Opening Doors to Integration: What You Need to Know about Kansas Policies, Credentialing and Reimbursement

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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)

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

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

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

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

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

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)

Integrating SUD Services in Primary Care in Kansas6 easy steps:

1. Be a licensed/certified SUD provider or sub-contract with one

2. Be in the ValueOptions Provider Network3. Provide the service or provide for the service4. Bill and be paid by ValueOptions5. ValueOptions will send your encounters to the Medicaid

State Authority who will figure and pay the wrap payment

6. These encounters will become part of the annual settlement

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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