Ensuring Full Continuum SUD Benefits

Substance Use Disorder Services

The Department of Health Care Policy and Financing (the Department) is committed to better health outcomes for the whole person by offering a full range of healthcare services for Health First Colorado (Colorado’s Medicaid program) members. Health First Colorado members get physical health and dental services and are also eligible for behavioral health services, which include substance use disorder (SUD) treatment. Behavioral health services including SUD treatment are available to all members without the need for a referral or copay. Health First Colorado members can find SUD benefit information in the member handbook. Providers looking for more information about offering SUD services can go to the SUD provider page.

The current SUD benefit ensures a full continuum of care as outlined by The American Society of Addiction Medicine (ASAM). ASAM establishes guidelines for what services are available at each level of care. It’s also a uniformed approach to identifying the most appropriate level of care for a member based on their individual needs. The ASAM criteria is a nationally recognized, evidence-based system that guides clinicians with matching patient needs to specific levels of care.

Colorado uses ASAM Criteria to determine Level of Care placement for members. Office of Behavioral Health provider licensing rules align with the ASAM criteria descriptions of each level of care.

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ASAM Level of Care Criteria for Adults

 

Prevention .5 Early Intervention
Level 1 1 Outpatient Services
Level 2 

2.1 Intensive Outpatient Services
2.5 Partial Hospitalization Services

Level 3

3.1 Clinically Managed Low-Intensity Services
3.3 Clinically Managed Population Specific High-Intensity Residential Services
3.5 Clinically Managed High-Intensity Residential Services
3.7 Medically Monitored Intensive Inpatient Services

Level 4 4 Medically Managed Intensive Inpatient Services
ASAM Level of Care Criteria for Adolescents

 

Prevention .5 Early Intervention
Level 1 1 Outpatient Services
Level 2 

2.1 Intensive Outpatient Services
2.5 Partial Hospitalization Services

Level 3

3.1 Clinically Managed Low-Intensity Services
3.5 Clinically Managed High-Intensity Residential Services
3.7 Medically Monitored Intensive Inpatient Services

Level 4 4 Medically Managed Intensive Inpatient Services

Services ranging from screening and harm reduction to outpatient, intensive outpatient and medication-assisted treatment services to withdrawal management (also known as) "detox" to both residential and hospital inpatient services, are all available treatment options for members. Providers work to find the right level of care that meets the member’s specific needs.

SUD Providers Map

SUD Residential Care in Colorado

Providers are included on the SUD Residential Services Map searchable by level of ASAM care or region, they meet the following criteria:

  • Licensed to provide care at a specific ASAM level and
  • Enrolled as Health First Providers at that ASAM level
  • The Department maintains a full list of SUD providers enrolled in Health First Colorado and contracted with the MCEs.

In addition, the map includes information about which MCEs a provider is contracted with to provide services to members from that region.

 

Take Note/Learn More

Upcoming Forums

The second annual SUD stakeholder forum will be held in October via Zoom and requires participants to register to attend. Rather than one single event, the Department will offer four times to fit our stakeholders’ schedules. Below are the options to choose from and registration links.

During the annual forum, we will review the Annual Report for Demonstration Year 1 and update the community about the 1115 Waiver “Expanding the Substance Use Disorder Continuum of Care”. Participants will be able to have questions answered about how the benefit expansion works, and they can share ideas about community needs in the SUD space.

CMS 1115 Waiver Documents

CMS 1115 Waiver Reports

State Legislative Requirements and Reporting

Resources

 

SUD Newsletter Library

Archives

 

Stay Informed

We encourage you to sign up for SUD Benefits updates.

Ask a question or make a suggestion: hcpf_sudbenefits@state.co.us