September 8, 2020
This newsletter provides implementation updates from the Department of Health Care Policy & Financing (the Department) on House Bill (HB) 18-1136 and is distributed periodically during the benefit development process.
Information for Providers
Contact Regional Accountable Entities (RAEs) and Managed Services Organizations (MSOs)
In order to receive Medicaid reimbursement for residential and inpatient SUD services in Colorado, providers must be contracted and credentialed with the Regional Accountable Entities. The Department encourages treatment providers to contact the RAEs and Managed Services Organizations to initiate contracting at this time if they have not already done so. MSOs will oversee the reimbursement process for room and board charges associated with SUD services.

Resources and training opportunities for treatment providers
Program staff are finalizing a Provider Manual and revising the Uniform Service Coding Standards Manual to include coding pages for the new SUD residential and inpatient services that will be billable in 2021. The Department and RAEs will also be offering training opportunities for providers this fall. These trainings will include information on how to enroll with Health First Colorado as a residential/inpatient SUD provider, how to bill for the new services, how to use the American Society of Addiction Medicine (ASAM) Criteria to document medical necessity and other topics. Please watch this space for announcements about upcoming training.
Federal Authorities for expanded SUD service continuum
The Department is actively engaged with the Centers for Medicare and Medicaid Services (CMS) in discussions pertaining to the three federal authorities which apply to the SUD treatment benefits: the 1115 SUD demonstration waiver application, Medicaid State Plan amendments (SPA) and the 1915(b)(3) waiver. Progress toward approvals are currently on track for a January 2021 benefit expansion.
Preparation for benefit implementation
Rate Development for the SUD residential benefit portion of the Behavioral Health Capitation will be complete in September. System changes to allow for billing of new services in 2021 are underway and the provider portal will open for enrollment this Fall. Rule changes to reflect coverage of residential and inpatient SUD services are in process. The Department is also developing plans for monitoring the utilization of SUD services and evaluating their effectiveness.
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