Transcript Document
Medicated Assisted Treatment (MAT) Te r r y R . J o n e s 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 Suboxoneprescribing physicians • Recognizes the commitment required by providers that deliver MAT to an opioiddependent 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