Opioid State Targeted Response (STR) Project Requirement: Frequency: Due Date: The Office of Substance and Abuse and Mental Health (SAMH) Contract On going On going The major goal of Florida's Opioid State Targeted Response (STR) Project (under SAMHSHA Notice of Award Grant Number 1 H79TI080273 01) is to support additional Medication Assisted Treatment (MAT) services through the Managing Entity subcontracts with Network Service Providers. Details about the scope of the STR authorized services are included in the newly adopted Other Cost Accumulator (OCA) MSOPM. The following authorized covered services described in ch. 65E 14.021, F.A.C., are allowable uses of these funds when provided to individuals in conjunction with methadone maintenance or buprenorphine maintenance or oral naltrexone. Code Covered Service 1 Assessment 2 Case Management 4 Crisis Support/Emergency 5 Day Care 6 Day Treatment 8 In Home and On Site 12 Medical Services 13 Medication Assisted Treatment (methadone maintenance or buprenorphine maintenance) 14 Outpatient Individual Outreach (to identify and link individuals with opioid use disorders to medication assisted 15 treatment providers) 18 Residential Level I 19 Residential Level II 24 Substance Abuse Inpatient Detoxification 25 Supported Employment 26 Supportive Housing/Living 28 Incidental Expenses (excluding housing/rental assistance and direct payments to participants) 29 Aftercare 32 Outpatient Detoxification 35 Outpatient Group 43 Aftercare Group 46 Recovery Support Individual 47 Recovery Support Group These funds may also be used to support individuals receiving VIVITROL and naltrexone, except for Assessment, Medical Services and Medication Assisted Treatment, as this will be paid through the Florida Alcohol and Drug Abuse Association. Updated 03/29/2018 ID 32, Page 1 of 5
Inpatient detoxification and residential services may only be used to stabilize and transition eligible individuals to medication assisted treatment. When determining level of care, individuals must be assessed using the ASAM dimension spectrum criteria to determine appropriate care level followed by documentation justifying placement. Level of care should be reevaluated at least every five days for inpatient detoxification placements and 14 days for residential treatment placements. Inpatient detoxification may be used in conjunction with buprenorphine or methadone induction, as medically indicated. Residential services may be utilized to provide a safe and supportive transition during opioid withdrawal for those entering an extended release naltrexone (Vivitrol) program. Post injection, individuals must be assessed and linked to the determined level of care. MAT services are already authorized, using other recurring fund sources, in both the Department's contracts with Managing Entities and some Network Service Provider subcontracts. SAMH has received reports some providers may have already exhausted their previously allocated FY16 17 MAT service funding. To the extent these services would be allowable under OCA MSOPM after subcontract amendment, the Notice of Award supports the use of STR funding as of May 1, 2017. However, Managing Entity contract amendments and Network Service Provider subcontract amendments incorporating these funds will be effective at various future dates. Pursuant to Governor Scott's Executive Order 17 146, the Office of SAMH authorizes the use of these funds to reimburse providers for otherwise uncompensated MAT services provided beginning May 1, 2017, the effective date of the SAMHSA Notice of Award, notwithstanding the effective date of the implementing contract or subcontract amendment. This authorization is expressly limited to the following conditions: The Network Service Provider must already be authorized by subcontract for the delivery of MAT services. The service events subject to this reimbursement must be in compliance with the eligibility and allowability conditions of OCA MSOPM. Network Service Provider documentation on file must clearly establish the services provided would, but for this authorization, remain uncompensated by existing resources. The SRT Project will be administered according to the Department of Children and Families guidance document, or the latest version thereof. Phase one of the project will take place from May 1, 2017 through April 30, 2018. Opioid STR Network Service Providers Network Service Provider County Coverage Circuit Meridian Behavioral Healthcare Alachua, Baker 3/8 LifeStream Behavioral Center Hernando, Lake, Sumter 5 The Centers Marion, Citrus 5 Operation PAR Hernando 5 Starting Point Behavioral Healthcare Nassau 4 Gateway Community Services Duval 4 Clay Behavioral Health Center Clay 4 EPIC Community Services St. Johns 7 Updated 03/29/2018 ID 32, Page 2 of 5
SMA Behavioral Health Services Volusia, Flagler, Putnam 7 Metro Treatment of Florida, LP, d/b/a Jacksonville Metro Treatment Duval, Marion 4, 5 Center, d/b/a Quad County Treatment Center Contracting with For Profit Opioid Treatment Programs (OTPs): Per the DCF Memorandum with Subject Title: Authorizing Opioid STR Funds to For Profit OTPS, effective February 20, 2018, Managing Entities (MEs) are authorized to contract with for profit Opioid Treatment Programs (OTPs) for methadone and buprenorphine assisted treatment and recovery supported services using SAMHSA s State Targeted Response to the Opioid Crisis (Opioid STR) grant funding. According to SAMHSA s Opioid STR FAQ, grantees are permitted to provide Opioid STR funds to private for profit OTPs if these activities are done through a contract mechanism. The Opioid STR FOA (TI 17 014) FAQs can be found here: www.samhsa.gov/sites/default/files/grants/pdf/other/ti 17 014 faq.docx. In accordance with this guidance, the Department authorizes MEs to subcontract with private for profit OTPs, using Opioid STR funds to pay for methadone and buprenorphine assisted treatment services, under the following conditions: 1. Private for profit OTPs must ensure that Opioid STR funded individuals have access, either directly or through referral, to the comprehensive continuum of treatment and recovery services identified in the Chart 8. 2. All Opioid STR funded individuals must be provided information and education on all FDA approved medications for opioid use disorders. If the Opioid STR funded individual prefers a FDA approved medication not offered by the provider, a referral must be made. 3. STR contracted private for profit OTPs must meet DCF reporting requirements. This authorization is expressly limited to services provided with fund under the Opioid STR grant and does not affect any requirements currently in effect under the Substance Abuse Prevention and Treatment Block Grant. Eligibility Criteria: 1. Individuals who are indigent, uninsured, or underinsured and have an opioid use disorder. 2. The following individuals who misuse opioids should be given preference in admissions in the following order: a. Pregnant women who are injecting opioids; b. Pregnant women; c. Caretakers involved with child welfare; d. Caretakers of children ages 0 5; and e. Individuals re entering the community from incarceration. Budget Restrictions: Funds may not be expended by any agency which would deny eligible client, patient or individual access to their program because of their use of FDA approved medications for the treatment of substance use disorders (e.g., methadone, buprenorphine, or naltrexone). In all cases, MAT must be permitted to be Updated 03/29/2018 ID 32, Page 3 of 5
continued for as long as the prescriber or treatment provider determines that the medication is clinically beneficial. Grantees must assure that clients will not be compelled to no longer use MAT as part of the conditions of any programming if stopping is inconsistent with a licensed prescriber s recommendation or valid prescription. Opioid STR funds may not be used for the following purposes: 1. To provide services to incarcerated populations (defined as those persons in jail, prison, detention facilities, or in custody where they are not free to move about in the community). 2. To make direct payments to individuals to induce them to enter prevention or treatment services. 3. To make direct payments to individuals to encourage attendance and/or attainment of prevention or treatment goals. 4. To pay for the purchase or construction of any building or structure to house any part of the program. 5. To pay for housing. 6. To pay for covered services that are not listed in the Chart 8 and the above listed allowable covered services. 7. To supplant (or replace) existing funds for services. Medication Assisted Treatment (MAT) Guidelines: 1. Medications prescribed under MAT will be reimbursed through the MAT covered service rate. 2. Each dosage of the medication for the consumer, whether issued daily, weekly, or monthly should be entered into the Managing Entity s data system daily for the duration of the prescription. a. Example If Jane Doe has a prescription for 14 days, you must enter it daily for 14 days to receive payment. 3. To ensure that the medication is being administered and monitored, the substantiating documentation for MAT, in lieu of a Medication Assisted Record (MAR), the following is required: a. The consumer s chart note for the date the prescription was written and b. Copies of all prescriptions. The role of the Network Service Provider is to: 1. Administer the project as outlined in the initial proposal which is subject to change based on the need identified through referrals, waitlist, special populations, and observation of outcomes. 2. Ensure any eligible client, patient or individual receive access to their program regardless of their use of FDA approved medications for the treatment of substance use disorders (e.g., methadone, buprenorphine, or naltrexone). In all cases, MAT must be permitted to be continued for as long as the prescriber or treatment provider determines that the medication is clinically beneficial. 3. Ensure that clients will not be compelled to no longer use MAT as part of the conditions of any programming if stopping is inconsistent with a licensed prescriber s recommendation or valid prescription. Updated 03/29/2018 ID 32, Page 4 of 5
4. Ensure monthly reporting of STR reports are provided to Managing Entity (LSFHS) by the 10 th of each month. Source of Match: No Match Required Cost Allocation Methodology: Costs associated with this BE/OCA combination are directly charged State Targeted Response (STR) to the Opioid Crisis Grant. Source of Funds: This BE/OCA combination is funded through the Substance Abuse and Mental Health Services Administration, State Targeted Response to the Opioid Crisis Grant. Updated 03/29/2018 ID 32, Page 5 of 5