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This e-Memo is a follow up to e-Memo #18-45 that announced
that the State Register (Volume 42, number 34, Feb. 20, 2018) had posted public notice of the proposed state plan
amendment to the Medical Assistance (Program) to add the substance use
disorder reform new services of peer recovery support services,
care-coordination and comprehensive assessment that passed in the 2017
legislative session. This e-Memo is a follow up to the questions the
Department has received regarding why the proposed care coordination
services reimbursement rate is less than the peer recovery support
services rate.
The proposed state plan
amendment to the Medical Assistance (Program) includes:
1.
Effective for services provided on
or after July 1, 2018, the Department shall pay for peer recovery-support
services provided by a recovery peer to treat substance use disorder, at the
lesser of the provider’s charge, or $15.02 per 15-minute unit. This change is
estimated to result in a net spending increase of $375,000 in the MA program in
state fiscal year 2019.
2.
Effective for services provided on
or after July 1, 2018, the Department shall pay for care-coordination services
provided by a care coordinator to treat substance use disorder, at the lesser
of the provider’s charge, or $11.71 per 15-minute unit. This change is
estimated to result in a net spending increase of $294,000 in the MA program in
state fiscal year 2019.
Peer Support
Services
Minnesota has only previously
reimbursed peer support services for persons with substance use disorder as
part of grant-funded programs and pilots conducted over the last five
years. The reforms passed in 2017 will allow Medicaid to reimburse this
service on or after July 1, 2018. To determine the proposed rate, and in
an effort to keep rates consistent across all types of services, DHS looked to
the payment rate previously approved by CMS for the mental health peer support
service. Substance use disorder peers and mental health peers provide
similar services and both must have training and certification approved by the Commissioner. The rate for comparable peer support services in mental health is $15.02 per 15
minutes.
Care
Coordination Services
Care coordination, (or
treatment coordination) is a new
service provided by an unlicensed staff member, who has a bachelor’s
degree or UMICAD certification, 30 hours of classroom training on care
coordination for an individual with substance use disorder, and 2000 hours of
supervised experience working with individuals with substance use
disorder. This service is a supportive service, assisting the licensed counseling staff in the facilitation and the implementation
of the individual’s treatment plan. The care coordination rate was set at 65%
of the payment rate for the service when provided by a licensed counselor. When
applying the 65% factor, the rate is reduced to $11.71 per 15 minutes.
This is an appropriate rate based on the level of credentialing/licensure
needed for care coordination. The $11.71 per 15 minutes translates to $46.84
per hour.
During the continuum of care pilot, this service was paid at
a rate of $70 per hour. However, during the pilot, the provider of care
coordination services was a licensed SUD counselor. During the course of
continued stakeholder engagement in the community, it was recognized that
certain treatment coordinating tasks could be provided by non-licensed
individuals. In order to avoid over-qualified individuals from providing this
service, it was proposed to lower the credentials for individuals who provide
this service. Because of the reduced qualifications of the care coordinator,
the payment rate was also reduced.
The draft state plan amendment with more detail will be
published shortly. Hopefully, the added detail and context will help answer any
additional questions.
About the e-Memo
The e-Memo is the official communication method for the Alcohol and Drug Abuse Division.
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