Tags Posts tagged with "ASAM Transition"

ASAM Transition

DDAP Modifies ASAM Transition Web Page, Archives Addendums That Outlined IOP Ratio and Daily Therapeutic Hour “Expectations”

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) has overhauled its ASAM Transition web page, removing previous references to “expectations for contractual compliance” in areas of ASAM Criteria where DDAP originally went beyond the Criteria as explicitly written. Newly revised information, including an updated “Guidance for the Application of The American Society of Addiction Medicine, 3rd Edition, 2013 in the Pennsylvania Substance Use Disorder Treatment System for Adults” and “ASAM Frequently Asked Questions” document, references the 1:15 intensive outpatient (IOP) counselor-to-patient ratio and the six to eight daily therapeutic hours at residential level of care as a DDAP “recommendation.”

The change is significant because, according to the Pennsylvania Department of Human Services (DHS) Office of Mental Health and Substance Abuses Services (OMHSAS), per its HealthChoices Behavioral Health Program Standards and Requirements for Primary Contractors document, “the Primary Contractor and its BHMCO must ensure that the SUD providers in the network comply with program standards in the ASAM Criteria, included but not limited to admission criteria, discharge criteria, interventions/types of services, hours of clinical care, and credentials of staff as set forth in the ASAM transition requirements found at https://www.ddap.pa.gov/Professionals/Pages/ASAM-Transition.aspx.” In other words, providers were expected to be in compliance with any information published as an expectation on that page.

For months following DDAP’s testimony in Commonwealth Court that the IOP and daily therapeutic overreaches were simply “guidelines,” the provider community remained unclear on whether they would be required to comply with the “guidelines” as part of their contracts with the BHMCOs. Still, providers have not yet seen the evaluation tool that will be used to audit their compliance with ASAM Criteria despite DDAP’s expectation that they be “substantially aligned” with those Criteria by Jan. 1, 2022.

The Pennsylvania Department of Human Services (DHS) is making available for public review and comment the proposed renewal application for the extension of the Section 1115 Medicaid Demonstration titled “Medicaid Coverage for Former Foster Care Youth from a Different State and SUD Demonstration” (Project Number: 11-W-003083/3). The effective dates of the current approved demonstration are October 1, 2017, through September 30, 2022. The extension requested will be for an additional five years, through September 30, 2027.

In 2016, the CMS Medicaid and CHIP Managed Care Final Rule eliminated Pennsylvania’s ability to use $55 million in federal funding to pay for residential SUD treatment. However, the Commonwealth was able to preserve the funding through an approved Section 1115 Waiver Demonstration. It is within this waiver that Pennsylvania committed to transitioning to ASAM Criteria as a condition for approval of the waiver.

The following links provide information regarding this extension request, extension application, public input process, schedule of public hearings, and other relevant information:

Photo by Markus Winkler on Unsplash

Following the Commonwealth Court’s decision to deny the Drug and Alcohol Service Providers Organization of Pennsylvania’s (DASPOP) request for a preliminary injunction against key pieces of the ASAM transition, the Department of Drug and Alcohol Programs (DDAP) participated in RCPA’s Drug and Alcohol Committee meeting on Tuesday, Dec. 14. You can read the court’s opinion here.

Despite establishing a deadline by which providers must align with the ASAM Criteria, including the “PA-Specific Alignment Requirements,” and in particular referencing the changes in IOP ratio, daily therapeutic hours, and credentialing as “PA-Specific Alignment Requirements” of the ASAM transition on its website, DDAP argued in court that these are “guidelines,” not requirements. The challenge for providers, however, is that the single county authorities (SCAs) and behavioral health managed care organizations (BHMCOs) have signaled all along that they will require providers to comply with these pieces of the ASAM transition through contracts. Now, DDAP’s pivot to calling them “guidelines” has created confusion among providers and payers. RCPA has contacted each of the five BHMCOs and the Pennsylvania Association of County Drug and Alcohol Administrators (PACDAA) to ask whether DDAP’s testimony and the court’s decision will change their approach to enforcing the guidelines/mandates in question through their contracts. We will pass along any relevant information we may receive. In addition, DDAP told us it will be issuing guidance and clarification on these guidelines right before or after the new year.

At RCPA’s D&A Committee meeting last week, DDAP Deputy Secretary Ellen DiDomenico explained how ASAM explicitly defines its criteria versus DDAP’s interpretation of that criteria and what it is now calling recommended guidelines. For example, while the ASAM Criteria explicitly calls for daily clinical hours, DDAP has established six to eight daily therapeutic hours as the application of ASAM’s criteria in Pennsylvania. As DDAP has communicated all along, Deputy Secretary DiDomenico explained that if providers can demonstrate the ability to provide individualized care in ways other than what DDAP “recommends,” it will consider those.

DDAP also said at the meeting that nothing has changed with the court’s decision, which we would interpret to mean that unless a provider has been approved to provide care in a way other than what DDAP recommends, providers must be aligned with their guidelines by Jan. 1, 2022. For example, unless a provider has been approved to provide intensive outpatient services at a ratio other than 1:15, that provider must meet the 1:15 guideline. DDAP also said at the meeting that it is working with the MCOs and SCAs to develop a monitoring tool with the goal being development of a collaborative monitoring process so that providers will not need to be monitored for ASAM alignment by multiple payers. Deputy Secretary DiDomenico also said that monitoring of ASAM compliance would focus on ASAM Criteria as explicitly written in the ASAM Criteria 3rd Edition.

Lastly, House Bill 1995, which would have forced DDAP to go through the regulatory review process any time it made changes that affect licensed addiction treatment providers, has stalled in the Senate. After sailing out of the House of Representatives on a timeline that would have enabled it to pass the Senate and land on the governor’s desk before Jan. 1, the Senate Health and Human Services Committee did not take up the bill for vote. With the General Assembly recessed through the end of the year, there is no possibility of HB 1995 providing relief to providers on the confusion around these ASAM guidelines before Jan. 1.

Given the contradictions and confusion, we will share any guidance we get from DDAP as soon as we get it. Please contact RCPA Drug and Alcohol Division Director Jason Snyder with any questions.

Photo by Joakim Honkasalo on Unsplash

Tomorrow’s hearing on the request for a preliminary injunction against the ASAM transition in the lawsuit filed against the Department of Human Services and the Department of Drug & Alcohol Programs by the Drug and Alcohol Service Providers Organization of Pennsylvania (DASPOP) will be live-streamed here.

The hearing is set for 10:00am Thursday, Oct. 28 in Courtroom 3001, 3rd Floor of the Pennsylvania Judicial Center, 601 Commonwealth Avenue, Harrisburg.

The Drug & Alcohol Service Providers Organization of Pennsylvania (DASPOP) has sued the Department of Drug and Alcohol Programs (DDAP) and the Department of Human Services (DHS) in the Commonwealth Court of Pennsylvania, calling DDAP’s and DHS’s transition to ASAM from the Pennsylvania Client Placement Criteria (PCPC) unlawful and unconstitutional. DASPOP is seeking injunctive relief that prevents DDAP and DHS from enforcing or moving forward with the ASAM alignment and other aspects of the ASAM transition until the formal regulatory review process required by Pennsylvania law has been completed.

Further, the lawsuit asks the court to declare that DHS, as administrator of Pennsylvania’s Medical Assistance program, is required to use PCPC in making addiction treatment placement, continued stay, and discharge decisions, and to prohibit DHS from using or requiring the use of ASAM Criteria 3rd Edition.