providers incorporating MAT into their programs.

Regional Meetings

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Fairplay
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Golden
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Denver
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Alamosa
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Pueblo
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Colorado Springs
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Durango
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Fort Collins
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Hugo
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Fort Morgan
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Steamboat Springs
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