BH Update - October 2017
Key Highlights This Month:
1) The Department of Human Services continues to roll out information regarding SUD Reform through bi-weekly WebEx forums. A recent WebEx: Rule 31 to 245G presentation contains a great web-information list along with Details on specific Rule and Statute Changes. The Presentation is on the attached Link. https://mn.gov/dhs/assets/sud-reform-rule-31-245g_tcm1053-310339.pdf
2) SUD Reform Updates: Counties should try to position themselves to optimize MA billing when it becomes available: Expected by July 1, 2018 (or upon CMS approval, whichever is later), Counties will be considered eligible vendors for “Care Coordination” (CC) and “Comprehensive Assessment” (replaces R25 assessment) and will be able to apply as vendors for reimbursement. Estimated $150 (?)/hour per comprehensive assessment (lesser amount for comp assessment updates). Expected July 1, 2019 (or upon CMS approval, whichever is later): DHS will have a per diem Medicaid rate established with CMS for withdrawal management services. Estimated $575/day for higher level of care; $460/day for next step down (includes Room & Board rates billable to Medicaid will be minus the $75 R & B costs). American Society of Addiction Medicine (ASAM) has two levels of detox care that the state has approved for Medicaid funding: 1) Medically monitored (requires 24/7 RN coverage; physician availability every day; CC and peer support). 2) Clinically managed (peer support and CC). Hennepin is trying to work with health plans (HP’s) prior to Medicaid approval to get funding prior to July 2019 and if not, looking to do a pilot project for temporary funding to see if the HPs would pay sooner. Counties should engage with the HP's re: detox per diems. PMAPs and Medicaid pays for detox, expected July 2019. However, if the person is indigent, detox is paid through the CCDTF.
3) CCDTF fund: CMS putting pressure on DHS = can't use CCDTF for treatment services, must only pay for room/board, CC, supportive services out of CCDTF. Treatment services paid for through Medicaid expansion and HPs. Counties now have to pay a higher rate for IMDs than non-IMDs. Providers thought the counties would refer to non-IMDs, so MAARCH helped lower the county share so it wouldn't impact their referrals, but this was only temporary relief for counties (was a one year legislative allocation). This no longer exists and now counties pay the higher IMD rate –and- there are more IMDs.
4) Counties should try to prepare for SUD changes: 1) R25s - phased out through 2020 and changed to reimburse Comprehensive Assessment Providers will have direct access and place people without county involvement. There will be a two years transition time with both systems in play. Counties can choose to do it. For R25s not on health insurance - that cost comes back to the CCDTF - so concern is whether any 3rd party tries to get clients on 3rd party coverage because the path of least resistance is to just let the county pay for it as “payor of last resort.” CCDTF is payment of last resort. So, counties need a safeguard before we pay! Idea is that most everyone has MA or is on a HP. MUST ASSURE SAFEGUARDS that something is in place for the CCDTF.
5) LADCs Licensure: LADCs will be able to send their counselors to other sites to meet with people and get reimbursed - not locked in to do it at their facility site (We believe eligible counselors must have a clinical supervision credential in order to be mobile…). Shortage of LADCs is a concern that ADAD is aware of at the State. MH professionals with certain experience in addiction can do it, but it is still a very high bar to meet.
6) Court ordered treatment: Counties will likely have problems with the CPS, court, corrections judges. In the future, clients can theoretically choose to go where they want.
7) Brian Zirbes, Deputy Director of ADAD, will be meeting with counties soon. Another forum may be a good idea in the next few months.
8) Mental Health/State Operated Services (SOS) Update: In response to rising county cost shares and communication challenges, county social services managers/supervisors are convening to share information and enhance communication between AMRTC/DHS. The group has met twice so far and will meet again on October 27 at AMRTC. AMRTC and DHS staff participated in the second meeting. Topics discussed so far include: the DNMC (“Do Not Meet Criteria” DNMC process, RTC/CRP flow, AMRTC data review, AMRTC/case manager communication, community resource gaps, and processes to support transition to community. If MACSSA members are interested in more information, please contact Kathleen Kelly, Dakota County Project Manager, at Kathleen.firstname.lastname@example.org
Requested Actions Needed From MACSSA:
At the next topic lead meeting, should discuss timing of another SUD Reform Forum.
New Trends in This Area:
Issues/Concerns Regarding This Topic:
LADC licensure issues continue to be a problem as discussed at last month’s topic forum discussion. Counties should pay attention to what happens with the CCDTF in the upcoming legislative session – counties need safeguards around when/how the CCDTF is used by outside providers.