DHSS News Promoting the health and well-being of Alaskans. June 2019

Section 1115 Medicaid Waiver: New substance use disorder treatment services

In 2018 the Division of Behavioral Health began working on redesigning the state’s behavioral health system with a vision of providing Alaskans with a comprehensive suite of cost-effective, high quality behavioral health services to ensure access to the right services, at the right time, in the right setting.

A key tool being used in the redesign is the U.S. Department of Health and Human Services’ Section 1115 Medicaid Demonstration Project which provides states with flexibility to test new approaches within Medicaid to redesign, build and expand the behavioral health treatment framework. Alaska has applied for an 1115 Behavioral Health Medicaid Waiver to focus on improving services for Alaskans experiencing serious mental illness, severe emotional disturbance, substance use disorder (SUD), co-occurring substance use and mental illness, and at-risk families and children.

In March, one part of the 1115 Medicaid Waiver – the substance use component – received approval from the Centers for Medicare and Medicaid Services (CMS). This approval allows the division to move forward with addressing gaps in services for substance use disorder by providing Medicaid coverage for upstream prevention efforts in the areas of improved screening, referral, treatment and recovery support. The remaining portions of the 1115 waiver are still under review by CMS.

Key strategies identified for the substance use component include:

  • Universally screening all Medicaid recipients to identify symptoms of substance use disorder and intervene early.
  • Implementing Screening, Brief Intervention and Referral to Treatment (SBIRT) in 10 hospital emergency departments to identify, reduce and prevent problematic use, abuse and dependence on alcohol and illicit drugs.
  • Implement the American Society of Addiction Medicine’s (ASAM) Criteria to match people to appropriate services and tools necessary for recovery.
  • Increase SUD treatment options for youth (ages 12-17) and adult (ages 18-64) Medicaid recipients.
  • Improve infrastructure and capacity of SUD providers using industry-recognized standards for certification and accountability.
  • Elevate the SUD workforce to increase the number of qualified addiction professionals.

Implementation of the SUD component is anticipated to begin July 1, 2019 with a rollout to providers by region. While many treatment options for substance use disorder are currently covered by Medicaid, the waiver aims to increase the continuum of treatment choices for substance use disorder, as well as bolster the capacity of providers to offer those services.  The following newly-approved treatment services will be covered by Medicaid to address the complex behavioral health needs of Alaskans suffering from addiction:

  • Intensive Outpatient Program (IOP): Structured programming services, 9-19 hours per week for adults (6-19 hours for adolescents), focused on major lifestyle, attitudinal and behavior issues that impair the person’s ability to cope with major life tasks without use of substances.
  • Partial Hospitalization Program (PHP): Clinically intensive outpatient programming for 20 or more hours per week that address the same issues of IOP but also have the capacity to treat individuals with substantial medical and psychiatric problems.
  • Residential: Evaluation, observation, medical monitoring and addiction treatment services provided in an in-patient, 24-hour supportive living environment.
  • Withdrawal management: Assessment, supervision, observation, and support services provided in ambulatory, clinically managed or medically monitored settings depending on the level of the individual’s need.
  • Community Recovery Support Services: Counseling and wraparound support for newly recovering people to prevent relapse and promote recovery.

In preparation for the implementation of the new SUD plan, the Division of Behavioral Health has been conducting meetings statewide with providers to share information about the changes and to gather feedback. Training is being delivered to emergency department staff on SBIRT and to Medicaid providers on universal screening tools. Guidance is also being provided on new regulations and Medicaid billing procedures.

For more information about the 1115 Section Waiver, including the approved SUD implementation plan, visit the DHSS web page or stay up-to-date on the latest news by subscribing to e-newsletters on the topic.

 

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