September 28, 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
New SUD licensure rules
The State Board of Human Services adopted new licensure rules for SUD treatment providers, which will align Office of Behavioral Health licensing standards more closely with the American Society of Addiction Medicine (ASAM) Criteria. Visit the Colorado Department of Human Services webpage and expand the “Laws & Rules Updates” menu for additional information regarding the new SUD licensure rules. Providers seeking Medicaid reimbursement for SUD services must be licensed according to the newly adopted rules.

Residential SUD Provider Training - Oct. 22 and 29 (Please Register)
The Department will host two training sessions focusing on the upcoming residential and inpatient SUD service benefit. Two sessions, both covering the same content, will be offered on Thursday, Oct. 22 from 1 p.m. - 5 p.m. and Thursday, Oct. 29 from 9 a.m. - 1 p.m. The training will cover topics including an overview of the SUD benefit expansion, enrollment with Health First Colorado as a residential/inpatient SUD treatment provider, billing procedures for the new services, ASAM Criteria documentation of medical necessity, utilization management, provider licensure requirements and content provided by RAEs and MSOs for treatment providers. Those interested must register for the training and can visit the Department’s SUD webpage, Ensuring a Full Continuum of SUD Benefits, for additional information. 

Reminder for providers: contact your RAEs and MSOs
The Department strongly encourages treatment providers to contact their Regional Accountable Entities (RAEs) and Managed Services Organizations (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 services and with MSOs, which oversee the reimbursement process for SUD room and board charges.
Coming soon: Residential SUD Provider Manual and revisions to Coding Standards
The Department will release a new Residential SUD Provider Manual, which will cover topics such as member eligibility, provider requirements, provider enrollment procedures, SUD benefit policies and the roles of MSOs and RAEs in benefit management. Additionally, the upcoming revision of the Uniform Service Coding Standards Manual will include pages outlining the new SUD residential and inpatient treatment and withdrawal management services that will be billable starting in January 2021.
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