Take Note
Quarterly Provider Forum: Time for PROVIDER FEEDBACK. Please register for the Upcoming VIRTUAL SUD Provider forum coming up April 3, 2023. This space is designed for all SUD providers to share challenges and ask questions about Medicaid coverage of SUD services.
- This quarter a review of Colorado’s 1115 SUD Waiver “Expanding the Substance Use Disorder Continuum of Care” will be provided and provider feedback for the mid-point assessment is needed.
- Provider feedback is also needed for planning a transition to a collaborative BHA/HCPF facilitated meeting for SUD providers to address a broader variety of provider concerns.
Guest Dosing Guidance for Opioid Treatment Programs (OTP): Every once in a while a member may need to travel further away than is practical to get to their usual OTP. For a member who needs to receive OTP services on a brief temporary basis, there would not be a change in provider. Instead, an OTP that would be closer may serve the member as a guest for that brief period. In addition to the two OTP providers communicating to arrange clinical care, there is also a need for the temporary provider to contact the member’s MCE (Managed Care Entity [RAE or MCO]) as outlined below to ensure prompt reimbursement for the covered temporary services delivered including abbreviated evaluation, dosing and management of care during the “guest” period.
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If the temporary provider is already contracted with the member’s MCE network: The in-network Medicaid provider does not need to make further arrangements with the MCE, beyond clinical care coordination between providers.
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If the temporary provider is not contracted in the member’s MCE network: The out-of-network Medicaid provider needs to contact member’s MCE to inform them that the provider will give guest dosing to their member. Temporary providers should contact the MCE in advance to define service and duration. Note that the reimbursement timeline may be affected if contact is made less than 10 days in advance.
