Behavioral Health Organizations with spotlight on the Substance Use Disorder (SUD) Benefit
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1 Behavioral Health Organizations with spotlight on the Substance Use Disorder (SUD) Benefit Lindsey S Lambert, LPC, LAC, CACIII Substance Use Coordinator, Colorado Access
2 Objectives Understand: What are Colorado Medicaid s behavioral health system regions What the BHOs do What services and conditions are covered Substance use benefit How to access & coordinate services 2
3 CO Medicaid Mental Health Program Implemented in 1995, expanded in 1998 Behavioral Healthcare Organizations (BHOs) contract to provide services for specified diagnoses and services Medicaid members are automatically enrolled in their BHO based on county of Medicaid enrollment
4 Five BHO Regions
5 BHO Regions Colorado Access (ABC-Denver) Denver Behavioral Healthcare, Inc. (BHI) Adams, Arapahoe, Douglas Northeast Behavioral Health Partnership Colorado Access (ABC--NE) Cheyenne, Elbert, Kit Carson, Larimer, Lincoln, Logan, Morgan, Phillips, Sedgwick, Washington, Weld, Yuma 5
6 BHO Regions Foothills Behavioral Health Partners Jefferson, Boulder, Broomfield, Gilpin, Clear Creek Colorado Health Partnership Alamosa, Archuleta, Baca, Bent, Chaffee, Conejos. Costilla, Crowley, Custer, Delta, Dolores, Eagle, El Paso, Fremont, Garfield, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, Lake, La Plata, Las Animas, Mesa, Mineral, Moffat, Montezuma, Montrose, Ouray, Otero, Park, Pitkin, Prowers, Pueblo, Rio Blanco, Rio Grande, Routt, Saguache, San Juan, San Miguel, Summit, Teller 6
7 BHO Program Services and Coverage 7
8 BHO Program Covered Mental Health Diagnoses 295 Schizophrenia 296/311 Mood disorders 297/8 Delusional/Psychotic disorders 300 Anxiety disorders 301 Personality disorders 307 Eating, elimination, and childhood disorders 308 Acute stress disorder 309 Separation & adjustment disorders, PTSD 312 Impulse control and behavioral disorder 313 Childhood and adolescent disorders 314 Attention disorders Ref: CO Medicaid Bulletin B
9 BHO Program Non-Covered Diagnoses Sexual disorders Autism Developmental disabilities Neurologic mental disorders, dementia Traumatic brain injury BHO is responsible for providing services for covered diagnoses/services if co-occurring with these conditions. 9
10 BHO Program Covered Mental Health Services Medically necessary Assessment, screening and monitoring ( mental health and alcohol/drug) Inpatient, outpatient, emergency/crisis Individual, group, family therapies Psychiatrist, medication services/management, detox Case management Vocational, clubhouse, drop-in, recovery Residential, hospital, respite ACT, home and community (children) Prevention, early intervention (children) Rehabilitative and recovery services 10
11 What do the BHOs do? Care management/coordination, utilization management Grievance and appeals Engage providers Engage consumers, families, stakeholders 11
12 Access to Care Standards Members should be seen within 1 hour of arriving at an Emergency Department Members should be seen within 7 days after a behavioral health hospitalization Myths You can only be seen at your local mental health center for treatment You must have a covered diagnosis to get an assessment 12
13 Substance Use Disorder (SUD) Benefit
14 BHO Program Covered Substance Use Diagnoses Effective January 1, 2014 Two main categories of substance induced disorders Alcohol Related Drug Related DSM V Induced disorders include Intoxication, withdrawal, delirium, other mental disorder, psychotic disorder with delusions/with hallucinations, mood disorder, anxiety disorder, sexual dysfunction, etc. Main categories of substance use disorders Alcohol Drug Dependence DSM V Severity of the disorder in Mild, Moderate and Severe Categories 14
15 BHO Program Covered Substance Use Diagnoses 291/303, 305 * Alcohol Related Disorder 292/304, 305* Amphetamine Related Disorders 292/304, 305* Cannabis Related Disorders 292/304, 305* Cocaine Related Disorders 292/304, 305* Hallucinogen Related Disorders 292/304, 305* Inhalant Related Disorders 292/304, 305* Opioid Related Disorders 292/304, 305* Phencyclidine Related Disorders 292/304, 305* Sedative- Hypnotic Related Disorders 305 Tobacco Use Disorder * Substance Induced/Substance Use Disorders 15
16 What is Covered? Medication Assisted Therapy (MAT) Methadone (only medication covered) Other MAT (ex Suboxone, Naltrexone, Antabuse) covered through pharmacy benefit Social Detox Arapahoe House Denver Cares Outpatient Treatment IOP, CDOP, Relapse Prevention, Therapy Multiple Providers 16
17 What isn t covered? Inpatient substance use treatment IMD Benefit Signal Behavioral Health Court ordered services DUI Education Medications 17
18 Substance Use Providers Largest Providers of both Inpatient & Outpatient Arapahoe House Denver Health ARTS Examples of Outpatient Providers Community Mental Health Centers Arapahoe/Douglas Mental Health Dual Diagnosis Program Coalition for the Homeless Mile High Council IDEA 18
19 BHO Care Management & Collaboration
20 ABC Care Management Every ABC Member has a direct care manager Assigned based on Alpha- Split Automatically involved at hospitalizations, but we are available to every member at any time What we do? Help members access behavioral health and substance use services within our provider network Make referrals to non-bho services such as resources, waivers, pcp Coordinate care across multiple systems Help manage all behavioral health hospitalizations Queue Line: Available 8:00 AM-5:00 PM Monday-Friday for direct access to any ABC care manager (Press 3) there is no prompt. 20
21 Collaboration Outside of the BHO (ABC), Colorado Access provides Care Management for several other products including: Regional Care Collaborative Organization (RCCO) 2,3,5 Access Long Term Support Solutions (ALTSS) HCBS Waiver Access Advantage (Medicare) Child Health Plan Plus (CHP+) Members can often have 1 or more of these products together Care Managers collaborate to have one point of contact and coordinate care 21
22 How Members are Assigned Manager: Paula Jung ABC Denver Care Managers Alpha Split (based on the last name of the member) ABC NE Care Managers Adult Care Managers A - H Bryce Hogle (720) Bryce.Hogle@coaccess.com I P Ryan Law (720) Ryan.Law@coaccess.com Q - Z Ryan Orsak (720) Ryan.Orsak@coaccess.com Child Care Managers A - F Kimberly Lambert (720) Kimberly.Lambert@coaccess.com G - M Jill Ferretti (720) Jill.Ferretti@coaccess.com N - Z Cristy Davis (720) Cristina.Zeier@coaccess.com Subrena Moore Subrena.Moore@coaccess.com Touchstone Mental Health. Larimer County catchment area Deborah Edsall deborah.edsall@coaccess.com Centennial Mental Health. 10 county catchment area Cheyenne, Elbert, Lincoln, Logan, Kit Carson, Morgan, Phillips, Sedgwick, Washington, Yuma Elissa Unger Elissa.Unger@coaccess.com North Range Behavioral Health. Weld County catchment area 22
23 Questions? Lindsey Lambert, LPC, LAC, CACIII
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