What’s New 

Coverage for Partial Hospitalization Program (PHP) Services begins July 1, 2024 

Beginning July 1, 2024, Health First Colorado (Colorado’s Medicaid program) will cover ASAM Level 2.5 Partial Hospitalization Program (PHP) services. Partial hospitalization programs provide 20 hours or more of clinically intensive programming each week to support patients who are living with an SUD condition and an unstable medical and/or psychiatric condition in need of daily monitoring and management in a structured outpatient setting.  

SUD providers who currently offer PHP services, or are interested in adding PHP level of care, are encouraged to reach to your Managed Care Entities regarding contracting and reimbursement.  

SUD Provider Engagement Opportunities 

HCPF wants to ensure that SUD providers understand that under new Behavioral Health Administration (BHA) rules, SUD is included as part of behavioral health. You are invited to all behavioral health stakeholder meetings, such as crisis services, safety net services, etc. See the list of SUD Provider Engagement Opportunities posted on the HCPF SUD webpage.  

Follow up Notes from the April 3rd SUD Provider Forum 

HCPF hosted a quarterly SUD Provider Forum on April 3rd and follow up notes are posted on the SUD webpage. The next SUD Provider Forum will be on Wednesday, July 3rd. The agenda will be posted on the webpage in early June. Register via Zoom.  

Take Note

1115 Waiver Amendment Submitted April 1  

HCPF is requesting to the Centers for Medicare and Medicaid Services (CMS) an amendment to Colorado’s Expanding the Substance Use Disorder Continuum of Care Section 1115 demonstration waiver (1115 SUD waiver).  

HCPF has submitted the amendment to CMS on April 1, 2024, in accordance with HB23-1300. The amendment request would authorize:  

• Continuous eligibility for two populations:  
• Children ages 0-3  
• Adults leaving a Colorado Department of Corrections (DOC) facility;  
• Prerelease services for individuals transitioning from correctional facilities; and  
• Reimbursement for acute inpatient and residential stays in institutes for mental disease (IMD) for individuals diagnosed with a serious mental illness (SMI) or serious emotional disturbance (SED). 

For additional information and the full amendment please visit the 1115 SUD website or contact hcpf_1115waiver@state.co.us 

Proposed Health Related Social Needs Amendment to the 1115 SUD Waiver 

HCPF is pursuing a Health-Related Social Needs (HRSN) 1115 demonstration waiver amendment earlier than anticipated, with authority through House Bill 24-1322 “Medicaid Coverage Housing & Nutrition Services”. If approved, the HRSN 1115 waiver amendment will expand health related social needs (HRSN) housing and nutrition services and supports for certain eligible Health First Colorado (Colorado’s Medicaid program) members. This is in addition to the 1115 waiver amendment submitted to the Centers for Medicaid and Medicare (CMS) on April 1, 2024. 

Debunking Myths & Misinformation About Health First Colorado

Did you know...

Procedure code H2036 is used to bill for ASAM level 3.1, 3.3, 3.5, and 3.7 services. This per diem could include services such as:  

• Substance use disorder assessment 
• Individual and family therapy 
• Group therapy 
• Alcohol/drug screening counseling 
• Service planning 
• Discharge planning 

Medication Assisted Treatment (MAT), medication management and psychological evaluations are the only services that may be billed separately on the date a per diem treatment code is billed. The allowable codes are H0020, H0033, H0034, 96372, 96116, 96121, 96130, 96131, 99218-99220, 90792, and 90785. Medication products such as buprenorphine are billed through Medicaid fee-for-service.