Briefing on ARTS to Secretary Hazel October 2017

Transcription

1 Agenda -DMAS -DBHDS -VDH -Final discussion Briefing on ARTS to Secretary Hazel October

2 Medicaid Addiction and Recovery Treatment Services (ARTS) Partial Hospitalization Intensive Outpatient Programs Opioid Treatment Case Management Magellan will continue to cover community-based substance use disorder treatment services for feefor-service members Residential Treatment Inpatient Detox Effective April 1, 2017 Addiction and Recovery Treatment Services (ARTS) Peer Recovery Supports effective July 1, 2017 Peer Recovery Supports Crisis Intervention All Community- Based SUD Services will be Covered by Managed Care Plans A fully integrated Physical and Behavioral Health Continuum of Care 2

3 Budgeted Costs for ARTS Benefit Funding Included in 2016 Appropriations Act as Substance Use Disorder funding: $2.5 million GF ($5 million total funds) $8.3 million GF ($16.6 million total funds) This year's Medicaid forecast is not changing these projected costs. 3

4 Health Systems Asks for Health Systems and Health Plans Add inpatient detox beds and Addiction Detox Units Add DBHDS Detox License to Inpatient Psych Units Develop Intensive Outpatient and Partial Hospitalization Programs Provide integrated MAT in outpatient clinics buprenorphine-waivered physicians with integrated behavioral health providers and peer supports Encourage physicians and behavioral health providers to attend VDH Addiction Disease Management sessions Commercial Health Plans Implement CDC Opioid Prescribing Guidelines for Chronic Pain that FFS implemented on 7/1/16 and Medicaid plans will implement 12/1/16 Offer similar rates for addiction treatment as Medicaid plans to catalyze expansion of addiction treatment 4

5 Payment Model for Office-Based Opioid Treatment Providers Service Description Codes Physician Visit Counseling H0014 MAT Induction CPT E/M Code: Established Patient H0020 Opioid Treatment - individual, group counseling and family therapy / prescribing and medication oversight Care Coordination G9012 Substance Abuse Care Coordination Peer Supports H0038 Peer Support Services S9445 Peer Patient Education Individual S9446 Peer Patient Education - Group Urine Drug Screen G0477-G0483 Examples: Hepatitis B Test (86704), Hepatitis C test (86803), HIV Labs Test (86703), Pregnancy Test (81025), PPD (86585) 5

6 OBOT Providers will be Credentialed by Health Plans Care Team Requirements Buprenorphine-waivered physician may practice in a variety of practice settings including primary care clinics, outpatient health system clinics, psychiatry clinics, FQHCs, CSBs, Health Departments, and physician s offices On site licensed behavioral health provider providing counseling to patients receiving buprenorphine MAT Requirements 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 compelling clinical rationale for higher dose up to maximum of 24 mg No tolerance to other opioids, soma, stimulants, or benzodiazepines except for patients already on benzodiazepines for 3 months during a relapse or tapering plan 6

7 OBOT Providers will be Credentialed by Health Plans Risk Management and Adherence Monitoring Requirements Random urine drug screens, a minimum of 8 times per year. Virginia Prescription Monitoring Program checked at least quarterly. Opioid overdose prevention education including naloxone. Patients seen at least weekly when initiating treatment. Periodic utilization of unused medication and opened medication wrapper counts Benefits No PA required for buprenorphine or buprenorphine/naloxone Buprenorphine-waivered physician in the OBOT can bill all Medicaid plans for substance abuse care coordination code (monthly per member payment) for members with moderate to severe opioid use disorder receiving MAT. Can bill for Certified Peer Recovery Support specialists 7

8 Buprenorphine Prior Authorization Requirements Uniform Requirements Adopted by FFS and Managed Care Plans Diagnosis of Opioid Use Disorder, and > 16 years of age; and Prescriber s personal DEA and XDEA numbers are required; and Individual is participating is psychosocial counseling Maximum of 16 mg per day Initial authorization for 3 months; subsequent authorizations for 6 months No set time limit or duration of treatment Buprenorphine only products for pregnant women Patient is locked-in to prescribing physician and dispensing pharmacy No concurrent use with benzodiazepines, tramadol, carisoprodol, other opiates or stimulants Urine drug testing at least 4 times per 6 months 8

9 Implementation of CDC Guidelines for Prescribing Opioids Uniform, Stream-lined Prior Authorization Forms for All Short acting opioids > 14 days or 90 MME and long-acting opioids Will require PMP check and urine drug screen Increase access to Naloxone Available without PA and no quantity limits Naloxone injection and Naloxone nasal spray (Narcan ) Include non-opioid pain relievers on all MCO formularies without PA Lidocaine patches Capsaisin topical gel SNRIs including duloxetine Gabapentin and pregabalin (Lyrica ) NSAIDs including oral and topicals (diclofenac gel) Baclofen Tricyclic antidepressants (TCAs) Buprenorphine patches and buccal film for pain 9

10 Implementation of CDC Guidelines for Prescribing Opioids Uniform Quantity Limits (QL) for Short and Long-acting Opioids QL based on maximum of 90 MME (morphine milligram equivalents) PA required for any individual drug dose > 90 MME or cumulative dosage > 120 MME Concomitant use of benzodiazepine with opioid will trigger a PA Provider and Member Education Prescriber Letters Identify patients receiving benzos and opioids concomitantly Identify patients receiving >90 MME individual drug opioid doses Identify patients receiving >120 MME cumulative opioid doses Member Letters Identify members that meet PUMS 2 criteria and provide lock-in information or educational materials regarding opioid use 10

11 Aligning ASAM Criteria with DBHDS Licensing Requirements 11

12 ASAM Training Offerings Two Day Skill Building (10 trainings total) Ten two-day skill building sessions intended primarily for those providing assessments, designing and implementing programs, providing case management services, and managing quality assurance. Sessions are limited to 40 participants. each. One Day Administrative Sessions (2 Total) Two one-day sessions intended for nonclinical managers, such as CEOs, CFOs, and CIOs. One Day Coach Trainings (2 Total) Two one-day sessions to train coaches who will provide ongoing continuity to assure that Virginia providers are consistently utilizing the ASAM Criteria Registration Fees $50 per person for CSBs and contract agencies $200 per person for MCOs and contract providers. The ASAM Criteria, 3rd Edition, Up to three participants can share a copy. 12

13 ASAM TWO DAY TRAINING SCHEDULE DATE LOCATION REGISTRATION November 1-2, 2016 November 3-4, 2016 VA Housing Development Authority Dorey Park Recreation Center, Henrico TRAINING FULL TRAINING FULL December 5-6, 2016 Fairlington Center, Arlington OPEN December 7-8, 2016 Northern VA, TBA OPEN January 3-4, 2017 Southwest VA, TBA OPEN January 5-6, 2017 Southwest VA, TBA OPEN January 31-February 1, 2017 Region Ten CSB, Charlottesville, VA OPEN February 2-3, 2017 The Cove, Winchester, VA OPEN February 27-23, 2017 Tidewater Area, TBA OPEN March 1-2, 2017 Tidewater Area, TBA OPEN 13

14 DBHDS Certified Peer Recovery Specialists (CPRS) Peer Certification HB 583 (2016) authorizes DBHDS Commissioner to certify individuals as peer providers in accordance with regulations adopted by the Board of Behavioral Health and Developmental Services GA Appropriations Act directed DBHDS to promulgate emergency regulations for implementing the CPRS program and designation. DBHDS is in the process of developing a curriculum for Certified Peer Recovery Specialists (CPRS). Curriculum is expected to be established by January DBHDS is developing CPRS training timelines to support the implementation of peer services in the ARTS Waiver, for July 1, CPRS Train the Trainer sessions will begin in the spring of 2017 and will focus on the 5 regions to ensure broad availability and statewide workforce development. 14

15 DBHDS Certified Peer Recovery Specialists (CPRS) CPRS Structure and Development DBHDS is working with DHP and DMAS to develop regulations on the certification of peer recovery specialists. DBHDS is promulgating regulations that define the educational and experience requirements for certification, as well as certification bodies that will be accepted in Virginia. Proposed legislation and subsequent regulations will institute the requirement for CPRS to register with DHP and establish DHP authority to renew registration, investigate complaints, and implement any disciplinary actions. Registration will be required for a CPRS to be eligible for the payment of services by DMAS. 15

16 Health Systems DBHDS Asks Consider developing peer support programs in Emergency Department settings Implement CDC Opioid Prescribing Guidelines Encourage behavioral health providers to become ARTS providers or Encourage ARTS providers (and those who will become ARTS providers) to attend ARTS ASAM trainings. 16

17 Addiction Disease Management Removing the Barriers for Integration and Application into Outpatient Clinical Practice Statewide Trainings for Healthcare, Behavioral Health, and Clinical Administration Professionals Statewide trainings within the 7 MCO regions: January 2016 to April 2017 Intended Audience: Practicing MDs/DOs, APNs, PAs, medical students, behavioral health professionals, substance abuse professionals, and administrators supporting provider clinical practice Content Virginia Medicaid s Addiction and Recovery Treatment Services (ARTS) new benefit; Assessment, screening, and monitoring of the integrated care patient at risk for, or with a history of, addiction Discovery of addiction as an underlying disease Integrated outpatient clinical practice and behavioral health care interventions for addiction disease management (ADM) Specialty track content for removing barriers and challenges to integration, coordination, and operational practice National framework content for obtaining the waiver to prescribe buprenorphine Development of a seamless OBOT primary care, behavioral health, and business model Framework Integration of ASAM criteria; Utilization of PCSS MAT criteria; Meets the requirement of the federal DATA 2000 law Physicians will complete the 8 hour SAMSHA funded Provider Clinical Support System: MAT criteria online and in-person hours to meet the requirement for providers to obtain the waiver to prescribe buprenorphine in their practice for treatment of opioid addiction. Free CMEs available for online and live trainings, including Virginia specific content 17

18 Association Meeting Presentations: Psychiatric Society of Virginia: October 2016 Medical Society of Virginia: October 2016 Community Care Network of VA October 2016 Va Academy of Family Physicians: February 2017 Specialty Trainer Expert Areas: Medical Behavioral Health Administrative Training Areas: Medical: Clinical and business delivery Behavioral Health: Primary to BH Integration Administrative: Operations Training Opportunities October 2016: ADM Sneak Peek Key SME experts to provide a Sneak Peak on the benefits and barriers to implementing ADM in an office setting, and on state level resources for the provider team November 2016: ADM Train-the-Trainer Model In each MCO region, selected champions will be trained to target and to educate local physicians, behavioral health providers, and administrators in the ADM curricula January-April 2017: ADM Train-the-Provider Model Approximately 4 trainings will be hosted in each of the 7 MCO regions Anticipated Reach: Approximately 300 providers. 18

19 VDH Addiction Workgroup Purpose: To convene VDH staff in an effort to analyze current policy, program, intervention, and data management related to the Opioid Epidemic and Addiction in the Commonwealth. Workgroup meets approximately every 6 weeks VDH Addiction Workgroup participants: OEpi, OCME, OEMS, OHE, OFHS, OCOM, ORCE Invited guests: include other state agencies DBHDS, OHP, Fusion Center, etc. Key areas of focus: Data management and availability related to Addiction/Opioid Epidemic Training needs in the state for providers Analysis of OCME OD Death data and trends Gap Analysis for overall VDH response by Office and Subject area Collaboration activities with other agencies, partners Policy Needs Workgroup meets approximately every 6 weeks Next meeting: November