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Tags Posts tagged with "ASAM Transition"

ASAM Transition

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DDAP Modifies ASAM Transition Web Page, Archives Addendums That Outlined IOP Ratio and Daily Therapeutic Hour “Expectations”

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) has overhauled its ASAM Transition web page, removing previous references to “expectations for contractual compliance” in areas of ASAM Criteria where DDAP originally went beyond the Criteria as explicitly written. Newly revised information, including an updated “Guidance for the Application of The American Society of Addiction Medicine, 3rd Edition, 2013 in the Pennsylvania Substance Use Disorder Treatment System for Adults” and “ASAM Frequently Asked Questions” document, references the 1:15 intensive outpatient (IOP) counselor-to-patient ratio and the six to eight daily therapeutic hours at residential level of care as a DDAP “recommendation.”

The change is significant because, according to the Pennsylvania Department of Human Services (DHS) Office of Mental Health and Substance Abuses Services (OMHSAS), per its HealthChoices Behavioral Health Program Standards and Requirements for Primary Contractors document, “the Primary Contractor and its BHMCO must ensure that the SUD providers in the network comply with program standards in the ASAM Criteria, included but not limited to admission criteria, discharge criteria, interventions/types of services, hours of clinical care, and credentials of staff as set forth in the ASAM transition requirements found at https://www.ddap.pa.gov/Professionals/Pages/ASAM-Transition.aspx.” In other words, providers were expected to be in compliance with any information published as an expectation on that page.

For months following DDAP’s testimony in Commonwealth Court that the IOP and daily therapeutic overreaches were simply “guidelines,” the provider community remained unclear on whether they would be required to comply with the “guidelines” as part of their contracts with the BHMCOs. Still, providers have not yet seen the evaluation tool that will be used to audit their compliance with ASAM Criteria despite DDAP’s expectation that they be “substantially aligned” with those Criteria by Jan. 1, 2022.

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The Pennsylvania Department of Human Services (DHS) is making available for public review and comment the proposed renewal application for the extension of the Section 1115 Medicaid Demonstration titled “Medicaid Coverage for Former Foster Care Youth from a Different State and SUD Demonstration” (Project Number: 11-W-003083/3). The effective dates of the current approved demonstration are October 1, 2017, through September 30, 2022. The extension requested will be for an additional five years, through September 30, 2027.

In 2016, the CMS Medicaid and CHIP Managed Care Final Rule eliminated Pennsylvania’s ability to use $55 million in federal funding to pay for residential SUD treatment. However, the Commonwealth was able to preserve the funding through an approved Section 1115 Waiver Demonstration. It is within this waiver that Pennsylvania committed to transitioning to ASAM Criteria as a condition for approval of the waiver.

The following links provide information regarding this extension request, extension application, public input process, schedule of public hearings, and other relevant information:

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