Ensuring a Full Continuum of SUD Benefits

Notice of Post Award Forum

Public comments on the progress of State of Colorado’s Section 1115 Substance Use Disorder (SUD) Demonstration 

Notice is hereby given that the Colorado Department of Health Care Policy & Financing (Department) is seeking public comments on the progress of the State of Colorado’s Medicaid Section 1115 Substance Use Disorder (SUD) Demonstration. The Department welcomes public comments on the progress of the state’s Section 1115 SUD Demonstration at the Post Award Forum, as follows. (Note: due to social distancing requirements in effect at time of this notice, only a virtual meeting option will be offered.)

Date/time: Thursday, May 20, 2021, 12:30 - 2:00 p.m.
Meeting link:  meet.google.com/dwn-xrwd-rzx
Call-in:   (240) 763-0081  PIN: ‪947 177 531#

Full notice for the Post Award Forum

Reasonable accommodations will be provided upon request for persons with disabilities. Please notify the Department 504/ADA Coordinator or Shingo Ishida at least one week before the event date to make arrangements.

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

CMS-Approval Documents and Reports

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 Stakeholder Update - May 2021

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: 

SUD Provider Forums - Version Two

Thank you to SUD treament 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 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

The Department is seeking candidates for employement 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.

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

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.

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.

December 28, 2020 Update

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.

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.

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.

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

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:

Using this Question Submission Form, or

Join one of the sessions listed below

Contract with their RAE(s).

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

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.

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)

December 21, 2020 Update

Information for Providers:

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.
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
 
Transition to Medicaid reimbursement for residential, inpatient and withdrawal management SUD providers on Jan. 1, 2021
 
To facilitate a smooth transition to Medicaid reimbursement for Health First Colorado members already in residential, inpatient or withdrawal management treatment on Jan. 1, 2021, the Department is asking providers to do the following:
  • Generate a list of Medicaid members in treatment as of Dec. 11, 2020 using the Department's template. The list must contain the following information:
    • Member Name.
    • Medicaid ID.
    • Treatment Provider (indicate whether Special Connections provider).
    • Date of Admission.
    • Anticipated Date of Discharge.
    • Contact information for provider staff person.
  • Submit the above list to the Managed Service Organizations (MSOs) by Dec. 14, 2020.
  • Contact a member's RAE directly as new Health First Colorado members enter treatment
  • Coordinate with Health First Colorado members' RAEs to discuss treatment plans, support transitions to community-based services for appropriate members and arrange for stays that will extend beyond Jan. 1.
  • Beginning Dec. 28, 2020, submit continued stay authorization requests to the RAEs for all Health First Colorado members that will remain in SUD treatment after Dec. 31, 2020.
    • All continued stay authorization requests must be received by the RAEs by Jan. 15, 2021for 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 Colorado Medicaid in order to be eligible for reimbursement from the RAEs for services provided to Medicaid members. RAEs will establish single case agreements with inpatient, residential, and withdrawal management SUD providers not contracted with a RAE for any members that initiated treatment prior to Jan. 1, 2021.
Providers should start this process immediately as it requires a manual approval process that may take several days. To assist providers with this process, the Department is offering specific SUD provider support hours staffed by both SUD staff and provider relations staff.
 
Wednesday, Dec. 16
12 p.m.- 1p.m.
Phone: 1-813-563-9519 PIN: 418 836 279#
Webinar Link - Completed
 
Friday, Dec. 18
12p.m.-1p.m.
Phone: 1-318-737-1603 PIN: 819 950 379#
Webinar Link - Completed
 
Tuesday, Dec. 22, 12 p.m. - 1 p.m.
Phone:1-347-352-9235 PIN: 235 340 502#
 
Wednesday, Dec. 30, 12 p.m. - 1 p.m.
Phone:1 413-338-0354 PIN: 637 989 890#
 
December 14, 2020 Update

Information for Providers:

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.
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.
 
Transition to Medicaid reimbursement for residential, inpatient and withdrawal management SUD providers on Jan. 1, 2021
 
To facilitate a smooth transition to Medicaid reimbursement for Health First Colorado members already in residential, inpatient or withdrawal management treatment on Jan. 1, 2021, the Department is asking providers to do the following:
  • Generate a list of Medicaid members in treatment as of Dec. 11, 2020 using the Department's template. The list must contain the following information:
    • Member Name.
    • Medicaid ID.
    • Treatment Provider (indicate whether Special Connections provider).
    • Date of Admission.
    • Anticipated Date of Discharge.
    • Contact information for provider staff person.
  • Submit the above list to the Managed Service Organizations (MSOs) by Dec. 14, 2020.
  • Contact a member's RAE directly as new Health First Colorado members enter treatment
  • Coordinate with Health First Colorado members' RAEs to discuss treatment plans, support transitions to community-based services for appropriate members and arrange for stays that will extend beyond Jan. 1.
  • Beginning Dec. 28, 2020, submit continued stay authorization requests to the RAEs for all Health First Colorado members that will remain in SUD treatment after Dec. 31, 2020.
    • All continued stay authorization requests must be received by the RAEs by Jan. 15, 2021for 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 Colorado Medicaid in order to be eligible for reimbursement from the RAEs for services provided to Medicaid members. RAEs will establish single case agreements with inpatient, residential, and withdrawal management SUD providers not contracted with a RAE for any members that initiated treatment prior to Jan. 1, 2021.
December 7, 2020 Update

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.
  • 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.
  • 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:
    • Discuss with each RAE opportunities for establishing a contracting arrangement.
    • Member name
    • 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.

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.

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.

October/November 2020 Update

Information for Providers

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.

Provider Training

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 Management
Part 2: Provider Requirements, OBH SUD Provider Licensure, Medicaid Provider Enrollment, RAE Presentation
Part 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:

ASAM Level Specialty Type
3.1 871
3.3 872
3.5 873
3.7 874
3.2WM 875
3.7WM 876
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 and 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. 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.

August 2020 Update

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.

Information for Providers

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 providers

Program 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.

July 2020 Update

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.

Information for Providers

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 #3

Registration 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 hdolan@signalbhn.org for additional information. Many thanks to the Colorado Office of Behavioral Health and Signal for collaborating with the Department to make this training available.

June 2020 Update

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.

Information for Providers:

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 hdolan@signalbhn.org.

May 2020 Update

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.

Information for Providers

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.

April 2020 Update
After careful consideration, the Department has delayed the implementation date for the Substance Use Disorder (SUD) benefit changes to January 2021. Please see below for a discussion of the decision from our Executive Director, Kim Bimestefer. For more updates on the benefit implementation, stay tuned to this space.
 
February 2020 Update

Information for PROVIDERS

OBH Licensure Rule Changes
 
The Office of Behavioral Health is revising its rules that apply to substance use disorder treatment programs. Providers are encouraged to review the proposed rules and consider their potential implications for service provision in the future. It will be helpful for providers to think about where their services fall relative to the proposed rules. Providers should consider whether they will continue to provide services at the level at which they are currently licensed, which will require that they meet new licensure requirements for that level of care, or consider relicensing at a different level of care. Providers should begin to plan for any adjustments to their program offerings to meet new requirements or develop a plan to seek licensure at a different level. Please note that these rules are not approved at this time, so providers are also encouraged to provide feedback to the Office of Behavioral Health and stay abreast of changes to the rule as feedback in incorporated prior to approval.
 
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 Communication

At 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 training

Providers 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.

Federal Approval Process Update

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.

SUD Capacity Assessment and Planning

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.

January 2020 Update

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.

Regional Capacity Stakeholder Meeting Summaries

Aurora/Centennial
Meeting Summary

Fairplay
Meeting Summary

Golden
Meeting Summary

Denver
Meeting Summary

Alamosa
Meeting Summary

Pueblo
Meeting Summary

Colorado Springs
Meeting Summary

Durango
Meeting Summary

Fort Collins
Meeting Summary

Hugo
Meeting Summary

Fort Morgan
Meeting Summary

Steamboat Springs
Meeting Summary

Regional Stakeholder Meeting Presentation Slides

Additional Information

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