Substance use disorder reform

In November, 2017, the U.S. Department of Health and Human Services and the Center for Medicare & Medicaid Services (CMS) issued a letter to announce a new direction in how CMS would like to work with states to improve access to high quality clinically appropriate treatment for opioid use disorder (OUD) and other substance use disorders (SUDs) for Medicaid beneficiaries. Following this new direction, and under the authority of section 1115(a) of the Social Security Act, Minnesota has been approved to implement a Substance Use Disorder (SUD) System Reform federal Medicaid demonstration.

• Rule 31 to 245G Table of Legislative Changes (PDF)

• SUD Reform-Overview of the New Services (PDF)
• Treatment Coordination (PDF) Audio Recording (MP3), PowerPoint (PDF), Transcript (PDF)
• Comprehensive Assessment/Direct Access (PDF) Audio Recording (MP3), PowerPoint (PDF), Transcript (PDF)
• Direct Reimbursement (PDF) Audio Recording (MP3), PowerPoint (PDF), Transcript (PDF)
• Peer Support Recovery (PDF) Audio Recording (MP3), PowerPoint (PDF), Transcript (PDF)
• Withdrawal Management (PDF) Audio Recording (MP3), PowerPoint (PDF), Transcript (PDF)

• SUD Reform Implementation Timeline (PDF)

• SUD Reform WebEx Presentation (PDF)
• SUD Reform WebEx Presentation: Overview of the SUD system reform section 1115 waiver and Governor Dayton’s opioid action plan (PDF)
• SUD Reform WebEx Presentation: Treatment Coordination (PDF)
• SUD Reform WebEx Presentation: Rule 31 to 245G (PDF)
• SUD Reform WebEx Presentation: Clearing Up Some Mistaken Information (PDF)
• SUD Reform WebEx Presentation: Location of Service (PDF)
• SUD Reform WebEx Presentation: Location of Service-Continuation of Conversation (PDF)
• SUD Reform WebEx Presentation: Telemedicine (PDF)
• SUD Reform WebEx Presentation: Documentation (PDF)
• SUD Reform WebEx Presentation: Discharges and Group Size Limits (PDF)
• SUD Reform WebEx Presentation: Halftime Report and FAQs (PDF)
• SUD Reform WebEx Presentation: ADAD SUD Reform WebEx (PDF)
• SUD Reform WebEx Presentation: SUD Treatment Admission Trends and Patterns (PDF)
• SUD Reform WebEx Presentation: Diagnostic Assessment of Substance Use Disorder and Coding (PDF)
• SUD Reform WebEx Presentation: SUD Reform Update (PDF)
• SUD Reform WebEx Presentation: SUD Reform Update June 7 (PDF)
• SUD Reform WebEx Presentation: SUD Reform Update and Stakeholder Engagement Planning (PDF)
• SUD Reform WebEx Presentation: SUD Reform Update (PDF)
• SUD Reform WebEx Presentation: CMS Approval (PDF)
• SUD Reform WebEx Presentation: SUD Reform Update September 6 (PDF)
• SUD Reform WebEx Presentation: MCO-DHS October 4 (PDF)
• SUD Reform WebEx Presentation: Reform Update November 1 (PDF)
• SUD Reform WebEx Presentation: Reform Update December 6 (PDF)
• CCDTF and SUD Reform January 29, 2019 (PDF)
• Withdrawal Management Webex Presentation: April 22, 2019 (PDF)
• Withdrawal Management Webex 1 of 3: August 20, 2019 (PDF)
• Withdrawal Management Webex 2 of 3: August 20, 2019 (PDF)
• Withdrawal Management Webex 3 of 3: August 20, 2019 (PDF)

The Behavioral Health Division, Department of Human Services, is seeking stakeholder engagement on policy recommendations from Minnesota’s Plan for the Prevention,Treatment and Recovery of Addiction policy recommendations report (PDF).

The report was developed with stakeholder engagement input from a core and fiscal stakeholder workgroup that was convened in 2016. The core workgroup incorporated and built on the recommendations of the 2013 Legislative Report: Minnesota's Model of Care for Substance use Disorder and the input collected in the fall 2015 ADAD listening sessions.

Several of the policy recommendations were included in legislation that passed as part of SUD reform legislation in 2017 (i.e. care coordination, peer recovery support, comprehensive assessments, direct reimbursement and withdrawal management).

We are now seeking stakeholder input on policy recommendations.

Stakeholder input will help inform the Division about what policy recommendations should be introduced in the 2019 legislative session. The Stakeholder Engagement WebEx's are intended to obtain stakeholder input from a broad audience. Participants can join the WebEx's based on availability and there is not an expectation that the same participants will be at each WebEx.

Clinical, Primary Prevention, and Problem Gambling sub-workgroups will be led by Behavioral Health Division staff and participation is open to WebEx registrants. Various WebEx’s pertaining to particular stakeholder engagement topics will be held at different times to encourage participation.

How can I participate?

1. Join the WebEx’s: Register for the 2018 Stakeholder Engagement WebEx's
2. Provide input by email: The following form can be utilized to provide input: Feedback Guide on Reform Concepts Under Consideration. Submit feedback to youropinionmatters.dhs@state.mn.us.

1. Rule 25 Workforce Preservation and Comprehensive Assessment Language (draft for discussion only) (PDF)
   
   After July 1, 2020, Rule 25 assessments will no longer be administered. Many current Rule 25 Assessors already meet the qualifications for completing a comprehensive assessment, although many do not. If enacted, this proposal will allow certain Rule 25 assessors the ability to provide comprehensive assessments effective immediately and until June 30, 2020, and if the individual completes required coursework by June 30, 2020, they are exempt from the internship requirements when working for a county, MCO or tribe doing comprehensive assessments July 1, 2020 and beyond. However, an individual would need to complete the internship requirement prior to providing any other substance use disorder service in any other setting.
   
   
2.  245G Opioid Treatment Programs Proposed Changes (PDF)
   
   
3. OTP Unbundle Bill Language (draft for discussion only) (PDF)
   
   Unbundling OTP payments bill language. The basic per diem would include the cost of the minimum treatment hours, but permit billing for individual and group sessions provided in excess of that amount. The bill would also align the language of minimum treatment service requirements with billing code requirements, but this does not increase or decrease minimum hour requirements.
   
   
4. Small Policy Changes to 245G and Technical fixes with Bill Language (draft for discussion only) (PDF)
   
   Various technical fixes related to citations, tweaks, and changing wording to align with CMS approval, etc.

1. Stakeholder Engagement Updates: Please register for these WebExs if you would like an update on the Stakeholder Engagement Process. There will be an update on the sub-workgroups that have convened so far.
   • August 23, 11:30am-12:30pm
   • September 13, 11:30am-12:30pm
     
     
2. Clinical Services Sub-workgroup
   • Workforce and Withdrawal Management: Monday, August 6th 11:30am-12:30pm
   • 245G Recommendations: Tuesday, August 14th 3:00pm-4:00pm
   • Opioids and OTP’s: Thursday, August 30th 12:30pm-1:30pm
   • Cultural Recommendations and Additional Topics: Tuesday, Sept 4th 1:30pm-2:30pm
3. Primary Prevention Sub-workgroup
   • Planning & Implementation (P&I) Grants: Tuesday, August 7, 12:00pm-1:00pm
   • Regional Prevention Coordinators (RPC’s), Minnesota Prevention Resource Center (MPRC),
     State Epidemiological Outcomes Workgroup (SEOW): Tuesday, August 14, 11:00am-12:00pm
   • Strategic Prevention Framework Partnership for Success Grant: Thursday, August 9, 10am-11am
   • Strategic Prevention Framework for Prescription Drugs (SPF Rx): Thursday, August 16, 12pm-1pm
4. Problem Gambling Sub-workgroup
   • Discussion: Wednesday, August 29th 11:30am-12:30pm
   • Discussion: Tuesday, September 4th 10:30am-11:30am

• Workforce and Withdrawal Management - August 6^th Presentation (PDF)
• Primary Prevention Planning and Implementation - August 7^th Presentation (PDF)
• Primary Prevention SPF-PFS - August 9^th Presentation (PDF)
• Primary Prevention Regional Prevention Coordinators (RPC’s), Minnesota Prevention Resource Center (MPRC), State Epidemiological Outcomes Workgroup (SEOW) - August 14th Presentation (PDF)
• Primary Prevention SPF Rx- August 16th Presentation (PDF)
• 245G Proposed Changes (PDF)
• 245G Opioid Treatment Programs Proposed Changes (PDF)
• Stakeholder Engagement Update - August 23 (PDF)
• Problem Gambling - August 29^th Presentation (PDF)
• Opioids and OTP’s - August 30^th Presentation (PDF)
• Problem Gambling - Part 2 - September 4 Presentation (PDF)
• Cultural Recommendations and Additional Topics - September 4 Presentation (PDF)
• 245G Recommendations- September 5 Presentation (PDF), 245G Proposed Language Stakeholder Grid (PDF)
• SUD Reform WebEx Presentation: SUD Reform Update - September 13 (PDF)

Qualified list of professionals per 245G.07, subdivision 3, updated July 17, 2019 (PDF)

Draft 1115 Substance Use Disorder System Reform (PDF)