Human Services

CD Treatment Fund

Statewide Outcome(s):

The CD Treatment Fund supports the following statewide outcome(s).

Minnesotans are healthy.

Strong and stable families and communities.

Context:

Chemical addiction can affect persons of any age, race, religion, or income. According to the 2006 Substance Abuse and Mental Health Service (SAMHSA) National Survey on Drug Use, 22.6 million people, or 9.2 percent, of people in the U.S aged 12 and older were chemically dependent. Chemical dependence broke down as follows: 3.2 million people were dependent on both drugs and alcohol, 3.8 million were dependent on drugs alone, and 15.6 million were dependent on alcohol alone. Of this 22.6 million people, only 1.6 percent received treatment. Without treatment, the consequences of substance use for the individual and society are staggering. It includes unnecessary disability, unemployment, mental illness, homelessness, incarceration, and suicide.

The Consolidated Chemical Dependency Treatment Fund (CCDTF) provides funding for residential and non-residential addiction treatment services for eligible low-income Minnesotans who have been assessed as needing treatment for chemical abuse or dependency. Approximately 50 percent of all CD treatment admissions for Minnesota residents are paid for through the CCDTF. Almost all treatment providers in the state are enrolled as CCDTF providers.

The CCDTF combines otherwise separate funding sources – MA, Minnesota Care, other state appropriations and the federal Substance Abuse, Prevention and Treatment block grant – into a single fund with a common set of eligibility criteria, and a single process for evaluating and placing persons with substance abuse problems in appropriate treatment. Counties also contribute a share toward the cost of treatment, paying 15 percent of treatment costs for Medicaid recipients and 22.95 percent for non-Medicaid recipients. Federal Medical Assistance Percentage (FMAP) is collected on the treatment program services provided to Medicaid recipients.

Minnesota Statutes, section 254B.01 Subd.3 defines chemical dependency services payable by the CCDTF. This definition applies to a wide variety of services applicable within a service continuum of care.

Strategies:

A uniform, statewide process for determining eligibility and evaluating treatment needs is the primary strategy by which the CCDTF allocates is resources. For those eligible for Medicaid, DHS has permission from the Centers for Medicare and Medicaid Services to predicate access to treatment based in the results of a standardized clinical evaluation. Minnesota Indian tribes, counties, and state contracted managed care organizations are defined as placing authorities. Counties and Indian tribes assess and place persons who meet both clinical (Rule 25 - Minnesota Rules 9530.6600 through 9530.6655) and financial eligibility (Rule 24 - Minnesota Rules 9530.6800 through 9530.7030). State contracted MCO’s are required to use the same assessment tools to provided assessment and placement for their enrollees.

The CCDTF also provides the CD treatment services for all Medical Assistance and Minnesota Care clients enrolled on a fee-for-service basis. Because of this, it is imperative that the CCDTF adapt and align with the ongoing changes in the state’s health care programs. Recently, coordination between fee-for-service and state contracted managed health care plans presents a number of challenges.

·         Managed Care Organization billing systems do not accommodate the specificity of the current CCDTF rate structure, requiring manual processing by the MCOs.

·         CD treatment providers bear the burden of coordinating funding streams when recipients move between managed care and fee-for-service coverage.

·         While the fee-for-service and managed care plans have identical benefit sets for CD treatment services, the federal rules for financial participation in MCO capitation payments results in an awkward system where MCO’s initially pay residential-non-hospital CD providers for both treatment program services and room and board services, and then must obtain reimbursement for the room and board from the CCDTF.

Results:

Treatment completion has been found to be a strong indicator of continued sobriety after treatment. While there has been a small decrease in the percentage of clients completing treatment, there is also concern as to how trends of reduced authorizations for treatment might reflect emerging barriers to both access to and completion of treatment.

The CCDTF was designed to allow funding to follow clients to clinically appropriate services. Persons who obtain treatment through the CCDTF must obtain placement authorization through their local county or tribal placing authority. For fiscal years (FY) 2010, 2011, and 2012, the number of clients authorized varies by placing authority. Placements tabulated for FY 2012 indicate that 13 counties/tribes authorized an increase in placements over FY 2011. However, across all counties and tribes, there is a 19 percent average reduction in the number of placements. For those same placements, the average dollar amount authorized was also reduced from an average of $9,245.67 to $6,258.67. The department plans further analysis to identify and then ameliorate any negative impact of non-clinical considerations on access and provision of treatment.

Performance Measures Notes:

NOTE: Measures in this section are based on reports from all CD treatment admissions, not just those funded through public funds.

(1)   Previous year represents Fiscal Year 2009 and current year represents FY 2010.

(2)   Change in percent of clients who reported alcohol use within the last 30 days at time of admission and then on discharge. Previous figures from calendar year (CY) 2009 (Admit 48.2 percent, Discharge 15.2 percent) Current figures from CY 2010 (Admit 46.7 percent, Discharge 14.2 percent).

(3)   Previous year represents FY 2010 and current year represents FY 2011.