State law on substance use disorder services in MassHealth takes effect & CarePlus-PCC Plan Bulletin
1. Substance use disorder services
Last year a state law improving substance use disorder services was enacted (c. 258 St. 2014). A provision requiring MassHealth & MassHealth managed care plans to cover detox and up to 14 day crisis stabilization services without prior authorization took effect on Oct 1, 2015.
So far, MassHealth has only released a Provider Bulletin describing how this provision will apply to One Care, but the statute applies across the delivery system:
http://www.mass.gov/eohhs/docs/masshealth/bull-2015/mco-5.pdf
Pasted below is the applicable state statute now in effect:
SECTION 19. Chapter 118E of the General Laws is hereby amended by inserting after section 10G the following section:-
Section 10H. For the purposes of this section the following terms shall, unless the context clearly requires otherwise, have the following meanings:-
Acute treatment services, 24-hour medically supervised addiction treatment for adults or adolescents provided in a medically managed or medically monitored inpatient facility, as defined by the department of public health, that provides evaluation and withdrawal management and which may include biopsychosocial assessment, individual and group counseling, psychoeducational groups and discharge planning.
Clinical stabilization services, 24-hour clinically managed post detoxification treatment for adults or adolescents, as defined by the department of public health, usually following acute treatment services for substance abuse, which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others and aftercare planning, for individuals beginning to engage in recovery from addiction.
The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall cover the cost of medically necessary acute treatment services and shall not require a preauthorization prior to obtaining treatment.
The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall cover the cost of medically necessary clinical stabilization services for up to 14 days and shall not require preauthorization prior to obtaining clinical stabilization services; provided that the facility shall provide the carrier both notification of admission and the initial treatment plan within 48 hours of admission; provided further, that utilization review procedures may be initiated on day 7.
Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patients medical record.
2. PCC Plan Option in CarePlus.
Last month MassHealth proposed a rule change to increase managed care choices for people eligible for CarePlus to include the Primary Care Clinician (PCC) Plan in addition to a Managed Care Organization. It has now released a provider bulletin making clear that CarePlus members can elect the PCC option at any time after Oct 1 with enrollment to take effect on the first of the following month. It is not addressed in bulletin, but it looks like new applicants can go into PCC Plan in October.
The provider bulletin is here:
http://www.mass.gov/eohhs/docs/masshealth/bull-2015/all-255.pdf
3. MassHealth -The Basics.
The BCBS Foundation updated its Chartpack on July 2015 with tables and graphs providing basic information about enrollment and spending in MassHealth. If you missed its October webinars, the chart pack is here:
http://bluecrossmafoundation.org/publication/updated-masshealth-basics-facts-and-trends