Transcript Medicaid and Vivitrol Strategies in Colorado

Medicaid and Vivitrol
Strategies in Colorado
Bill Wendt, JD, CAC III
Chief Executive Officer/General Counsel
History of Signal

A non-profit dedicated to managing a network of providers of
substance abuse treatment services that are accessible to,
affordable, and efficacious for consumers of these services

In 1996, the Colorado Alcohol and Drug Abuse Division
(ADAD) issued an RFP for managed service organizations
(MSO) to manage and monitor substance abuse treatment
services

In 1997, Signal was awarded contracts for northeast
Colorado, southeast Colorado, and metro Denver.

In 2003, Signal was designated as the MSO for the three
regions.
Signal Services

A complex online service management and billing website
available to providers, counties, and internal Signal staff

Clinical auditing and oversight of network providers as well as
performance monitoring

Management of state, county, and judicial district funds

Data collection and reporting resource for the state

Lobbying to obtain monies or effect public policy for
substance abuse treatment
Advancing Recovery Projects

Signal chose continuation as the year 1 AR project and
MAT as the year 2 project. 38% of statewide treatment
admissions have alcohol as the primary drug of abuse.
Less than 1% receive any MAT.

Signal submitted an Investigator Sponsored Study (ISS)
protocol to Alkermes for 480 clients to receive 4 months
worth of donated Vivitrol through 3 Signal provider
locations.

Signal targeted key legislators (Joint Budget Committee,
Speaker of House) to submit letters of support.

Still waiting for protocol approval from Alkermes--- long
process
Medicaid - HCPF

Signal has no direct relationship with Health Care Policy
Financing (HCPF) – the state agency who administers
Medicaid.

There is limited outpatient substance abuse benefit
managed by HCPF directly to providers. May be included
in the mental health capitation contracts beginning 2009.
Medicaid - Vivitrol

HCPF was invited to an AR MAT team meeting to discuss
Medicaid reimbursement of Vivitrol.
–
Medicaid reimburses Vivitrol as part of Medicaid medical
benefit – not a pharmacy benefit nor part of substance
abuse treatment benefit.

HCPCS Code J2315 at $2.52 per mg is used by HCPF.

CPT Code 90772 for injection is not used.

Reimbursement for both medication and time for administering
injection is covered in J2315.

At 380 mg each – the injection reimbursement rate is $957.60.
Medicaid – Vivitrol

Signal requested current Vivitrol Medicaid utilization data.
There are barriers to getting the data – must submit an
Open Records Request. (Request still pending)

Signal brought Alkermes reimbursement consultants to the
MAT team meeting to offer resources to providers.

Signal lobbyists retained by Alkermes are working with
Single State Agency, Governor’s Office and Joint Budget
Committee to submit a decision item to fund MAT through
MSO’s. (Multi-year process)
Lessons Learned

Include Medicaid office early in the process.

Many MSO clients are not Medicaid eligible. Strategies must
cut across multiples systems, funding streams and various
policy makers.

Providers need technical assistance to bill Medicaid.

FQHC’s get low reimbursement---less than $100 per injection
Lessons Learned

Number of Medicaid eligible clients not accurately
captured in current treatment system.

Vivitrol managed by different part of HCPF system from
treatment benefit. Need to include both parts of the
system.

Need incentives to identify Medicaid eligible clients. Rates
are low and billing is a hassle.