1. Methadone and Managed Care
KDADS/BHS Presentation
March 2015

2. Continuum of Services in Kansas
All services are all based on clinical need/medical necessity and providers must obtain authorization to provide the services.
Assessment
Outpatient
Intensive outpatient
Reintegration
Social detox
Intermediate
Overnight boarding for children in residential services at the designated women’s programs
Sub-acute detox
Peer Support Services
There are 267 licensed SUD treatment providers across the state. Of these 267, forty three providers, with a total of 103 locations statewide, are designated to provide BHS funded treatment services. These providers offer a range of funded services including assessment, outpatient, intensive outpatient, reintegration, social detox, and intermediate. Licensed programs must have Licensed Addiction Counselors provide the services per Statute. Medicaid funded providers are able to offer and bill for Medicaid case management. These services are all based on clinical need/medical necessity and providers must obtain authorization to provide the services. All are publically funded by the BG, MCD, or both.
March 2015

3. Methadone clinics in Kansas
KDADS/BHS licenses 9 methadone clinics throughout the State.
Only one receives public funds.
Clinics have the capacity to serve a total of 2850 clients.
The one publically funded clinic has the capacity to serve 600 each day.
November 11, 2018

4. Drug of Choice
This data comes from the KCPC which all publically funded programs must use. As you can see there are 816 clients that have other opiates as their drug of choice, and 192 that list Heroin as their drug of choice. These are statewide numbers. Only one of the clinics is included in this data. This is 400 over the number of clients the funded program has the capacity to serve.
March 2015

5. History 1995- Integrated data system implemented
Kansas Client Placement Criteria (KCPC) and ASAM criteria
Fee for Service
Required to target Federal Priority Populations
KCPC was updated later to include the ASAM II criteria but has not historically included the ASAM criteria for MAT
Paid for a daily unit of service $7.50, program allowed to charge a co-pay
March 2015

6. History Continued 2007 Issues with Medicaid
Applied for a 1915b waiver to ensure residential treatment was paid for
Behavioral Health Services-Carve out
Prepaid Inpatient Health Plan (PIHP) contract
Oversees/Manages both Block Grant and Medicaid funds
Clinic now approved to bill for Medicaid
Methadone is not included in the Medicaid formulary for Addiction Treatment. Program initially allowed to continue to bill for units of service for block grant. Transitioned to requiring them to bill for outpatient individual and group and intensive outpatient treatment so MCO could approve or decline based on medical necessity.
November 11, 2018

7. Current 2013 KanCare implemented
Behavioral Health Services now Carved in
Three Managed Care Contractors-Statewide
Block Grant funding stays with non-Medicaid contractor
So now we have a total of 4 entities that all of our publically funded programs must use.
November 11, 2018

8. Performance/Quality
Data Integrity-by looking at claims data and documentation
BG monitoring
CAP plan
Quarterly census and other data collected
Block Grant: VO pays for methadone maintenance via T1015 procedure code
• FY 2013 – 5,029 units of methadone maintenance was received by 49 unique members (71.4% female)
• FY 2014 – 4,614 units of methadone maintenance treatment was received by 41 unique members (58.5% female)
o 7 members received T1015 methadone maintenance therapy during both fiscal years (65.1% female)
o Clinical does not do any UM, looking at KCPCs or monitoring diagnoses. VO has only paid Block Grant claims.
Quarterly census-look at trends, discuss at the quarterly director’s meeting
November 11, 2018

9. Issues ASAM criteria not in the current KCPC
MCOs and their Medical Directors lack of knowledge regarding MAT
Private Pay clinics lacks the understanding of providing medical necessity
Other clinics unwilling to provide funded services despite the higher rate for counseling
KCPC does not currently include the new ASAM criteria
Services for maintenance clients may be denied if they don’t fit into the criteria for IOP and OP services
Documentation is not always “clinical enough” especially for long term clients
Private pay providers don’t want to use our tool. Would like to do a data extract only. Not sure we can do that with the system we have. Don’t want to jump through government hoops so they remain publically funded.
The clinics provide data that shows 46% of all the methadone clients make under $35,000 a year and that 48% all have a high school diploma or less. This indicates a possible need for public funding. All but one are privately funded (the one that is publically funded is actually a privately funded company. The one publically funded is KU Hospital. They do not want this track of funding to interfere with other funding streams they receive.
March 2015

10. Solutions
Conversion to a new data system in process, will include new ASAM criteria for opiate addiction
Provide training to all MCO staff and Treatment providers requiring the use of the ASAM MAT criteria
Work with non-funded clinics to become MCD providers.
The conversion will include the new ASAM and clinical criteria for MAT
March 2015

11. Questions
March 2015