Medicated Assisted Treatment (MAT) Terry R. Jones Director of Behavioral Health

What is MAT? Whole-patient approach to the treatment of substance use disorders Use of medications, in combination with counseling and behavioral therapies Spectrum of care encompassing both detoxification and maintenance Potentially combats pain and addresses co-occurring psychiatric illness 2

Our Commitment to MAT Strong provider network Defined clinical guidelines Clear provider expectations Commitment to access and quality care for members Reduce Fraud, Waste, and Abuse 3

Our Commitment to MAT We know where our opiate dependent members are We are proactive and diligent in our analysis to meet need –Consumer populations (Suboxone users) –Provider caseloads (Suboxone prescribers) –By county –Urban vs. rural Goal is to anticipate gaps in our provider network and bridge them Recruit new providers as needed (Gold Card) Careful, strategic and ongoing process to know the supply and demand 4

Our Commitment to Providers: Gold Card Defines standards for Suboxone-prescribing providers Establishes provider performance criteria Overrides PA requirements for Suboxone- prescribing physicians Recognizes the commitment required by providers that deliver MAT to an opioid- dependent population Puts our trust in our Suboxone-prescribing providers 5

CareSource Provider Standards for Suboxone Review the state’s prescription monitoring program monthly See MAT members at least monthly for the first 3 months and at least every 2 months thereafter Maximum prescribing dosage of 24mg/day Develop a treatment plan based on the member’s particular problems and needs Ensure member engagement in therapeutic counseling Obtain and review urine screening or other tests if specifically indicated 6

CareSource Provider Standards for Suboxone Refrain from billing members directly for any reason Refrain from establishing waivers with members agreeing to alternate payment arrangements, cash, or otherwise Continually assess for the potential of drug interactions Recognize potentially problematic situations as a result of pregnancy, psychiatric or medical comorbidities 7

CareSource: Monitoring of Provider Performance Special Investigations Unit (SIU) will audit prescribing physicians’ compliance with the Drug Addiction Treatment Act of 2000 (DATA) and address physicians who do not meet criteria SIU will investigate all allegations of prescribers charging Medicaid members cash –Confirmed allegations will result in a written notice and providers have the opportunity to correct the situation –Continued violations may result in contract termination SIU will analyze data for any fraud, waste, and abuse SIU will continually look for opportunities for improvement 8

CareSource: Billing Expectations Bill treatment using the standard office E & M codes, pharmacologic management, or individual psychotherapy with E & M codes Bill associated counseling using standard individual management counseling codes If individual counseling codes are billed, the E & M code or pharmacologic management code should not be billed and will not be reimbursed If counseling is referred outside the office, only E & M or pharmacologic management codes should be billed Refrain from billing members directly for any reason 9

CareSource: Expertise & Resources Strength in 25 years of experience Established community relationships and partnerships Strong connections for referrals to ancillary resources Over 1,000,000 members Knowledge in Continuum of Care: Wellness to Acute intensive Access to the spectrum of Behavioral Health services CareSource24® staffed with nurses around the clock Behavioral Health crisis line with 24/7 Online provider portal for ease of information access 10