Nov. 16, 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
SUD Provider Manual
The Residential SUD Provider Manual is now available on the Department’s SUD web page, Ensuring a Full Continuum of SUD Benefits. The manual covers member eligibility, provider requirements, provider enrollment procedures, SUD benefit policies, the roles of Regional Accountable Entities (RAEs) and Managed Services Organizations (MSOs) in benefit management and coding pages for the new services. Additionally, the upcoming revision of the Uniform Service Coding Standards Manual released in January 2021 will include the coding pages outlining the new SUD residential and inpatient treatment and withdrawal management services that are found in the SUD Provider Manual.

Provider Training
The Department, in collaboration with the RAEs, MSOs and the Colorado Office of Behavioral Health (OBH), hosted two provider-centered trainings on Oct. 22 and 29 covering topics related to the implementation of the SUD benefit expansion. Recordings of the October 29 session will be posted on the Department’s SUD web page, Ensuring a Full Continuum of SUD Benefits, and can be found at the links below. The recordings are divided into three sections, as follows:

Part 1: Training Overview, SUD Benefit: Current and Future, ASAM Criteria and Medical Necessity, Utilization Management
Part 2: Provider Requirements, OBH SUD Provider Licensure, Medicaid Provider Enrollment, RAE Presentation
Part 3: MSO Presentation, Coding and Billing Procedures, Facilitation of Medication Assisted Treatment

Reminder for providers: contact your RAEs and MSOs
The Department strongly encourages treatment providers to contact RAEs and MSOs to ensure contracting and credentialing processes are in place before the SUD residential/inpatient benefit is in place on Jan. 1, 2021. Providers must be contracted with RAEs to receive Medicaid reimbursement for residential and inpatient SUD treatment and withdrawal management services. In order to receive reimbursement for room and board, residential providers must also contract with the MSOs.  

Provider Enrollment - Enrollment portal for the new SUD benefit available November 5
In order to bill for residential SUD treatment services starting January 1, residential providers will need to be enrolled with Health First Colorado as an SUD Clinic (Provider Type 64) and each specialty provider type associated with the ASAM level(s) of care for which they are licensed. Starting November 5, providers are able to enroll as the new
specialty types in the provider web portal. The codes by ASAM level are as follows:

Implementation Plan Submission to CMS
On Nov. 2, the Department submitted its Implementation Plan to the Centers for Medicare and Medicaid Services (CMS). The Implementation Plan is a required component of the 1115 SUD demonstration application process.
Helpful Links