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Drug & Alcohol

RCPA has received notice that the long-awaited psychiatric outpatient regulations have been posted for comment. RCPA has been fighting long and hard for the regulatory changes that appear to be in this document and will be creating a task force to fully and comprehensively analyze the proposed document in the next weeks. In the meantime, RCPA is asking members to hold “wish” requests and concentrate on the previous work of the RCPA Stakeholder Work Group from 2014, before submitting anything other than supportive comments. Please contact Sarah Eyster for more information.

The Department of Human Services proposes to amend 55 Pa. Code Chapters 1153 and 5200 relating to outpatient behavioral health services and psychiatric outpatient clinics. The proposed rulemaking was published in the Pennsylvania Bulletin on August 12, 2017, and can be accessed here.

Written comments, suggestions, or objections regarding this proposed rulemaking may be submitted to the Office of Mental Health and Substance Abuse Services, Attention: Michelle Rosenberger, Bureau of Policy, Planning and Program Development, Commonwealth Towers, 11th Floor, 303 Walnut Street, PO Box 2675, Harrisburg, PA 17105-3675 or by email during the 30-day comment period which closes on September 11, 2017.

August 17, 2017
3:30 – 5:00 pm ET

Presenters:

  • Mitchell Berger, SAMHSA
  • Peggy O’Brien, IBM Watson Health
  • Colleen LaBelle, Boston University Medical Center
  • Mark Stringer, Missouri Department of Mental Health
  • Molly Carney, Evergreen Treatment Services

Register for free
The webinar will cover a forthcoming update to the 2014 SAMHSA report on Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders and will review information on state Medicaid payment policies for medication assisted treatment (MAT).  Speakers also will present case studies of innovative MAT models. This up-to-date information about Medicaid MAT coverage will be helpful for consumers and family members, providers, health plan and Medicaid staff, policymakers and government officials.
After this webinar, participants will:

  • Understand how MAT currently is covered under Medicaid at the state level
  • Understand barriers to MAT coverage and possible actions to improve coverage
  • Be able to describe some innovative financing models

Questions? Send via email.
Disclaimer: This webinar is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views and opinions expressed and the content of the webinar are those of the participants and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.

The Centers for Medicare and Medicaid Services (CMS) is interested in launching a new payment model that will target behavioral health services and is seeking public comment on what the new effort should look like. On Thursday, July 20 CMS announced that its Innovation Center would like to design a payment or service delivery model to improve health care quality and access for Medicare, Medicaid, or Children’s Health Insurance Program beneficiaries with behavioral health conditions. The model may address the needs of beneficiaries battling substance use or mental health disorders; it could also target Alzheimer’s disease and related dementias. The Innovation Center will be soliciting ideas at a public meeting on Friday, Sept 8 at CMS headquarters in Baltimore. More information about the effort and registration for the meeting is available online.

RCPA is hosting a free educational webinar on the Federal ORP (order, refer, or prescribe) Requirements on Wednesday, August 16, 2017, 1:00 pm – 3:00 pm. The webinar will be presented by David C. McAdoo, MBA, Executive Director, Southwest Behavioral Health Management, Inc. and Jamie Buchenauer, Director, Bureau of Fee for Services. Registration is required. Please register here to participate.

The Affordable Care Act requires all physicians including psychiatrists, physician assistants, and certified registered nurse practitioners to directly enroll in PA State Medicaid (PROMISe) to order, refer, or prescribe medications, testing, services, or other items billed to Medicaid. Any MD acting as the Medical Director in a licensed substance abuse or mental health facility must meet this requirement for the facility to bill Medicaid. Specifically, each psychologist, MD, CRNP, or PA touching the PA State Medicaid program must have at least one PROMISE ID under the NPI number on their license.

This webinar will address the requirement, the specific services that are covered, documentation that must be collected, the modifications needed in claims to bill Medicaid moving forward, and strategies for maintaining patient safety and uninterrupted access to medication and services during the transition to full compliance with this new requirement.

Outline

  • Introductions
  • Overview of Goals
    1. Understand the purpose of the ORP
    2. Understand which medical licenses are covered under the ORP
    3. Understand which medications, labs, services, and other benefits are covered under the ORP
    4. Understand the impact of the ORP on Medicaid and Medicare access to:
      1. Medications
      2. Lab Testing
  • PH Testing
  1. Behavioral Health Services
    • BHR Services
    • Peer Support and Psych Rehab
    • Family Based
    • BH services with an identified “medical director”
  • Understand the technical requirements for paper and electronic claim submission compliance with the ORP
  • Identify the changes and/or modifications needed in BH services to document ORP compliance
  • Identify the actions that are needed to assure all clients have uninterrupted access to BH and all prescribed medications
  • Review the timelines for ORP implementation in PA