Substance Use Disorder SUD Fee For Service FFS

Substance Use Disorder (SUD) Fee For Service (FFS) Prior Authorizations Re-Opening of Prior Authorization Plan for October 1, 2020 PRESENTED SEPTEMBER 2020

Webinar Agenda 2 Discharging inactive clients in NJSAMS Restarting State FFS Prior Authorizations Billing and Benefit Packages

Discharging Inactive Clients in NJSAMS 3 To be able to restart the Prior-Authorization process for State SUD FFS, only individuals who are currently in active status should be in admitted status in NJSAMS Providers should: Discharge any client who is no longer receiving services at your agency. Resolve Outlier list in NJSAMS by clicking “Still Active” or “Discharge”

Discharging Inactive Clients in NJSAMS 4 The IME will continue to work with providers to process any clients appearing on their Outlier lists for both State SUD FFS and Medicaid by: Being available to review the Outlier List with agencies Provide technical assistance on NJSAMS Follow up with providers that require TA in the process Contact the IME should you have any questions or require assistance with discharges and/or your outlier list: UM Phone: 1 -844 -276 -2444 UM Email: imeum@ubhc. rutgers. edu

Prior to re-start of FFS SUD Prior-Authorizations on October 1, 2020 5 Prior to September 29, 2020, Providers must check Medicaid eligibility for all admitted consumers via Electronic Medicaid Eligibility Verification System (e. MEVS) or Recipient Eligibility Verification System (REVS) at 1800 -676 -6562 If a consumer is determined to be Medicaid eligible, provider must change the funding source to Medicaid and submit to the IME for prior-authorization All information in the DASIE must be complete and verified via required documentation

State SUD FFS Prior Authorizations 6 • • • State SUD FFS authorizations and claiming will commence on October 1, 2020 All active FFS funded consumers will need a new authorization Providers will not be able to secure authorizations prior to 5 pm on October 1 State FFS initial authorizations will be auto generated by NJSAMS for active consumers based on levels of care. Providers will not need to submit the request Providers must add the enhancements in NJSAMS. These will not be auto generated o Only add enhancements that are needed to avoid over-encumbering funds

State SUD FFS Levels of Care Authorizations 7 NJSAMS auto generated Prior Authorizations for State SUD FFS will be generated for the following lengths of stay: Residential Levels of Care: • Long Term Residential (Level 3. 5)* includes Tier I and Tier II • 30 -day LOC auth • Short Term Residential (Level 3. 7) • 14 -day LOC auth for Managed Initiatives • 25 -day LOC auth for State Parole Board FFS • 30 -day LOC auth for Drug Court FFS • Halfway House (Level 3. 1) • 30 -day LOC auth • Inpatient Withdrawal Management-(IWM) (Level 3. 7 -WM) • 5 -day LOC auth

State SUD FFS Levels of Care Authorizations 8 Ambulatory Levels of Care : • Outpatient (Level 1) • 30 -day LOC auth - Outpatient – 3 units per week package • Intensive Outpatient (Level 2. 1) • 30 -day LOC auth • MOP (Level 1 – MOP) • 28 -day LOC auth • Partial Care (Level 2. 5) • 30 -day LOC auth • Ambulatory Withdraw Management (AWM) (Level 2 -WM) • 5 -day LOC auth

State SUD FFS – Administrative approval 9 • • Providers are to ensure that consumers are admitted into the clinically appropriate LOC in NJSAMS Clinical approval requirements for LOCs typically requiring a clinical justification will be waived for the initial auto generated State FFS authorizations Once the initial administrative PA is issued, regular business rules will apply to both managed and nonmanaged initiatives Extension Request Level of Care Index (ERL) will be required based on current State FFS business rules

State SUD FFS Billing 10 All claims must be submitted within 15 days of the start date of the authorization Authorizations will void back to the start date if claims are not submitted timely All claims must be submitted no later than close of business on Thursday, October 8, 2020 to be included in the first payment run Early cut=off due to Columbus day holiday

State SUD FFS Billing 11 Bi-weekly payment schedule is available on nj. das. net Current benefit packages are available on NJSAMS at: https: //njsams. rutgers. edu/njsams/Documents. aspx

Drug Court Efficiency 12 Drug Court Efficiency (DCE) authorizations will be available in NJSAMS and billed through nj-das. net as of October 1, 2020. Authorizations will be available for consumers admitted under Drug Court Medicaid in NJSAMS. Providers will bill Medicaid for the treatment and other Medicaid covered services, and bill DCE for the services not covered by Medicaid but funded through DMHAS, previously billable off-line as Drug Court Medicaid.

Contacts 13 Subject Matter Contacts State SUD FFS Catherine Spencer Catherine. Spencer@dhs. nj. gov IME Sarah Maxfield sarahwi@ubhc. Rutgers. edu Medicaid Gwen Carrick Gwen. carrick@dhs. state. nj. us E-Mail Address