Integrating Substance Use Disorder Services in Kansas: Medicaid Policies Explained

1. Opening Doors to Integration: What You Need to Know about Kansas Policies, Credentialing and Reimbursement March 27, 2012

2. In Kansas Medicaid pays for Substance Use Disorder Services Via… • 1915 b Managed Care Waiver • SUD-PIHP – Pre-paid Inpatient Health Plan • ValueOptions-Kansas (VO-KS) • Medicaid State Plan - Fee For Service • Small amount of SUD services paid FFS • Since 2007 VO-KS has been responsible for managing most SUD care in KS (Medicaid and SAPT BG/state funds)

3. Medicaid Covered Services • DRG’s • Outpatient: • H0001 – Assessment • H0004/5 – Outpatient individual and group counseling • H0006 – Substance Use Disorder Case Management • H0007 – Substance Use Disorder Crisis intervention • H0015 – Intensive Outpatient • H0038 – Peer Support Services • Community Based Residential: • H0018 – Intermediate • H0019 – Reintegration • Telemedicine

4. Medicaid Liaison Position • Medicaid Coordinator positioned in the Single State Authority for Substance Use Disorder’s Division • This position’s primary role is to develop and maintain relationship with the Medicaid State Authority Division • We had to learn each other’s language: addiction/recovery language is different than Medicaid language

5. Kansas Licensing & VO Credentialing • All SUD Treatment providers must be licensed by the State • VO-KS Credentials only licensed SUD providers into their managed care provider network

6. Integration: State Policy • Integration is created case by case • Grass-roots focus • Process starts in local community with SUD provider connecting to Primary Care or vice versa • Advantage for Primary Care is SUD provider cares for difficult SUD clients • Each entity (i.e. OP SUD and FQHC) must be part of SUD Managed Care network • State’s focus is barrier removal

7. Barrier Removal • Primary Care doesn’t want to do SUD • SUD isn’t connected or always seen as valuable by Primary Care • Most foot work done by SUD • Make Primary Care’s “life” easier by managing SUD patients • Primary Care clinics can typically only bill for one service per visit – we worked to develop policy to allow more than one service per visit • State’s role is to facilitate unique partnerships that work in the community

8. Billing/Payment • Individualized Grass-roots Approach • Encounter based system • Primary Care can contract with SUD and bill for services and pay SUD provider • SUD secures authorization from MCE and provides service • SUD provider submits billing to Primary Care billing staff • Primary Care (enrolled with MCE) bills and is paid by MCE • Primary Care pays SUD provider • OR - Primary Care can hire SUD staff and provide, bill and be paid (but must be licensed by State) • OR SUD could hire Primary Care and provide, bill and be paid (this has not occurred in KS yet)

9. Integrating SUD Services in Primary Care in Kansas 6 easy steps: • Be a licensed/certified SUD provider or sub-contract with one • Be in the ValueOptions Provider Network • Provide the service or provide for the service • Bill and be paid by ValueOptions • ValueOptions will send your encounters to the Medicaid State Authority who will figure and pay the wrap payment • These encounters will become part of the annual settlement

11. Contact Information • State SUD Medicaid Coordinator: Kim Brown • Kim.brown@srs.ks.gov • 785-296-6754 • ValueOptions-KS • http://www.valueoptions.com/kansas/ • Provider Relations Director: Frances Breyne • Frances.breyne@valueoptions.com • 785-338-9012