Substance Use Disorder Reform-Treatment Coordination

Charlie Mishek| Alcohol and Drug Abuse Division

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Welcome

• Please mute microphones with *6.

• If you have questions during the presentation please use the Q&A section of the WebEx found in the upper right hand corner of your screen.

• If you have any technical difficulties please send your comments to “Brytanie Mertes” by selecting her name from the drop down menu in the Q&A section.

• If you are using your computer speakers and have trouble hearing the volume, we recommend participating with a telephone line. Teleconference call information is available in the event info section of the WebEx.

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Welcome (cont.)

• YourOpinionMatters.DHS@state.mn.us and put “SUD Reform" in the subject line.

Submit questions or comments following the WebEx

Request a presentation about SUD reform (e.g. regional provider meetings, provider/county meetings, etc.)

Provide suggestions for future WebEx topics

• This presentation will be made available on our SUD Reform Page at our website: DHS Website. The presentation will include notes with the slides for additional information on the material.

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E-MEMO and Website Resources

• Visit our website to sign up for the e-memo to receive updates from the Alcohol and Drug Abuse Division.

• SUD Resources are posted on the SUD Reform Page at our website: DHS Website

• We are encouraging participants to review the SUD Reform e-memos and website resources available on the website prior to attending the WebEx's. These materials provide basic information that is helpful to understand reform and its implications.

• Broadcasts will allow participants to submit questions for clarification if what is presented is unclear, although complex or situation-specific questions that are submitted will be responded to through frequently updated FAQs and will be used to inform future WebEx content.

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Website Resources (cont.)

• SUD Treatment Coordination (PDF & Audio)

• Comprehensive Assessment/Direct Access (PDF & Audio)

• Direct Reimbursement (PDF & Audio Recordings)

• Peer Recovery Support (PDF & Audio Recordings)

• Withdrawal Management (PDF & Audio Recordings)

• New Services in 2017 SUDReform Legislation

• SUD Reform ImplementationTimeline

• Rule 31 to 245G Table ofLegislative Changes

• 2017 session law: BillLanguage (Article 8)

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SUD Treatment Coordination

• Individuals with SUD often experience needs in other life areas (e.g. medical, mental health, family, employment, criminal justice, housing, finances), and SUD treatment coordination addresses these issues concurrently to improve treatment outcomes.

• SUD treatment coordination is defined at 245G.07, subdivision 1, paragraph (a), clause (6).

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SUD Treatment Coordination (cont.)

• Adds SUD treatment coordination to the Medicaid benefit set on July 1, 2018, or upon federal approval, whichever is later, and directs the Department to seek this approval.

• Intend service to be billable in 15 minute increments. Staff credentials to be lower than what is required for other SUD treatment services.

• We do expect a lower reimbursement rate for SUD treatment coordination than is currently available for an individual SUD counseling session by a licensed professional.

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Rule 31 to 245G

Treatment coordination provider qualifications (245G.11, subdivision 7).

This subdivision is entirely new, describing the qualifications for a treatment coordinator, which is a position that exists to support the delivery of services over a longer period and help connect the client to other services that the client will need to truly build a self-directed recovery process. There will need to be training for these care coordinators and ongoing supervision, so they can extend the support needed by clients as they move forward on the path of recovery.

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SUD Treatment Coordination (cont. 2)

• SUD treatment coordination is defined at 245G.07, subdivision 1, paragraph (a), clause (6) and includes:

1. Assistance in coordination with significant others to help in the treatment planning process whenever possible;

2. Assistance in coordination with and follow-up for medical services as identified in the treatment plan;

3. Facilitation of referrals to substance use disorder services as indicated by the client’s medical provider, comprehensive assessment, or treatment plan;

4. Facilitation of referrals to mental health services as identified by a client’s comprehensive assessment or treatment plan;

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SUD Treatment Coordination (cont. 3)

5. Assistance with referrals to economic assistance, social services,housing resources, and prenatal care according to the client’sneeds;

6. Life skills advocacy and support accessing treatment follow-up,disease management, and education services, including referral andlinkages to long-term services and supports as needed, and

7. Documentation of the provision of SUD care coordination servicesin the client’s file.

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SUD Treatment Coordination Provider Qualifications

• An individual is qualified to provide SUD treatment coordination if theindividual:

1. is skilled in the process of identifying and assessing a wide range of clientneeds;

2. is knowledgeable about local community resources and how to use thoseresources for the benefit of the client;

3. has successfully completed 30 hours of classroom instruction on SUD carecoordination for an individual with substance use disorder;

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SUD Treatment Coordination Provider Qualifications (cont.)

4. has either:

a. a bachelor's degree in one of the behavioral sciences or related fields; or

b. current certification as an alcohol and drug counselor, level I, by the UpperMidwest Indian Council on Addictive Disorders; and

5. has at least 2,000 hours of supervised experience working withindividuals with substance use disorder.

A care coordinator must receive at least one hour of supervision regarding individual service delivery from an alcohol and drug counselor weekly.

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SUD Treatment Coordination-Eligible Vendor

• Licensed SUD programs

• Licensed withdrawal management programs

• Licensed professionals in private practice that meet the credentialrequirements for direct reimbursement

• Counties

• Counties and individuals getting direct reimbursement are not required tohave an SUD or WM program license to provide this service.

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Treatment Coordination Questions-1

• If the County has an LADC on staff and they are providing treatmentcoordination, would they need to have weekly supervision by anLADC?

• Please refer to 254B. 05. If the LADC, themself, is providing thetreatment coordination, no; but if the county has peoplemeeting the qualifications of a treatment coordinator on staffthat are the ones actually providing the treatment coordination,yes.

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Treatment Coordination Questions-2

• I'm concerned with the answer about rural MN's work force issues.Without LADC's we have no one to supervise the treatmentcoordination, so access is clearly going to be an issue. Regional Directorshave indicated they will leave it all to providers.

• Supervision is a required part of any clinical service. Treatment Coordinators couldbe supervised not only by an LADC, but also by a clinician who meets the criteria in245G.11, subd. 5. Supervision may also be delivered via an appropriatetelemedicine arrangement. While some counties may choose to “leave it to theproviders,” many counties may choose to provide Comprehensive Assessments andtreatment coordination because funding will become available for providing thisservice.

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Treatment Coordination Questions-3

• Why are the reimbursement rates and qualifications for ServiceCoordination lower than those for LADC's? Wouldn't it run the risk thatthe quality of services provided would not be sufficient to accomplishthe mission of the position?

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Treatment Coordination Questions-4

• The term “service coordination” and “treatment coordination” refer to twodistinctly different services. Service Coordination has historically referred tothe case management activities performed by an LADC, and continues tohave that meaning, but to avoid confusion, the term “service coordination”no longer exists in 245G. It is described as a required counseling service in245G.07, subpt 1. and is reimbursed as a treatment service at the same rateas any other treatment service. Treatment Coordination is an adjunctive,supportive service to assist the LADC, and many of the services that comprisetreatment coordination do not need the scope of practice of an LADC. Therates we believe would be appropriate for a supportive, adjunctive serviceprovided by a person with lesser credential would therefore be lower thanthe rates for a clinical service provided by a licensed professional.

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Treatment Coordination Questions-5

• Would the 30 hour training we received for Rule 25 work for the trainingof treatment coordination?

• This will need to be examined in more detail, but as the existing 30 hour Rule 25training exists, probably not, unless there was a fair amount of additional contentadded, and some existing content eliminated as 30 hours of training aroundassessment does not address the same activities as would be part of providingtreatment coordination.

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Treatment Coordination Questions-6

• Can we use outside sources for treatment coordination that arealready providing these services in the community?

• If these outside sources met the criteria, yes.

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Treatment Coordination Questions-7

• Regarding treatment coordination provider qualifications. How do youpurpose that we (in rural MN) find a person who has thesequalifications? We have been looking for a 2nd LADC since fall of 2016and can't find someone to fill this position.

• Rural workforce shortages, particularly for LADCs, remains challenging. We hopethe new Treatment Coordinator's credential requirements make these positionseasier to fill than those of LADCs.

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Treatment Coordination Questions-8

• Will reimbursement for treatment coordination only be for individualswho are CCDTF eligible?

• Once treatment coordination is added to the state’s Medicaid benefit set, it will bereimbursable to individuals who access CCDTF funds, including those on Medical Assistancefee-for-service, as well as those enrolled in a PMAP.

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Q&A

Thank you!

Thank You

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