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VIRGINIA MEDICAIDADDICTION AND RECOVERY TREATMENTSERVICES (ARTS)OFFICE BASED OPIOID PROVIDER (OBOT)PAYMENT MODEL3rd Annual Mental Health SummitMay 9, 20171
Virginians Covered by Medicaid and CHIP1 in 8 Virginians rely onMedicaidMedicaid covers 1 in 3births in VirginiaMedicaid is the primary50% of Medicaidpayer for behavioralhealth servicesbeneficiaries are children2 in 3 nursing facilityresidents are supported byMedicaid62% of long-term servicesand supports spending is inthe communityMedicaid plays a critical role in the lives of over 1 million Virginians12
Virginia Medicaid: Enrollment and ExpendituresEnrollment vs. Expenditure SFY 2016100%80%Parents,Caregivers &PregnantWomen12%28%20%Children in LowIncome Families60%40%20%0%1.3 M49%49%17%Older Adults19%6%EnrollmentIndividuals withDisabilitiesEnrolled 8.41 BSpentExpenditures23% of the Medicaid populationDrives68% of total expendituresExpenditures are disproportionate to population where services for older adults andindividuals drive a significant portion of Medicaid costs23
Medicaid Members with Substance UseDisorder DiagnosisSource: Department of Medical Assistance Services – claims/encounter data (November 3, 2016).Circles # of Medicaid recipients whose claims/encounter data included an addiction related diagnosis.4
Communities Impacted by AddictionSource: Department of Medical Assistance Services – claims/encounter data (November 3, 2016) and 2010 U.S.Census Bureau Population.Circles % of Medicaid recipients whose claims/encounter data included an addiction related diagnosis respectiveto the total population in that zip code.5
Addiction and Recovery TreatmentServices (ARTS) BenefitChanges to DMAS’s Substance Use Disorder (SUD) Servicesfor Medicaid and FAMIS Members1Expand short-term SUD inpatient detox to all Medicaid /FAMIS members2Expand short-term SUD residential treatment to all Medicaid members3Increase rates for existing Medicaid/FAMIS SUD treatment services4Add Peer Support services for individuals with SUD and/or mental health conditions5Require SUD Care Coordinators at DMAS contracted Managed Care Plans6Provide Provider Education, Training, and Recruitment Activities6
Transforming the Delivery System forCommunity-Based SUD ementARTS4/1/17PeerRecoverySupportsEffective July 1, 2017Magellan will continue tocover community-basedsubstance use disordertreatment services for feefor-service membersAll CommunityBased SUDServices areCovered byManaged CarePlansA fully integratedPhysical andBehavioral HealthContinuum of Care
DMAS ADDICTION AND RECOVERYTREATMENT SERVICESOverview of ASAM Levels of Care8
ASAM Continuum of Care9
ASAM LOC Placement4Medically Managed Intensive Inpatient3.7Medically Monitored Intensive InpatientServices (Adult)Medically Monitored High-Intensity InpatientServices (Adolescent)3.5Clinically Managed High-Intensity ResidentialServices (Adults) / Medium Intensity(Adolescent)3.3Clinically Managed Population-Specific HighIntensity Residential Services (Adults)10VDH/DBHDS/DHP License Acute Care General Hospital(12VAC5-410) Freestanding Psychiatric Hospital with a DBHDS MedicalDetoxification License or Managed Withdrawal License; Inpatient Psychiatric Unit with a DBHDS Medical DetoxificationLicense or Managed Withdrawal License; Substance Abuse Residential Treatment Services (RTS) foradults/children with a DBHDS Medical Detoxification License; Residential Crisis Stabilization Unit with a DBHDS MedicalDetoxification License; Substance Abuse Residential Treatment Services (RTS) for Womenwith Children with a DBHDS Medical Detoxification License; Level C or Mental Health Residential Children with a substanceabuse residential license and a DBHDS Medical Detox license; Managed Withdrawal-Medical Detox Adult Residential TreatmentService (RTS) License; or Medical Detox/Chemical Dependency Unit for Adults. Substance Abuse Residential Treatment Services (RTS) for Adultsor Children; Freestanding Psychiatric Hospital or Inpatient Psychiatric Unit thathave substance abuse on their license or within the “licensed asstatements”; Substance Abuse RTS for Women with Children; Substance Abuse and Mental Health Residential TreatmentServices (RTS) for Adults that have substance abuse on theirlicense or within the “licensed as statements.”; or Level C or Mental Health Residential Children that have substanceabuse on their license or within the “licensed as statements.” Medical Detox License required for 3.2 WM
ASAM LOC Placement3.1Clinically Managed Low-Intensity ResidentialServices2.5Partial Hospitalization Services2.1Intensive Outpatient Services1Outpatient Services0.5Early InterventionOpioid Treatment Program (OTP)Office-Based Opioid Treatment (OBOT)11VDH/DBHDS/DHP License Substance Abuse Residential Treatment Services (RTS) for Adults; Substance Abuse Residential Treatment Services (RTS) for Womenwith Children; Substance Abuse and Mental Health Residential TreatmentServices (RTS) for Adults that have substance abuse on theirlicense or within the “licensed as statements.” or Level C or Mental Health Residential Children that have substanceabuse on their license or within the “licensed as statements.” Medical Detox License required for 3.2 WM Substance Abuse or SA/Mental Health Partial Hospitalization (2.5) Outpatient Managed Withdrawal Service Licensed required for2WM Substance Abuse Intensive Outpatient for Adults, Children andAdolescents (2.1) Outpatient Managed Withdrawal Service Licensed required for2WM Outpatient Services (Agency Option) Individual or Groups of Licensed Clinicians N/A; All Licensed Providers Medication Assisted Treatment/Opioid Treatment Services Buprenorphine Waivered Practitioners and Licensed Behavioral HealthPractitioners
Benefits of ASAM for ProvidersUniform Attestation to Apply with Health Plans and Magellan All health plans and Magellan are using uniform attestation based onASAM to credential providers at all ASAM Levels of CareUniform Patient Assessment/ Service Authorization One uniform form based on ASAM for providers to request serviceauthorization for all ASAM Levels 2.1 to 4.0 recognized by all healthplans and Magellan No service authorization for ASAM Level 1.0 Outpatient, OpioidTreatment Program, Office-Based Opioid Treatment Provider, or ASAMLevel 0.5 SBIRT Health plans and Magellan will review service authorization within 72hours with retroactive authorization to facilitate immediate access Level 4.0 inpatient detox and residential treatment services arereviewed within 24 hours12
DMAS ADDICTION AND RECOVERYTREATMENT SERVICESARTS Provider Qualifications13
Provider Qualifications for ARTS Services“Addiction Credential Physicians” have achieved professional recognition inthe treatment of addiction and have been certified for their expertise intreating addiction by one of the following three pathways: Any physician who has completed an addiction medicine fellowship or met othereligibility criteria and then by examination, received certification and diplomatestatus from the American Board of Addiction Medicine; or Psychiatrist who completed a fellowship in addiction psychiatry and then byexamination, became certified by the American Board of Psychiatry andNeurology; or Doctor of osteopathy (DO) who received certification in addiction medicinethrough examination and certification by the American Osteopathic Association. In situations where a certified addiction physician is not available, physicianstreating addiction should have some specialty training and/or experience inaddiction medicine or addiction psychiatry. If treating adolescents, they shouldhave experience with adolescent medicine.“Physician Extenders” are licensed nurse practitioners and physician assistants.14
Provider Qualifications for ARTS ServicesCredentialed Addiction Treatment Professionals Addiction-credentialed physicians or physicians with experiencein addiction medicine Licensed psychiatrists Licensed clinical psychologists Licensed clinical social workers Licensed professional counselors Licensed psychiatric clinical nurse specialists Licensed psychiatric nurse practitioner Licensed marriage and family therapist Licensed substance abuse treatment practitioner15
Provider Qualifications for ARTS ServicesCredentialed Addiction Treatment Professionals “Residents” under supervision of licensed professional counselor,licensed marriage and family therapist or licensed substanceabuse treatment practitioner approved by the Virginia Board ofCounseling “Residents in psychology” under supervision of a licensed clinicalpsychologist approved by the Virginia Board of Psychology “Supervisees in social work” under the supervision of a licensedclinical social worker approved by the Virginia Board of SocialWork Individual with certification as a substance abuse counselor(CSAC) or certified substance abuse counselor-assistant (CSAC-A)under supervision of licensed provider and within scope ofpractice16
DMAS ADDICTION AND RECOVERYTREATMENT SERVICESMedication Assisted Treatment(MAT): Covered Medications, RateStructure, and Office-Based OpioidTreatment Providers17
Medication Assisted TreatmentDefinition and Evidence The use of medications in combination with counseling and behavioral therapiesfor the treatment of substance use disorders. Use of MAT for opioid use disorder leads to successful recovery rates of 40-60%,compared to 5-20% with abstinence-only models MAT can be provided by: Opioid Treatment Providers (OTPs) – CSBs and private providers licensed byDBHDS Office-Based Opioid Treatment (OBOT) providers – primary care clinics, FQHCs,outpatient psychiatry clinics, physician’s offices; no DBHDS license required Length of treatment is based on patient’s changing multidimensional risk profile.ARTS Benefit Supports Comprehensive MAT Increases rates by 400% for individual and group counseling Allows OTPs and OBOT providers to bill for care coordination and peer supports Allows providers to bill separately for MAT when members are receiving treatmentin community based ASAM levels 1, 2.1, 2.5, 3.1, 3.3, 3.5, and 3.7.18
Medications Available for MedicationAssisted Therapy for all SUDsPrior one andBuprenorphine (for pregnant women only)Induction (7 days) – noInitiation ( 7 days) andMaintenance – yesNaltrexone Long-Acting InjectionNoMethadoneNaltrexone (oral)NaloxoneDisulfiramAcamprosate19No (for opioid use disorder)NoNoNoNoNote: Prior Authorizations are not required for buprenorphine/naloxone orbuprenorphine provided by OBOTs or OTPs (if dispensed on-site at OTPs).
Opioid Overdose Fatality PreventionIncrease Access to Naloxone FFS and Managed Care Plans Expanded Naloxone Coverage Prior Authorization not required for Naloxone injection Naloxone (Narcan )nasal spray20
OTP vs. OBOT LicensingOpioid Treatment Services (OTPs) are licensed by DBHDS Methadone and buprenorphine products are dispensed on site; and Treatment is combined with outpatient services such as counseling sessions(required) assessments, therapy, psychotherapy, etc; and The physician is operating within/under a DBHDS licensed entity.OBOTs do not need a DBHDS OTP/MAT license Are providing opioid treatment under the license of a buprenorphine-waiveredpractitioner; Will not be dispensing methadone or other opioid treatment medication on site orwill only dispense buprenorphine products during induction, and; Will provide prescriptions for buprenorphine products to patients after the induction.OTPs need to also be recognized as an OBOT to be exempt from PriorAuthorization for prescriptions of buprenorphine products21
MAT Payment Model for OTPs and lingMethadone in OpioidTreatment Programs(OTPs)Buprenorphine in OpioidTreatment Program (OTPs)DBHDS-Licensed CSBs andPrivate Methadone ClinicsH0014 MAT InductionCPT E/M Code: Established PatientH0004 / H0005 Opioid Treatment - individual, groupcounseling and family therapyH0020 – Medication administration by RN / LPNRN Induction LPN MaintenanceMedication2222J0572, J0573, J0574, J0575Buprenorphine/Naloxone OralS0109 Methadone 5 mgbilled by provideroral billed by providerJ0571 Buprenorphine Oralbilled by providerBuprenorphine in OfficeBased Opioid Treatment(OBOTs)Primary Care and otherPhysician Offices, FQHCs,etc.H0014 MAT InductionCPT E/M Code: Est PtH0004 / H0005 OpioidTreatment - individual,group counseling and familytherapyPatient given Rx; billed byPharmacy
MAT Payment Model for OTPs and OBOTsServiceDescriptionMethadone in OpioidTreatment Programs(OTPs)Buprenorphine inOpioid TreatmentProgram (OTPs)CareG9012 Substance Use Care CoordinationCoordinationPeerSupportsUrine DrugScreenLabs2323Buprenorphine in OfficeBased Opioid Treatment(OBOTs)G9012 Substance Use CareCoordinationT1012 Peer Support ServicesS9445 Peer Patient Education - GroupT1012 Peer Support ServicesS9445 Peer PatientEducation - Group80305-8030780305-80307Examples: Hepatitis B Test (86704), Hepatitis C test(86803), HIV Test (86703), Syphilis Test (86593),Treponema Pallidum (86780), Syphilis Test NonTreponema (86592), Pregnancy Test (81025), Skin TestTuberculin (86585), EKG (93000, 93005, 93010),Alcohol-Breathalyzer (82075)Examples: Hepatitis B Test(86704), Hepatitis C test(86803), HIV Test (86703),Pregnancy Test (81025), SkinTest-Tuberculin (86585)
MAT Reimbursed SeparatelyMAT ServicesPhysician/NPVisitPsychotherapyfor MATMedicationsUrine drugscreensLabs24Procedure CodeASAMASAM Level ASAM LevelLevel 2.13.1 RTS3.3 RTSand 2.5ASAM Level3.5 RTSASAM Level 3.5Inpt Psych Unit(sub-acute)ASAMLevel3.7RTSASAM Level3.7 InptPsych Unit(sub-acute)E&M CodesYesYesYesYesYesYesYesCPT sYesYesYes Prescriptionfilled atPharmacy Pharmacy Bills Dispensed on site HCPCS CodesYesYesYesYesNoYesNo80305 - 80307YesYesYesYesNoYesNoCPT CodesYesYesYesYesNoYesNo
Opioid TreatmentService Description Medication Administration (H0020 OTP only) Psychosocial Treatment for Opioid Use Disorder that includes at a minimum thefollowing components (H0004 individual / H0005 group) Assessment of psychosocial needs Supportive individual and/or group counseling Linkages to existing family support systems Referrals to community-based services Care coordination, medical/prescription monitoring, and coordination of on-siteand off-site treatment servicesProvider Requirements Provider Types for Psychosocial Treatment Credentialed Addiction Treatment Professionals Provider Types for Medication Administration Induction phase of MAT must be provided by Registered Nurse. Maintenance phase of MAT may be provided by Licensed Practical Nurse orRegistered Nurse.25
Substance Use Care Coordination G9012Service Description Integrates behavioral health into primary care and specialty medical settings throughinterdisciplinary care planning and monitoring patient progress and tracking patientoutcomes. Supports interdisciplinary team meetings with medical and behavioral health staff to developand monitor individualized treatment plans. Links patients community resources (including NA, AA, peer recovery supports, etc.) tofacilitate referrals and respond to social service needs. Tracks and supports patients when they obtain medical, behavioral health, or social servicesoutside the practice. This code must be billed with moderate to severe Opioid Use Disorder as the primarydiagnosis by a buprenorphine-waivered practitioner prescribing MAT to the patient.Provider Requirements26 At least a bachelor's degree in one of the following fields (social work, psychology, psychiatricrehabilitation, sociology, counseling, vocational rehabilitation, human services counseling)and has at least one year of substance abuse related clinical experience providing directservices to persons with a diagnosis of mental illness or substance abuse; or Licensure by the Commonwealth as a registered nurse with at least one year of clinicalexperience; or An individual with certification as a substance abuse counselor (CSAC) or CSAC-Assistantunder supervision .
Rate Structure for OTPs and OBOTsCodeServiceMedication AssistedH0014 Treatment (MAT)inductionMedicationH0020 Administration (OTPonly)H0004Opioid TreatmentServicesOpioid TreatmentH0005ServicesG901227Substance Use CareCoordinationUnitRate/UnitAlcohol and/or drug services;ambulatory detoxificationWithdrawal ManagementInductionPerencounter 140 8Opioid Treatment – individualand family therapyPerencounter1 unit 15 minDescriptionRN / LPN medication dosageOpioid Treatment – grouptherapySubstance Use CareCoordination1 unit 15min (perpatient)1 unit 1month 24 7.25 243
“Gold Card” OBOT Providers Recognizedby DMAS and Credentialed by Health PlansCare Team Requirements Buprenorphine-waivered practitioner may practice in variety of settings suchas CSBs, FQHCs, primary care clinics, outpatient clinics, psychiatry practices On site credentialed addiction treatment professional (licensed psychiatrist,licensed clinical psychologist, licensed clinical social worker, licensedprofessional counselor, licensed psychiatric clinical nurse specialist, a licensedpsychiatric nurse practitioner, a licensed marriage and family therapist,licensed substance abuse treatment practitioner) providing counseling topatients receiving MATMAT Requirements28 Buprenorphine monoproduct tablets prescribed only to pregnant women. Maximum daily buprenorphine/naloxone dose 16 mg unless documentation ofongoing compelling clinical rationale for higher dose up to maximum of 24 mg. No tolerance to other opioids, soma, sedative hypnotics, or benzodiazepinesexcept for patients already on benzos for 3 months during a tapering plan
“Gold Card” OBOT Providers Recognizedby DMAS and Credentialed by Health PlansRisk Management and Adherence Monitoring Requirements Random urine drug screens, a minimum of 8 times per year for all patients.Virginia Prescription Monitoring Program checked at least quarterly for all patients.Opioid overdose prevention education including the prescribing of naloxone.Patients seen at least weekly by buprenorphine-waivered practitioner or credentialed addictiontreatment professional when initiating treatment. Patient must have been seen for at least 3months with documented clinical stability before spacing out to a minimum of monthly visits. Periodic utilization of unused medication and opened medication wrapper counts when indicated.Benefits No Prior Authorizations required for buprenorphine products. Buprenorphine-waivered practitioner in the OBOT can bill all Medicaid health plans for substanceuse care coordination code (monthly per member payment) for members with moderate to severeopioid use disorder receiving MAT. Can bill for Certified Peer Recovery Support specialists. Can bill higher rates for individual and group opioid counseling. Buprenorphine waivered residents can complete structured moonlighting experiences under thesupervision of a credentialed attending physician.29
OBOT: Possible Models for WaiveredPractitioner Integrated Behavioral HealthWaivered Practitioner Behavioral Health Professional Employed by Same Site FQHC, CSB, or outpatient clinic employs both the buprenorphine-waiveredpractitioner AND behavioral health professional to offer MAT for opioid use disorder Services would be billed through the physicianWaivered Practitioner On-site at Behavioral Health Clinic Waivered physician goes on-site to private or public behavioral health provider 2-3xper week to provide MAT Services would be billed through the physicianBehavioral Health Professional On-Site at Physician’s Office Behavioral health professional (LCSW, LPC, etc.) goes on-site to psychiatrist’s office orprimary care clinic 2-3x per week to provide MAT Services would be billed through the physician30
Buprenorphine Prior AuthorizationRequirementsUniform Requirements Adopted by FFS and Health Plans thatAlign with the Board of Medicine Buprenorphine Regulations Diagnosis of Opioid Use Disorder, and 16 years of age; andPrescriber’s personal DEA and XDEA numbers are required; andIndividual is participating is psychosocial counselingMaximum of 16 mg per dayInitial authorization for 3 months; subsequent authorizations for 6 monthsNo set time limit or duration of treatmentBuprenorphine only products for pregnant womenPatient is locked-in to prescribing physician and dispensing pharmacyNo concurrent use with benzodiazepines, tramadol, carisoprodol, other opiates or sedativehypnotics Urine drug testing at least quarterly31
GOVERNOR’S ACCESS PLAN FOR THESERIOUSLY MENTALLY ILL (GAP)GAP and ARTS32
So what is GAP?Governor’s Access Plan for the Seriously Mentally Ill A targeted benefit packagefor uninsured, low incomeVirginians who have aserious mental illness (SMI).CMS Approved §1115Demonstration WaiverLaunched in January 2015 The GAP provides basicmedical and targetedbehavioral health careservices through anintegrated and coordinateddelivery model to qualifyingindividuals with SMI.33Expanding eligibility and ARTSbenefits October 2018Extended until December 2019
Eligibility & EnrollmentRequirementsAges 21 through 64U.S. Citizen or lawfully residing immigrantNot eligible for any existing entitlement programResident of VAIncome below 80%* of Federal Poverty Level (FPL) (*80% 5% disregard)- Increasing to 100% FPL October 1, 2017UninsuredDoes not reside in long term care facility, mental health facility or penal institutionScreened and meet GAP SMI criteriaFinancialcriteria34GAP SMIcriteriaGAPApplicationprocess
GAP Delivery SystemGAP leverages the DMAS established infrastructure to administer the GAP program Utilizes the same formulary as Medicaid Utilizes existing Medicaid fee-for-service provider networks,coverage rules and reimbursement policies Medical service authorization performed by KePRO Behavioral health including ARTS network management, serviceauthorizations, and claims managed by Magellan of Virginia,DMAS’ Behavioral Health Services Administrator (BHSA). GAP eligibility is based on SMI diagnoses. However a GAPmember experiencing SUD can receive ARTS Services - ARTSBillable Services must include the SUD diagnosis as primary.35
GAP Covered BenefitsIntegrating care coordination, primary care, specialty care,pharmacy and behavioral health servicesOutpatient MedicalOutpatient Behavioral HealthPrimary & Specialty CareGAP Case ManagementPharmacyCrisis Intervention and StabilizationLaboratoryDiabetic SuppliesDiagnostic Services/Physician’s officeOutpatient hospital coverage limited to: diagnosticultrasound, diagnostic radiology (including MRIand CAT) and EKG including stressPsychiatric Evaluation, Management and TreatmentPsychosocial RehabilitationPeer Supports- Recovery NavigationEffective July 1, 2017 – MH Peer SupportsAddiction and Recovery Treatment ServicesCurrently Covered:Outpatient Substance Use Disorder (SUD) TreatmentServicesSubstance Use Intensive OutpatientMedication Assisted Treatment including OTP and OBOTs36Effective July 1, 2017 - SUD Peer SupportsEffective October 1, 2017 – Partial Hospitalization(ASAM Level 2.5) and Community Based Residential(ASAM Level 3.1, 3.3, 3.5 and 3.7)
GAP Resources 24/7 toll-free line for For assistance with: To learn more about GAP &GAP members toapplications andGAP educational material-obtain informationrenewals over the phonewww.dmas.virginia.gov GAP Care Manager Questions about Questions about(800) 424-4279 or (800)application status,covered/non-covered424-GAP9coverage or benefitsservices– DMAS provider Recovery Navigation To report changes,helpline (800) 552-8627Line (800) 424-4520especially address Questions about the GAPchanges (855) 869-8190program email:BridgetheGAP@dmas.virginia.gov37
DMAS ADDICTION AND RECOVERYTREATMENT SERVICESProvider Education and ARTSProvider Manual Trainings38
ARTS Provider Education, and TrainingPartnership of DMAS, Department of Behavioral Health andDevelopmental Services, and Virginia Department of Health Over 800 providers attended 12 DMAS “ARTS 101” in-personsessions across the Commonwealth in the Fall, and anadditional 140 providers attended ARTS webinars. Over 750 physicians, NPs, PAs, behavioral health clinicians, andpractice administrators attended VDH Addiction DiseaseManagement trainings Over 500 providers attended DBHDS trainings on ASAMpatient placement criteria Over 800 providers attended 10 “ARTS provider manualtrainings”39
DMAS ADDICTION AND RECOVERYTREATMENT SERVICESPreliminary Increase in MedicaidAddiction Treatment Providers Dueto ARTS40
Preliminary Increases in AddictionProviders Due to ARTSAddiction Provider TypeInpatient Detox (ASAM 4.0)Residential Treatment(ASAM 3.1, 3.3, 3.5, 3.7)Partial HospitalizationProgram (ASAM 2.5)Intensive OutpatientProgram (ASAM 2.1)Opioid Treatment ProgramOffice-Based OpioidTreatment Provider41# of Providersbefore ARTS# of Providersafter ARTS% Increase inProvidersUnknown86NEW471 1675%14NEW4970 43%22 267%031NEW06
ARTS Medicaid Provider Network AdequacyASAM 4 Inpatient DetoxSource: Department of Medical Assistance Services - Provider Network data (March 10, 2017).Circles # of Medicaid providers included in network adequacy access calculation.Accessible is considered to be at least two providers within 60 miles of driving distance.Driving distance is calculated by Google services based on the centroid of each zip code.42
Before ARTS Medicaid Provider Network AdequacyResidential TreatmentSource: Department of Medical Assistance Services - Provider Network data (March 20, 2017).Circles # of Medicaid providers included in network adequacy access calculation.Accessible is considered to be at least two providers within 60 miles of driving distance.Driving distance is calculated by Google services based on the centroid of each zip code.43
After ARTS Medicaid Provider Network AdequacyASAM 3.1/3.3/3.5/3.7 Residential TreatmentSource: Department of Medical Assistance Services - Provider Network data (March 10, 2017).Circles # of Medicaid providers included in network adequacy access calculation.Accessible is considered to be at least two providers within 60 miles of driving distance.Driving distance is calculated by Google services based on the centroid of each zip code.44
*NEW* ARTS Medicaid Provider Network AdequacyASAM 2.5 Partial HospitalizationSource: Department of Medical Assistance Services - Provider Network data (March 10, 2017).Circles # of Medicaid providers included in network adequacy access calculation.Accessible is considered to be at least two providers within 60 miles of driving distance.Driving distance is calculated by Google services based on the centroid of each zip code.45
Before ARTS Medicaid Provider Network AdequacyIntensive Outpatient ProgramsSource: Department of Medical Assistance Services - Provider Network data (March 20, 2017).Circles # of Medicaid providers included in network adequacy access calculation.Accessible is considered to be at least two providers within 60 miles of driving distance.Driving distance is calculated by Google services based on the centroid of each zip code.46
After ARTS Medicaid Provider Network AdequacyASAM 2.1 Intensive OutpatientSource: Department of Medical Assistance Services - Provider Network data (March 10, 2017).Circles # of Medicaid providers included in network adequacy access calculation.Accessible is considered to be at least two providers within 60 miles of driving distance.Driving distance is calculated by Google services based on the centroid of each zip code.47
Before ARTS Medicaid Provider Network AdequacyOpioid Treatment ProgramSource: Department of Medical Assistance Services - Provider Network data (March 20, 2017).Circles # of Medicaid providers included in network adequacy access calculation.Accessible is considered to be at least two providers within 60 miles of driving distance.Driving distance is calculated by Google services based on the centroid of each zip code.48
After ARTS Medicaid Provider Network AdequacyOpioid Treatment ProgramSource: Department of Medical Assistance Services - Provider Network data (March 20, 2017).Circles # of Medicaid providers included in network adequacy access calculation.Accessible is considered to be at least two providers within 60 miles of driving distance.Driving distance is calculated by Google services based on the centroid of each zip code.49
*NEW* Medicaid Provider Network AdequacyOffice Based Opioid TreatmentSource: Department of Medical Assistance Services - Provider Network data (March 10, 2017).Circles # of Medicaid providers included in network adequacy access calculation.Accessible is considered to be at least two providers within 60 miles of driving distance.Driving distance is calculated by Google services based on the centroid of each zip code.50
CSBs and ARTSCSB Unique Provider/Locations in ARTs51
Resources DMAS ARTS Provider Manual Virginia Administrative Codes-regulations forcommunity based substance abuse services The ASAM Criteria; Treatment Criteria forAddictive, Substance –Related and Co-OccurringConditions, 3rd edition, 2013 ASAM Guidelines and Consensus elines-and-consensusdocuments/the-asam-criteria52
QUESTIONSFor more information, please nia.gov/Content pgs/bhsud.aspx53
In 2015 close to 70% of members were served in managed care. With the implementation of MLTSS, this will close to 90% served \൩n managed care. \爀屲To fully integrate physical and behavioral health services for individuals with SUD and expand access to the對 full continuum of services, DMAS plans to "carve in" non-traditional SUD .
