NOTICES
DEPARTMENT OF
HUMAN SERVICES
Addition of Community-Based Care Management Services Provided by Centers of Excellence for Opioid Use Disorders to the Medicaid State Plan and Medical Assistance Program Fee Schedule
[52 Pa.B. 98]
[Saturday, January 1, 2022]The Department of Human Services (Department) is announcing the addition of community-based care management services to the Medical Assistance (MA) Program Fee Schedule and its intent to seek the Centers for Medicare & Medicaid (CMS) approval to add community-based care management services provided by Centers of Excellence (COE) for opioid use disorders (OUD) to the Medicaid State Plan.
Discussion
COEs were developed in 2016 as a response to the opioid crisis. COEs address a patient's clinical and nonclinical needs by facilitating connections to other providers using a community-based care management approach. COEs are not limited to providing services at their physical locations. COEs make outreach and provide recovery support services in the community, including at hospital emergency departments and homeless shelters.
The COE Program started as a grant program with funding provided to 45 providers. In 2019, the Department transitioned from grant funding to the COEs billing the HealthChoices Physical and Behavioral Health Managed Care Organizations directly for care management services provided to members. The Department began enrolling providers as COEs using a designated provider specialty type beginning January 1, 2021. This expanded the number of providers recognized as COEs beyond the 45 initial grantees and increased beneficiary access to COE services.
Prior to the implementation of the COE program in 2016, only 48% of Medicaid patients diagnosed with an OUD were receiving treatment, with only 33% of that group remaining engaged in treatment for more than 30 days. By December 2018, more than 70% of Medicaid patients diagnosed with an OUD were receiving treatment, and of that group, 62% were remaining in treatment for more than 30 days.
The addition of the COE services to the Medicaid State Plan would allow this Commonwealth to continue to build on the results already seen through the first 4 years since implementing the COE program by allowing payment for services provided to beneficiaries in the Fee-for-Service delivery system.
To support the addition of COE care management services to the Medicaid State Plan and in accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department announces the addition of the following procedure code to the MA Program Fee Schedule. The effective date and MA Fee is indicated as follows.
Procedure Code Description Effective Date MA Fee G9012 Other specified case management service not elsewhere classified 1/1/22 $46.20 The Department will issue an MA Bulletin to inform providers enrolled in the MA Program of the addition of the current procedural terminology code for the provision of COE care management services.
Fiscal Impact
The estimated fiscal impact of the addition of COE care management services for Fiscal Year (FY) 2021-2022 is $120,444 in total ($21,527 State) funds. The estimated fiscal impact of the addition of COE care management services for FY 2022-2023 is $240,887 in total ($43,054 State) funds.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revision to the MA Program Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1480. (1) General Fund; (2) Implementing Year 2021-2022 is $22,000; (3) 1st Succeeding Year 2022-23 through 5th Succeeding Year 2026-27 are $43,000; (4) 2020-21 Program—$3,060,000,000; 2019-20 Program—$2,507,000;000; 2018-19 Program—$3,303,000,000; (7) MA—Capitation; (8) recommends adoption. Funds have been included in the budget to cover this increase.
[Pa.B. Doc. No. 22-23. Filed for public inspection December 30, 2021, 9:00 a.m.]
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