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Due to renovations the DSS Manchester office will be temporarily closed. A new temporary location opened Monday, Jan. 27 at 146 Hartford Road, Manchester. 

Section 1115 Demonstration Waiver for Substance Use Disorder (SUD) Treatment

Provider Resources

In alignment with the milestones of the Demonstration, SUD treatment services provided in the Medicaid fee-for-service (FFS) delivery system will comply with the current ASAM Criteria for activities including authorizations, utilization review decisions, multi-dimensional assessments and individualized treatment plans. 

Application and Provider Certification and Monitoring:

Beginning in April 2022, following CMS approval of the 1115 SUD Demonstration waiver, Connecticut began accepting applications from providers for provisional certification to provide SUD services under the demonstration for a two-year period. The provisional certification period allows providers who meet a level of readiness, to provide services under the demonstration while making progress toward full adoption of the current version ASAM adopted by the state. The provisional period for residential providers began April 1, 2022, and ended April 1, 2024; Ambulatory providers began on November 15, 2022, Outpatient Hospitals on March 1, 2023, and Federally Qualified Health Centers (FQHCs) on July 1, 2023. Providers applying to provide services during a provisional period will have the remainder of the provisional period for the level of care for which they are applying to achieve full certification. Providers applying to provide services for a level of care for which the provisional period has ended must meet the level of readiness detailed in the 1115 SUD Certification Standards and Process and 1115 SUD Demonstration Application Guidance. Applications for provisional certification will not be accepted if the end date of the provisional period is within two-months.

Program Resources:

The Policy and Clinical Assumptions Grids outlines the expectations for Medicaid treatment providers in areas including admissions, interventions and treatment services, documentation, staffing and supervision.

Rates have been developed to support providers in meeting the expectations outlined in the Policy and Clinical Assumptions Grids and to meet the goals and milestones of this Demonstration.

As part of the fee-for-service rate development process for residential and ambulatory SUD treatment providers, Mercer Health & Benefits LLC presented an overview of the rate setting process including reimbursement principles, fee assumptions and development of the treatment rates and, where applicable, the room and board rates.  This presentation occurred with residential providers on June 10, 2021 and with ambulatory providers on June 24, 2022.  Both presentations afforded continued opportunity for feedback from the provider network.  

Provider Bulletins: The Department of Social Services has issued the following guidance related to the Demonstration.  Provider bulletins can also be found on the ctdssmap.com webpage.

  • PB 2024-09 - POS 55 Requirements for SUD Residential Treatment Facilities
  • PB 2022-21 - Implementation of Medicaid Reimbursement for SUD Inpatient Treatment at State Operated and Private Psychiatric Hospitals Pursuant to Section 1115 Demonstration Waiver for Services Previously Excluded from Coverage by Federal Law.
  • PB 2022-39 - Implementation of Medicaid and Children’s Health Insurance Program (CHIP) Reimbursement for SUD Treatment at Free-Standing Residential Treatment Facilities.
  • PB 2022-86 - Reimbursement for Intermediate Substance Use Disorder (SUD) Treatment at Behavioral Health Clinics, Enhanced Care Clinics and Outpatient Drug and Alcohol Abuse. 
  • PB 2022-91 - Ambulatory Withdrawal Management Billing Guidelines.
  • PB 2023-01 - Billing Clarification for Intermediate Substance Use Disorder (SUD) Treatment at Behavioral Health Clinics, Enhanced Care Clinics and Outpatient Drug and Alcohol Abuse.
  • PB 2023-09 - Reimbursement for Intermediate Substance Use Disorder (SUD) Treatment at Outpatient Hospitals. 
  • PB 2023-51 - Clinical Treatment Hours for SUD IOP and PHP Programs.

State Plan Amendments (SPAs): The following approved State Plan Amendments (SPAs) have impact to or are related to the work under the Demonstration.

  • SPA 22-0020 - This SPA establishes coverage and reimbursement for substance use disorder services provided in outpatient and residential settings within the rehabilitative services benefit category.  For applicable levels of care, this SPA implements and is consistent with the state's approved SUD Section 1115 Demonstration waiver.
  • SPA 22-0021 - This SPA updates the Alternative Benefit Plan (ABP) to implement to add coverage for substance use disorder services under the rehabilitative services benefit category for services provided in outpatient and residential settings. 

Frequently Asked Questions (FAQs) and Answers: The State has compiled questions received throughout the planning of the 1115 Demonstration Waiver along with responses that we hope assist you as we transition into implementation. 

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