Ke’Shawn Harper, MIS, GCPAP, CLC, QMHP

Update on Medicaid addiction and recovery treatment services (ARTS) Program
Ke’Shawn Harper, MIS, GCPAP, CLC, QMHP ARTS/Behavioral Health Senior Policy Specialist Virginia Department of Medical Assistance Services July 2018

Transforming the Delivery System of Medicaid SUD Services
ARTS 4/1/17 Inpatient Detox Residential Treatment Partial Hospitalization Intensive Outpatient Programs Opioid Treatment Program Office-Based Opioid Treatment Case Management Peer Recovery Supports All ARTS Services are Covered by Managed Care Plans A fully integrated Physical and Behavioral Health Continuum of Care Magellan will continue to cover community-based substance use disorder treatment services for fee-for-service members In 2015 close to 70% of members were served in managed care. With the implementation of MLTSS, this will close to 90% served in managed care. To fully integrate physical and behavioral health services for individuals with SUD and expand access to the full continuum of services, DMAS plans to “carve in” non-traditional SUD services into Managed Care for members who are already enrolled in plans. The only service currently covered by managed care is inpatient detoxification. Non-traditional services that will be “carved in” include Residential Treatment, Opioid Treatment (medication and counseling component), Substance Abuse Day Treatment, Crisis Intervention, Intensive Outpatient Treatment, and Substance Abuse Case Management. Magellan will continue to cover these services for those Medicaid members who are enrolled in FFS Effective April 1, 2017 except for Peer Supports which will be effective July 1, 2017. Providers will need to become enrolled and credentialed with the managed care plans beginning 4/1/17. Majority of members are covered by managed care and most when the Managed Long Term Services and Supports (MLTSS) is implemented. Effective July 1, 2017

ASAM Continuum of Care Main Levels of Care 1. Outpatient Counseling
2. Intensive Outpatient, Partial Hospitalization and WM 3. Residential Treatment continuum from medical model RTC/Inpatient Psych facility (3.7) to halfway house/group home (3.1) 4. Medically Managed Hospital Level of Care CMS is requiring an independent agent to complete the assessment for placement in RTC. MCOs and Magellan care coordinators will be the independent agent to review the provider assessment and request for residential treatment. Individuals have individualized treatment plan to receive person centered care and can transition between levels depending on their need.

Opioid Treatment Program (OTP) Office-Based Opioid Treatment (OBOT)
ASAM LOC Placement Setting 4 Medically Managed Intensive Inpatient Acute Care General Hospital - Inpatient Detox in Medical Beds 3.7 Medically Monitored Intensive Inpatient Services (Adult) Medically Monitored High-Intensity Inpatient Services (Adolescent) Inpatient Psychiatric Unit Freestanding Psychiatric Hospital Community-Based Facility 3.5 Clinically Managed High-Intensity Residential Services (Adults) / Medium Intensity (Adolescent) 3.3 Clinically Managed Population-Specific High-Intensity Residential Services (Adults) Community-Based Facility Licensed for SA Residential Treatment Services Specialty Unit in a Health Care Facility 3.1 Clinically Managed Low-Intensity Residential Services Mental Health and Substance Abuse Group Home Supervised Living Services for Adults 2.5 Partial Hospitalization Services 2.1 Intensive Outpatient Services Licensed Program at a Health Care Facility or Community Provider 1 Outpatient Services 0.5 Early Intervention Emergency Departments, Primary Care Clinics, FQHCs, CSBs, Health Departments, Pharmacies, etc. Opioid Treatment Program (OTP) Public and Private Methadone Clinics Office-Based Opioid Treatment (OBOT) CSBs, FQHCs, Outpatient Clinics, Physician’s Offices Providers not only need to meet the DBHDS licensing requirements, but also ensure that the ASAM criteria for placement is being applied appropriately.

Covered Services ASAM Levels 0.5-4.0

ASAM Level 0.5 - Screening, Brief Intervention and Referral to Treatment
Services Description The purpose of SBIRT is to identify individuals who may have alcohol and/or other substance use problems. Following screening, a brief intervention is provided to educate individuals about their use, alert them to possible consequences and, if needed, begin to motivate them to take steps to change their behavior. Staff Requirements and Settings Physician, Pharmacist, and other Credentialed Addiction Treatment Professionals Variety of health care encounter setting including but not limited to: Health Departments, Federally Qualified Health Centers, Rural Health Clinics, Community Services Boards, Health Systems, Emergency Departments, Pharmacies, Physician Offices, and Outpatient Clinics Licensed providers, as allowed by their scope of practice, may delegate administration of the tool to other staff (for example physicians to registered nurses). CSACs are qualified to perform, under appropriate supervision or direction, the administration of substance abuse assessment instruments, Billing must occur through credentialed and licensed agency or provider. Approved Screening Tools The Department of Behavioral Health and Developmental Services (DBHDS) has a list of approved Screening Tools posted on the website: Free SBIRT Training and CME/CEU/CE Join SAMHSA and receive 1.75 CME/CEU credits for free! NAADAC - The Association for Addiction Professionals Free On Demand Webinars - Deeper dive into the ASAM levels of care. Can be provided in outpatient settings, FQHCs, CSB, pharmacies for example. Review staff requirements and where to find approved screening tools.

Rate Structure for ASAM Levels 0.5
Code Description Unit Rate/Unit As of 7/1/18 0.5 99408 Alcohol and/or substance abuse structured screening and brief intervention services 15 to 30min Age <21 =$25.78 Age >20 = $23.90 99409 greater than 30min Age <21 =$50.02 Age >20 = $46.37 SBIRT rates based on age of member. All currently covered. Rates are posted on the DMAS website.

ASAM Level 1.0 Outpatient Services
Setting Any appropriate setting that meets state licensure or certification criteria Support Systems Medical, psychiatric, psychological, lab and toxicology services, available on-site or thru consult Direct affiliation with (or close coordination thru referral to) more intensive levels of care Staff Requirements Appropriately credentialed and/or licensed professionals RNs/LPNs involved with medication management Therapies Skilled treatment service: Individual, family and group counseling, addiction pharmacotherapy Traditional outpatient services that are currently covered by DMAS.

ASAM Level 2.1 Intensive Outpatient Services
Settings and DBHDS License Type Any appropriate setting that meets state licensure or certification criteria Substance Abuse Intensive Outpatient for Adults, Children and Adolescents Support Systems Medical, psychological, psychiatric, lab and toxicology services available through consultation or referral. Psychiatric and other medical consult available within 24 hours by phone and ideally within 72 hours in person or via telemedicine Staff Requirements Interdisciplinary team of appropriately credentialed addiction treatment professionals Therapies Minimum of 9 hours up to 19 hours/week of adult and 6 hours/week of adolescent skilled treatment services such as individual/group/family therapies Medical management, provided in amounts, frequencies and intensities appropriate to the objectives of the treatment plan Examples of Level 2 programs are after-school, day or evening, and/or weekend intensive outpatient programs. Virginia legislation allows for telemedicine when provided by live interactive video, meets the standard of in person of “face-to-face” care for psychiatric consults.

ASAM Level 2.5 Partial Hospitalization Services
Settings and DBHDS License Type Any appropriate setting meeting state licensure or certification criteria Substance Abuse or Substance Abuse/Mental Health Partial Hospitalization Support Systems Medical, psychological, psychiatric, lab and toxicology services available through consultation or referral (includes telemedicine) Emergency services, which are available by phone 24/7 when treatment not in session Staff Requirements Interdisciplinary team of appropriately credentialed addiction treatment professionals MDs should have specialty training and/or experience in addiction medicine Therapies Minimum of 20 hours/week of skilled treatment services, individual and group. Medicaid standard of care for PHP is 5 hours of clinical programming per day. Counseling, family therapy, etc. provided in amounts, frequencies and intensities appropriate to the objectives of the treatment plan. Examples of Level 2.5 programs are day treatment or partial hospital programs.

Rate Structure for ASAM Levels 2.1 and 2.5
Setting Codes Service Description Unit Rate/ 2.1 H0015 or rev 0906 Intensive Outpatient Services Structured program delivering 9-19 hours per week, before/after work/school, in evening and/or weekends to meet complex needs of people with addition and co-occurring conditions. 1 unit = 1 day (min 3 hrs/day) $250 2.5 S0201 or rev 0913 Partial Hospitalization Services 20 or more hours of clinically intensive programming per week with a planned format of individualized and family therapies. 1 day (min 5 hrs/day) $500 Example of 20 hours per week would be 6/7/7 for 3 day week or more.

ASAM Level 3.1 - Clinically Managed Low-Intensity Residential Services
Settings and DBHDS License Type Offered in a (usually) freestanding, appropriately licensed facility in a community setting. Mental Health and Substance Abuse Group Home Service for Adults and Children (Required for co-occurring enhanced programs) Supervised Living Services for Adults Support Systems Phone or in person consultation with a physician and emergency services 24/7 Direct affiliations with other levels of care, or close coordination through referral to more and less intensive levels of care and other service Staff Requirements Allied health professionals (counselors aides/group living workers) available on site 24/7 Appropriately trained and credentialed medical, addiction and mental health professionals supports allied health professionals in interdisciplinary team approach Therapies Services designed to improve patient’s ability to structure and organize tasks of daily living Planned clinical program activities (at least 5 hours/week professionally directed treatment) Examples of Level 3.1 programs are halfway houses, group homes, or other supportive living environments with 24 hour staff and close integration with clinical services. Non clinical setting, unique level of care Would not expect member to start at this level but maybe higher level and transition to this once stabilized. Member could receive other lower levels of care such as IOP or PHP during the day and return to group home in evenings and followed up with peer support services.

Rate Structure for ASAM Level 3.1
Code Service Description Unit Rate/ 3.1 H2034 Clinically managed low intensity residential services Alcohol and/or drug abuse halfway house services, per diem. Supportive living environment with 24-hour staff and integration with clinical services. At least 5 hours of low-intensity treatment per week. 1 unit = 1 day $175 Group home rate does not include room and board.

ASAM Level 3.3 - Clinically Managed Population Specific High Intensity Residential Service
Settings Freestanding (usually), appropriately licensed facility located in a community setting or a specialty unit within a licensed health care facility Substance Abuse Residential Treatment Services (RTS) for Adults; Substance Abuse Residential Treatment Services (RTS) for Women with Children; Substance Abuse and Mental Health Residential Treatment Services (RTS) for Adults that have substance abuse on their license or within the “licensed as statements.” or Level C or Mental Health Residential Children that have substance abuse on their license or within the “licensed as statements.” If providers are providing withdrawal management, they will need to also have a DBHDS Medical Detox license. Support Systems Phone or in person consult with physician or physician extenders. Emergency services available 24/7. Direct affiliations with other levels of care such as vocational assessment and training, adult education Staff Requirements Licensed credentialed addiction professionals and/or physicians or physician extenders working with allied health professionals in an interdisciplinary team approach One or more clinicians with SUD competencies must be available on site or by phone 24/7 Staff with experience and knowledge working with populations with significant cognitive impairments resulting in impairment that outpatient services or other residential care are not effective Therapies Daily clinical services to improve the patient’s ability to structure and organize the tasks of daily living and recovery Clinically directed program activities to stabilize and maintain SUD symptoms, and apply recovery skills Examples of Level 3.3 programs are therapeutic rehab facilities or traumatic brain injury programs. Individual may have short term impairments due to SA use or long term impairments such as brain injury or individual with long term impairments due to substance use. Highly structured clinical environment. Should be short term stay for those who don’t have long term cognitive impairments. “Physician Extenders” are licensed nurse practitioners and physician assistants. Staff must have experience working with individuals with significant cognitive impairments.

Code Service Description Unit Rate/ 3.3 H Rev 1002 Clinically managed population-specific high intensity residential services Alcohol and /or drug services; sub-acute detoxification (residential addiction program inpatient). Adults only-Clinically managed therapeutic rehabilitative facility for adults with cognitive impairment including developmental delay. Staffed by credentialed addiction professionals, physicians/physician extenders, and credentialed MH professionals. 1 unit = 1 day Max $393.50 3.3 can deliver 3.2 with appropriate DBDHS license. Bill one of the rates for services provided. Ancillary services (physician and other evaluation services, medication and labs) billed separately. Per diem include program structure, interdisciplinary team structures and counseling, room and board.

ASAM Level 3.5 - Clinically Managed High Intensity Residential Services
Settings Freestanding (usually), appropriately licensed facility located in a community setting, or a specialty unit within a licensed health care facility, or in a “therapeutic community”. Substance Abuse Residential Treatment Services (RTS) for Adults or Children; Psychiatric Unit that have substance abuse on their license or within the “licensed as statements”; Substance Abuse RTS for Women with Children; Substance Abuse and Mental Health Residential Treatment Services (RTS) for Adults that have substance abuse on their license or within the “licensed as statements.”; or Level C or Mental Health Residential Children that have substance abuse on their license or within the “licensed as statements”. If providers are providing withdrawal management They will need to also have a DBHDS Medical Detox license. Support Systems Phone or in person consult with physician or physician extender. Emergency services available 24/7. Direct affiliations with other levels of care such as vocational assessment and training, adult education Staff Requirements Licensed credentialed addiction professionals One or more clinicians with SUD competencies must be available on site or by phone 24/7 Therapies Daily clinical services to improve the patient’s ability to structure and organize the tasks of daily living and recovery Clinically directed program activities to stabilize and maintain SUD symptoms, and apply recovery skills Examples of Level 3.5 programs are therapeutic communities of variable length of stay with appropriately clinically trained staff or residential treatment centers. Similar to 3.3 – but individuals are medical stable but need higher intensity clinical services. This level helps members learn to live, thrive and cope without using substances.

Code Service Description Unit Rate/Unit 3.5 H0010 Rev 1002 Clinically managed high-intensity residential services (Adult) Clinically managed medium-intensity residential services (Adolescent) Alcohol and /or drug services; sub-acute detoxification (residential addiction program inpatient). Clinically managed therapeutic community or residential treatment facility providing high intensity services for adults or medium intensity services for adolescents. Staffed by licensed/credentialed clinical staff including addiction counselors, LCSWs, LPCs, physicians/physician extenders, and credentialed MH professionals. 1 unit = 1 day Max $393.50 3.5 can provide 3.2 WM with appropriate DBHDS license.

ASAM Level 3.7 Medically Monitored Intensive Inpatient
Setting and DBHDS License Types Freestanding, appropriately licensed facility located in a community setting, or a specialty unit in a general or psychiatric hospital or other licensed health care facility. Freestanding Psychiatric Hospital and Inpatient Psychiatric Unit with a DBHDS Medical Detoxification License or Managed Withdrawal License; Substance Abuse Residential Treatment Services (RTS) for adults/children with a DBHDS Managed Withdrawal License; Residential Crisis Stabilization Unit with a DBHDS Medical Detoxification License or Managed Withdrawal License; Substance Abuse Residential Treatment Services (RTS) for Women with Children with a DBHDS Managed Withdrawal License; Level C or Mental Health Residential Children with a substance abuse residential license and a DBHDS Managed Withdrawal License; Managed Withdrawal-Medical Detox Adult Residential Treatment Service (RTS) License; or Medical Detox/Chemical Dependency Unit for Adults. Support Systems An in person licensed physician assessment within 24 hours of admission and as needed RN assessment completed at the time of admission. LPN and/or RN for medication administration On-site psychiatric services available within 8 hours by telephone or 24 hours in person Staff Requirements An interdisciplinary team (MDs, nurses, addiction counselors and behavioral health specialists) with clinical knowledge of the biological and psychosocial dimensions of addiction and other behavioral health disorders Therapies Daily clinical services; medical and nursing services, counseling and clinical monitoring Planned clinical program activities to stabilize acute addictive or psychiatric symptoms Examples of Level 3.7 adult programs are inpatient treatment centers within the context of an acute care hospital or acute psychiatric units or separate, more intensive units of freestanding Level 3.5 residential facilities. Examples of Level 3.7 adolescent programs are inpatient or medical model residential treatment programs (intermediate care facilities or residential treatment centers). Medical detox license is required at 3.7 level. Stay should be short term to stabilize medically and then transition to lower level for clinical focus.

Code Service Description Unit Rate/ 3.7 H Rev 1002 Medically monitored intensive inpatient services (Adult) Medically monitored high intensity inpatient services (Adolescent) Alcohol and/or other drug treatment program, per diem. Planned and structured regimen of 24 hour professionally directed evaluation, observation, medical monitoring and addiction treatment in an inpatient setting consisting of freestanding facility or a specialty unit in a general or psychiatric hospital or other licensed health care facility. 1 unit = 1 day Based on type of facility per diem: -Acute Inpt -Freestanding Psych -RTC These are the highest rates due to complexity of support needed. Should be transitioned to lower level of care when medically ready to best meet the needs of the member. Rates are currently posted on the DMAS website under Provider Services / Rate Setting. Based on type of facility.

ASAM Level 4.0 Medically Managed Intensive Inpatient Services
Setting and DBHDS License Types Acute care general hospital that offers addiction treatment services and intensive biomedical and/or psychiatric services. Licensed by Virginia Department of Health (12VAC5-410) Support Systems Includes a full range of acute care services specifically consultation, and intensive care Staff Requirements Managed by addiction-credentialed physician or physician with experience treating addiction. Interdisciplinary team of credentialed addiction treatment professionals (physicians, NPs, PAs, psychologists, social workers, and/or counselors) Professional counseling services available 16 hours a day Therapies Individualized array of treatment services for substance use disorder, as well as any concurrent biomedical, emotional, behavioral, or cognitive problems, depending on patient needs Acute care general hospital that offers addiction treatment services and intensive biomedical and/or psychiatric services.

Code Service Description Unit Rate/ 4.0 H0011 or Rev 1002 Medically managed intensive inpatient services Alcohol and/or drug services; acute detoxification (residential addiction program inpatient). Medically Managed Intensive-Inpatient Services consist of 24 hour nursing care and daily physician care for severe, unstable problems in dimensions 1, 2 or 3. Counseling available. 1 unit = 1 day Based on type of facility per diem or DRG (based on provider’s contract with health plan/Magellan) -Acute Inpatient Maximum of 15 day stay. Most members would not need this level of care long. Goal is to detox and transition to lower level of care such as residential for clinical focus.

Opioid Treatment Services
Definition and Evidence The use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders. Use of Medication Treatment Services (MAT) for opioid use disorder leads to successful recovery rates of 40-60%, compared to 5-20% with abstinence-only models MAT can be provided by: Opioid Treatment Providers (OTPs) – CSBs and private providers licensed by DBHDS Preferred Office-Based Opioid Treatment (OBOT) providers – primary care clinics, FQHCs, outpatient psychiatry clinics, other physician offices, etc. Buprenorphine Waivered Practitioners Length of treatment is based on patient’s changing multidimensional risk profile. Limits are individualized. ARTS Benefit Supports Comprehensive MAT Increases rates by 400% for opioid counseling component within OTP and Preferred OBOT Allows OTPs and preferred OBOT providers to bill for case management and peer supports Allows providers to bill separately for opioid treatment when members are receiving treatment in community based ASAM levels 1, 2.1, 2.5, 3.1, 3.5, 3.7. MAT is a foundational services for addiction treatment. Equivalent as insulin is to diabetes. Care Coordination and Peer Services are newly reimbursable. VDH Addiction Disease Management trainings being offered to assist providers in MAT and successful reimbursement.

Preferred OBOT Providers will be Credentialed by Health Plans
Care Team Requirements Buprenorphine-waivered practitioner may practice in a variety of practice settings including primary care clinics, outpatient health system clinics, psychiatry clinics, FQHCs, CSBs, Local Health Departments, and physician’s offices On site licensed behavioral health provider providing counseling to patients receiving buprenorphine MAT Requirements – follows BOM Regulations Buprenorphine monoproduct prescribed only to pregnant women. All other patients receive buprenorphine/naloxone or naltrexone products Maximum daily buprenorphine/naloxone dose 16 mg unless documentation of ongoing compelling clinical rationale for higher dose up to maximum of 24 mg. Over 16mg requires service authorization Due to a higher risk of fatal overdose when buprenorphine is prescribed with other opioids, benzodiazepines, sedative hypnotics, carisoprodol, and tramadol, the prescriber shall only co-prescribe these substances when there are extenuating circumstances and shall document in the medical record a tapering plan to achieve the lowest possible effective doses if these medications are prescribed. Benefits: No Prior Authorizations required for buprenorphine products. Can bill all Medicaid health plans for substance use care coordination code ($243 monthly per member) for members with moderate to severe opioid use disorder receiving MAT. Can bill higher rates for individual and group opioid counseling. Can bill for Certified Peer Recovery Support specialists. Risk management: Random urine drug screens, a minimum of 8 times per year. Virginia Prescription Monitoring Program checked at least quarterly. Opioid overdose prevention education including the prescribing of naloxone. Patients seen at least weekly when initiating treatment. Utilization of unused medication and opened medication wrapper counts

Rate Structure for Preferred OBOTs: New Codes
Service Description Unit Rate/ H0014 Medication Assisted Treatment (MAT) induction Physician/NP/PA Induction – Day One Per encounter $140 H0004 Opioid Treatment Services Opioid Treatment – individual and family therapy 1 unit= 15 min $24 H0005 Opioid Treatment – group therapy 1 unit = 15 min (per patient) $7.25 G9012 Substance Use Care Coordination Care Coordination within OBOT Model 1 unit = 1 month $243 T1012 Peer Support Ind Peer Recovery Support Specialist with Individual 1 unit = 15 minutes $6.50 S9445 Peer Support Group Peer Recovery Support Specialist with Group $2.70

Rate Structure for OBOTs: Existing Codes
Service Description CPT E/M Code Established Patient Visit Follow-Up Visits by Physician/NP/PA after Induction Day One Urine Drug Screens Urine Drug Screen for Opioids and Illicit Drugs CPT Codes for Labs Labs Examples: Hepatitis B Test (86704), Hepatitis C test (86803), HIV Test (86703), Syphilis Test (86593), Treponema Pallidum (86780), Syphilis Test Non-Treponema (86592), Pregnancy Test (81025), Skin Test-Tuberculin (86585), EKG (93000, 93005, 93010), Alcohol-Breathalyzer (82075)

Established in response to a legislative mandate
Peer Support Services A Peer Recovery Specialist (PRS) is a self-identified individual with lived experience with mental health or substance use disorders, or co-occurring mental health and substance use disorders who is trained to offer support and assistance in helping others in the recovery and community-integration process. Available to individuals who have mental health conditions and/or substance use disorders Established in response to a legislative mandate Supported by the Governor’s Task Force on Prescription Drug and Heroin Addiction Supported by The Centers for Medicare & Medicaid Services (CMS) as “…an important component in the State’s delivery of effective treatment.”

Medication Assisted Treatment (MAT) Requirements: RATE STRUCTURE, AND COVERED MEDICATIONS Changes coming 12/1/18

The Charge from CMS to DMAS and Our Psychiatric Facilities
In a letter to all State Medicaid Directors dated 11/1/17, in regards to states with 1115 SUD demonstration waivers such as Virginia, CMS explicitly requires that: “Residential treatment facilities offer MAT on site or facilitate access off-site”; As well, CMS will be monitoring how effectively states ensure ”sufficient provider capacity at critical levels of care, including for MAT for OUD” To meet this requirement, and to ensure our sickest members with Opioid Use Disorder have access to life saving treatment DMAS Provider Memo Posted to address changes and requirements. Medication Assisted Treatment must be offered/coordinated for IOP/PHP and Residential Treatment Services by 12/1/18

DMAS’ New Requirements
MAT is the standard of care for moderate to severe OUD-therefore, DMAS is requiring that all ARTS IOP, PHP, residential and acute psychiatric providers ensure that Medicaid members admitted to their programs have access to MAT, including both buprenorphine containing products and Vivitrol All ARTS IOP, PHP residential and acute psychiatric providers will required to attest to this capability by 12/1/18 Beginning 7/1/18, DMAS and its contractors will require documentation on the service authorization the need for MAT has been assessed and treatment initiated if clinically appropriate DMAS strongly encourages residential and acute psychiatric providers to employ or contract with buprenorphine waivered prescribers and/or ensure their existing staff obtain their waiver to ensure on site MAT access

DMAS New Requirements and Supports
In the future, programs which are not able to provide consistent access to MAT or convincing demonstrate inability to do so will be subject to financial penalties DMAS is developing quality measures as part of its VBP program that will incorporate- Percentage of members with opioid use disorder discharged from level 3.7 facilities on MAT Rates of timely follow up for members discharged on MAT with an community based MAT prescriber Support for Level 3.7 providers in addressing barriers to providing MAT ARTS portion of DMAS website provides a Google Map showing location of every ARTS provider in Virginia and neighboring states from ASAM level 2.1 thru 3.7, including contact information and includes all OBOT and OTP programs. Full time ARTS care coordinators with all 6 Managed Care Organizations can help identify waivered practitioners and other resources and help with multiple linkages

Payment Incentives for MAT in IOPs, PHPs, Psych Units
Medication Assisted Treatment Provided Simultaneously and Approved to be Reimbursed Separately from other ASAM Levels of Care MAT Services Procedure Code ASAM Level 2.1 and 2.5 ASAM Level 3.5 Inpt Psych Unit ASAM Level 3.7 Inpt Psych Unit Practitioner Induction Day 1 OBOT/OTP -H0014 Non OBOT/OTP = E&M Codes Yes Practitioner Visits after Day 1 (OBOT/OTP and non-OBOT/OTP) E&M Codes Psychotherapy* for MAT CPT Psychotherapy Codes No, included in IOP/PHP rate Medications Prescription filled at Pharmacy or Dispensed on site = HCPCS Codes S0109/J0571/J0572 /J0573/J0574/J0575/J2315 No Urine drug screens Labs CPT Codes Care Coordination G9012

Upcoming Trainings

Buprenorphine waiver trainings
DMAS, VDH, ASAM are collaborating for a virtual "live" course that will cover all medications and treatments for opioid use disorder. The training provides the required education needed to obtain the waiver to prescribe buprenorphine. This is a great opportunity for your prescribers not yet waivered to become so and help meet the 12/1/18 deadline Waiver trainings began July 6, 2018 and will be hosted monthly until the end of the year. Per ASAM's requirements, participants may take the four hour online portion either before or after the "virtual" Project ECHO session. Participants must complete the online session within 30 days of the "virtual" Project ECHO session or they will not receive credit for the course. No partial credit will be given.

Trainings Project ECHO Statewide Efforts
ASAM Waiver TeleEcho Buprenorphine Waiver Trainings Preferred OBOT Learning Collaborative via TeleECHO More information on Project ECHO including buprenorphine waiver training dates will be available in June and will be posted online at: Scheduling Training with Community Care Network of Virginia Stakeholders early fall Integrating addiction treatment in primary care at Federaly Qualified Health Centers (FQHCs) Collaboration opportunities with FQHCs and Community Services Boards (CSBs) Reimbursement options for FQHCs for Preferred-Office Based Opioid Treatment (OBOT) FQHC/OBOT Tool Kit Echo first training is July 19 from 12-1

VCU Evaluation Results

VCU Evaluation: Highlights from First Year
More Medicaid members with substance use disorders are receiving treatment The percent of Medicaid members with a substance use disorder who received any treatment increased from 24 percent before ARTS to 40 percent during the first year of ARTS.

VCU Evaluation Continued

Medicaid Expansion

Coming Soon: Medicaid Expansion!
Starting early 2019 Up to 400,000 more adults living in Virginia will have access to quality, low cost health coverage Voiceover on when it passed

Medicaid Expansion – Who Is Eligible?
Adults ages 19 – 64 Not already in or eligible for Medicare Income from 0% to 138% Federal Poverty Level Must meet income requirements, which vary by household size

Medicaid Expansion – What Services are Covered?
Doctor, hospital and emergency services, including primary and specialty care Prescription drugs Laboratory and X-ray services Maternity and newborn care Home health services Behavioral health services, including addiction and recovery treatment services Rehabilitative services, including physical, occupational and speech therapies Family planning services Medical equipment and supplies Preventive and wellness services, including annual wellness exams, immunizations, smoking cessation and nutritional counseling And more

1 in 5 nonelderly adults with opioid addiction is uninsured.
Estimating 100, 000 or more members with SUD will be part of the expansion population.

Regular Updates About Medicaid Expansion
Please visit the Cover VA website regularly for updates. More information will be coming soon on the timing and process for enrollment. Outreach materials will be posted on the website so that our partners can share them in their communities

How Can You Help? You can help support Medicaid expansion
Assist with intensive marketing and outreach to educate and inform newly eligible individuals, providers, and other stakeholders Support enrollment efforts and access to services for newly eligible individuals Share the Cover Virginia banner and link on your website and social media pages A banner button has been designed to direct people to the the Cover VA website. The marketing and communications team will share the banner button with partners and stakeholders to add to their websites.

For more information, please contact:
Questions For more information, please contact: ARTS Webpage

Ke’Shawn Harper, MIS, GCPAP, CLC, QMHP

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