DMHAS Substance Use Disorder Fee For Service Drug

DMHAS Substance Use Disorder Fee For Service Drug Court Efficiency EFFECTIVE OCTOBER 1, 2020 Approved June 2020 (revised 9/29/2020)

Drug Court Efficiency 2 The Drug Court Efficiency Initiative will launch on October 1, 2020 to enable Fee for Service reimbursement through the DMHAS fiscal agent for the specific services not covered by Medicaid but provided to Drug Court-referred consumers whose SUD treatment is primarily covered by Medicaid. NJSAMS is restructured to allow parallel funding for Drug Court Medicaid (Medicaid authorizations) and Drug Court Efficiency Fee for Service (DMHAS-funded) authorizations to occur at the same time.

Drug Court Efficiency 3 Medicaid reimburses for all SUD core services* and enhancement services that are also covered by DMHAS SUD FFS except the following: Case Management Continuing Care LOCI Transportation - staff time Transportation – mileage Court Liaison Psychoeducational Group* Halfway House*

Drug Court Efficiency 4 Drug Court Efficiency will not be an identified payer source that can be “selected” in the DASIE on NJSAMS. It will be an “implicit” payer source that can only be accessed once Drug Court Medicaid is determined as the primary funder in NJSAMS.

Drug Court Efficiency 5 Entering claims through the fiscal agent system will allow for: Reduction in time and resources used for preparing offline payment requests Efficient and timely billing and reimbursement processes Collecting accurate utilization and treatment data and generating reports

Drug Court Efficiency 6 Introduction of a $0 value core package for Long-Term Residential, Short-Term Residential and Inpatient Withdrawal Management to allow agencies to secure DMHAS SUD FFS authorizations and be paid for the following non-Medicaid-covered services: Case Management Continuing Care LOCI Transportation - staff time Transportation – mileage Court Liaison

Drug Court Efficiency - Exceptions 7 Drug Court Efficiency does not reimburse for services provided to consumers admitted to Halfway House or those consumers admitted to parallel care in Halfway House and any Ambulatory LOC.

Drug Court Efficiency 8 Introduction of a $0 value core package for Intensive Outpatient and Partial Care to allow agencies to secure DMHAS SUD FFS authorizations and be paid for the following non-Medicaid-covered services: Case Management Continuing Care LOCI Court Liaison

Drug Court Efficiency 9 Introduction of a core package for Standard/Traditional Outpatient and Opioid Maintenance Outpatient to allow agencies to secure DMHAS SUD FFS authorizations and be paid for the following non-Medicaid-covered services: Case Management Continuing Care LOCI Court Liaison Psychoeducational Group (PEG) The number of allowable units of PEG – 3 daily

Outpatient Core Packages & Enhancements 10

Drug Court Efficiency 11 As Drug Court-Medicaid authorizations are secured by the IME, but Standard/Traditional Outpatient and Opioid Maintenance Outpatient authorizations are not, agencies must identify a consumer as being Drug Court and Medicaid covered correctly in order to secure a Drug Court Efficiency authorization. Admission to Standard/Traditional Outpatient and Opioid Maintenance Outpatient allows agency access to one of 6 different core service packages which vary in value from $5. 95 to $172. 55.

Drug Court Efficiency – Fiscal Agent 12 While agencies are able to secure a FFS enhancement authorization at any time during the life of the authorization, an agency must: submit at least one Fee for Service claim for SUD services and/or enhancements within the first 15 days of a 30 -day authorization or it will cancel back to the start date with 0% Utilization; and submit claims during the remaining 15 days or the authorization will cancel to the mid-point with Partial Utilization.

Drug Court Efficiency 13 DMHAS SUD FFS site summaries will not change. All existing sites are uniformly contracted for the same LOCs in both Drug Court and Drug Court Efficiency. All new sites will be uniformly approved for Drug Court and Drug Court Efficiency at the same time.

How to Secure a DCE Authorization 14 Once the IME issues a Medicaid PA, the “Treatment Authorization” button will appear on the NJSAMS left side navigation bar. Clicking on the “Treatment Authorization” button will navigate a provider to a Treatment authorization module where a DCE authorization can be secured.

Drug Court Efficiency 15 An agency may only secure a Drug Court Efficiency authorization once they have secured a Drug Court Medicaid authorization. Agencies cannot secure a Drug Court Efficiency authorization if they have a Drug Court Initiative or Drug Court Contract authorization.

Drug Court Efficiency 16 An agency may only secure a Drug Court Efficiency authorization for the same LOC as the Drug Court Medicaid authorization secured through NJSAMS.

Drug Court Efficiency 17 Agencies are required to secure Drug Court Efficiency authorizations with start and end dates that coincide with the start and end date of the Drug Court Medicaid Authorization secured through the IME.

Drug Court Efficiency 18 Questions? Carmine Centanni 609 -438 -4254 carmine. centanni@dhs. nj. gov