COMPLETE BLOCKS 6 THRU 10 IF THIS IS AN AMENDMENT Separate transmittal for each amendment. b FFY
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1 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES 1 TRANSMITTAL NUMBER 2 STATE FORM APPROVED OMB NO TRANSMITTAL AND NOTICE OF APPROVAL OF STATE PLAN COLORADO MATERIAL FOR CENTERS FOR MEDICARE MEDICAID SERVICES 3 PROGRAM IDENTIFICATION TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAID TO REGIONAL ADMINISTRATOR CENTERS FOR MEDICARE MEDICAID SERVICES DEPA RTMENT OF HEALTH AND HUMAN SERVICES 5 TYPE OF PLAN MATERIAL Chek One 4 PROPOSED EFFECTIVE DATE NEW STATE PLAN AMENDMENT TO BE CONSIDERED A A NEW PLAN X AMENDMENT COMPLETE BLOCKS 6 THRU 10 IF THIS IS AN AMENDMENT Separate transmittal for eah amendment 6 FEDERAL STATUTEREGULATION CITATION 7 FEDERAL BUDGET IMPACT a FFY CFR 440 d130 b FFY PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT 9 PAGE NUMBER OF THE SUPERSEDED PLAN SECTION OR ATTACHMENT if Appliable Attahment Methods and Standards for Attahment Methods and Standards for Establishing Payment Rates Outpatient Substane Establishing Payment Rates Outpatient Substane Abuse Treatment Abuse Treatment TN Sy pp Umero Afti h 3 LAxnt b AMOLY JECT OF AMENDMENT Methods and standards for establishing payment rates for outpatient substane abuse treatment July 2010 Rate Change 11 GOVERNOR S REVIEW Chek One GOVERNOR SOFFICE REPORTED NO COMMENT COMMENTS OF GOVERNOR SOFFICE ENCLOSED NO REPLY RECEIVED WITHIN 45 DAYS OF SUBMITTAL X OTHER AS SPECIFIED Governor s letter dated 29 July SIGNATURE STATE AGENCYOFFiCtAt 16 RETURN TO 13 TYPED NAME i I Colorado Department of Health Care Poliy and Finaning 1570 Grant Street Robert C Douglas Denver CO TITLE Attn David Smith Legal Division Diretor 15 DATE SUBMITTED b6 FOR REGIONAL OFFICE USE ONLY 17 DATE RECEIVED 18 DATE APPROVED fo PLA APPROVED ONE COPY ATTAC 19 EFFECTIVE DATE OF APPROVED MATERIAL 20 S TYRE OF REGIONAL OFFICIAL j 21 TYPED NAME 2 TI E 23 REMARKS FORM CMS Instrutions on Bak
2 Attahment METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES OUTPATIENT SUBSTANCE ABUSE TREATMENT Outpatient substane abuse treatment servies shall be reimbursed at the lower of the following I Submitted harges or 2 Marketbased fee shedule as determined by the Department of Health Care Poliy and Finaning based on an analysis of private setor behavioral health are management orporation reimbursement rates and reimbursement rates of similar servies overed by the Department Reimbursable outpatient substane abuse treatment servies shall inlude the following 1 Substane abuse assessment A maximum of three sessions shall be reimbursed per 2 Individual and family therapy where one unit of servie equals fifteen minutes A maximum of four units shall be reimbursed per session and a maximum of 25 sessions shall be reimbursed per 3 Group therapy where one unit of servie equals one hour A maximum of three units shall be reimbursed per session and a maximum of 36 sessions shall be reimbursed per 4 Alohol drug sreening A maximum of 36 speimen olletions shall be reimbursed per Targeted ase management where one unit of servie equals fifteen minutes A maximum of eight units of servie shall be reimbursed per date of servie and a maximum of 36 ontats shall be reimbursed per 6 Soialambulatory detoxifiation exluding room and board for a maximum of seven days per fisal year Soialambulatory detoxifiation inludes the following servies a Physial assessment of detoxifiation progression where one unit of servie equals fifteen minutes A maximum of three units of servie shall be reimbursed per date of servie b Evaluation of level of motivation for treatment where one unit of servie equals fifteen minutes A maximum of three units of servie shall be reimbursed per date ofservie Safety assessment inluding suiide ideation and other mental health issues where one unit of servie equals fifteen minutes A maximum of three units of servie shall be reimbursed per date of servie TN No Approval Date Supersedes TN No Effetive Date 710 r
3 Attahment METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATES OUTPATIENT SUBSTANCE ABUSE TREATMENT CONTINUED d Provision of daily living needs where one unit of servie equals fifteen minutes A maximum of three units of servie shall be reimbursed per date of servie Exept as otherwise noted in the State Plan state developed fee shedule rates are the same for both governmental and private providers Reimbursement rates for dates of servie on or after July for these servies an be found on the offiial Web site ofthe Department of Health Care Poliy and Finaning at www olorado govhpf TN No Approval Date Supersedes TN No Effetive Date 710
4 Supplement to Attahment 31 A LIMITATIONS TO CARE AND SERVICES Item 13d Rehabilitative Servies ontinued Substane Abuse Treatment Servies Outpatient substane abuse treatment servies are provided to all Mediaid lients based on medial neessity Approved servies must be offered in failities that have been liensed by the Alohol and Drug Abuse Division ADAD of the Department of Human Servies or by physiians or other identified liensed pratitioners of the healing arts liensed and ertified by the Department of Regulatory Agenies DORA or nationally liensed and ertified by the National Assoiation of Alohol and Drug Abuse Counselors NAADAC the Amerian Soiety of Addition Mediine ASAM or the Amerian Board of Psyhiatry and Neurology ABPN 1 Liensed pratitioners inlude a Psyhologist PhD Dotoral degree from an aredited program offering psyhology ourses approved by the Amerian Psyhologial Assoiation and liensed by the State Board of Psyhologist Examiners with ertifiation in addition ounseling b Nurse Pratitioner Registered Nurse with a master degree in Nursing liensed by DORA as an advaned pratie nurse and ertified in addition ounseling Liensed Clinial Soial Worker LCSW Master sdegree from an aredited graduate program offering full time ourse work approved by the Counil on Soial Work Eduation liensed as an LCSW by DORA and ertified in addition ounseling d Liensed Professional Counselor LPC Holds a master or dotoral degree in professional ounseling from an aredited ollege or university liensed by DORA and ertified in addition ounseling e Marriage and Family Therapist Master degree from a graduate program with ourse study aredited by the Commission on Areditation for Marriage and Family Therapy Eduation liensed by DORA and ertified in addition ounseling f Liensed Addition Counselor LAC Holds a master degree in the healing arts Liensed in addition ounseling by NAADAC National Board for Certified Counselors NBCC 2 Allowable servies inlude a Substane abuse assessment An evaluation designed to determine the level of drug or alohol abuse or dependene and the omprehensive treatment needs of a lient Assessment is limited to three sessions per This servie an be provided by all liensed pratitioners identified above b Individual and family therapy Therapeuti substane abuse ounseling and treatment servies with one lient per session Family therapy will be diretly related to the lient s treatment for substane abuse or dependene Individual and family therapy is limited to TN No Approval Date W11 Supersedes TN No Effetive Date 710
5 Item 13d Rehabilitative Servies ontinued LIMITATIONS TO CARE AND SERVICES Supplement to Attahment 31 A 25 sessions at 15 minutes per unit four units one hour per session per This servie an be provided by all liensed pratitioners identified above Group therapy Therapeuti substane abuse ounseling and treatment servies with more than one lient One unit of servie equals one hour and a maximum of three units shall be reimbursed per session A maximum of 36 sessions shall be reimbursed per state fisal year This servie an be provided by all liensed pratitioners identified above d Alohol drug sreening ounseling Counseling servies provide in onjuntion with the olletion of urine to test for the presene of alohol or drugs Alohol drug sreening ounseling is limited to 36 speimen olletions per This servie an be provided by all liensed pratitioners identified above e Soialambulatory detoxifiation Soialambulatory detoxifiation servies exlude room and board and are limited to a maximum of seven days per These servies an be provided by all liensed pratitioners identified above Soial ambulatory detoxifiation inludes the following servies and limitations i Physial assessment of detoxifiation progression where one unit of servie equals fifteen minutes A maximum of three units of servie shall be reimbursed per date of servie ii Evaluation of level of motivation for treatment where one unit of servie equals fifteen minutes A maximum of three units of servie shall be reimbursed per date ofservie iii Safety assessment inluding suiide ideation and other mental health issues where one unit of servie equals fifteen minutes A maximum of three units of servie shall be reimbursed per date of servie iv Provision of daily living needs where one unit of servie equals fifteen minutes A maximum of three units of servie shall be reimbursed per date of servie TN No Approval Date Supersedes TN No Effetive Date 710
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