CREDENTIALING, LICENSING, AND REIMBURSEMENT OF THE SUD WORKFORCE: A REVIEW OF POLICIES AND PRACTICES ACROSS THE NATION. NOTES

12/01/2019

  1. Behavioral Health Workforce Research Center. Scopes of Practice for Behavioral Health Professionals. Accessed November 2018 at http://www.behavioralhealthworkforce.org/practice-data-visualizations/.

  2. See https://www.providerexpress.com/content/ope-provexpr/us/en/our-network/jon-states.html.

  3. Authorization for independent practice is not uniformly documented; in some states, we made an inference from available documentation in the absence of direct evidence for this capability.

  4. CMS, Medicare Coverage of Substance Abuse Services, https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se1604.pdf, accessed December 31, 2018. SUPPORT for Patients and Communities Act, 2018, https://www.congress.gov/bill/115th-congress/house-bill/6, accessed September 9, 2019.

  5. See https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/t/treatment-drug-abuse-chemical-dependency.pdf, accessed December 31, 2018.

  6. Optum Provider Express, https://www.providerexpress.com/content/ope-provexpr/us/en/our-network/jon-states.html, accessed October 11, 2018.

  7. National Association of State Alcohol and Drug Abuse Directors (NASADAD). (2013). State Regulations on Substance Use Disorder Programs and Counselors: An Overview. Retrieved from http://nasadad.org/wp-content/uploads/2010/12/State_Regulation_of_SUD_Programs_and_Counselors-7-26-13.pdf.

  8. See http://www.behavioralhealthworkforce.org/practice-data-visualizations/.

  9. See https://www.providerexpress.com/content/ope-provexpr/us/en/our-network/jon-states.html.

  10. Padwa, H., & Oeser, B. (2013). White Paper on California Substance Use Disorder Treatment Workforce Development. Los Angeles, CA: UCLA Integrated Substance Abuse Programs.

  11. For a description of this waiver opportunity, see the July 2015 letter from the Centers for Medicare & Medicaid Services to state Medicaid directors, available at https://www.medicaid.gov/federal-policy-guidance/downloads/smd15003.pdf.

  12. ASAM levels 3.7 and 4.0 are currently not covered under the ODS. However, the state working to include these levels under the waiver.

  13. U.S. Census Bureau, Population Division. (2018). Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2017. Available at http://factfinder2.census.gov.

  14. Wilhelm, P. (2016). DMC-ODS at the Starting Blocks: Insights from Phase I. A study for the California Senate Office of Research on the expansion of substance use treatment under California's Medi-Cal 2020 waiver. Berkeley, CA: University of California. Retrieved from https://sor.senate.ca.gov/sites/sor.senate.ca.gov/files/DMC-ODS%20Final%20Report%20Wilhelm%20Hyperlinked.pdf.

  15. Substance Abuse and Mental Health Services Administration (SAMHSA). (2011). Scope of Practice and Career Ladder for Substance Use Disorder Counseling. Retrieved from http://atforum.com/documents/PEP11-SCOPES.pdf.

  16. Urada, D., Antonini, V.P., Teruya, C., Tran, E., Huang, D., Padwa, H., Castro-Moino, K., Lee, A.B., & Grossman, J. (2017). California Drug Medi-Cal Organized Delivery System, FY 2016-2017 Evaluation Report. Los Angeles, CA: UCLA Integrated Substance Abuse Programs.

  17. Brassil, M., Backstrom, C., & Jones, E. (2018). Medi-Cal moves addiction treatment into the mainstream: Early lessons from the Drug Medical Organized Delivery System pilots. Oakland, CA: California Health Care Foundation. Issue brief retrieved from https://www.chcf.org/publication/medi-cal-addiction-treatment-mainstream/.

  18. See https://www.medicaid.gov/medicaid/managed-care/downloads/managed-care-regulations-42-cfr-part-438.pdf.

  19. See https://www.dhcs.ca.gov/formsandpubs/Documents/MHSUDS%20IN_17-008.pdf and https://www.dhcs.ca.gov/formsandpubs/Documents/SUD_Peer_Support_Plan_Guide.pdf.

  20. See, for example, https://www.dhcs.ca.gov/provgovpart/Documents/DMC_ODS_Peer_Support_Training_4.5.18.pdf.

  21. See https://www.cibhs.org/dmc-ods-waiver.

  22. See https://www.cibhs.org/sites/main/files/file-attachments/dmc-ods_waiver_training_plan.pdf.

  23. See, for example, Los Angeles County's provider support resources at https://www.cibhs.org/la-county-learning-collaborative.

  24. A sunrise review is a statutory process that investigates whether there is a need to regulate a previously unregulated profession.

  25. We are grateful to Sherri Daly for sharing the text of the budget request with us.

  26. See https://files.nc.gov/ncdhhs/documents/files/Joint-Communication-Bulletin-J195-Out-of-Network-Agreement.pdf.

  27. See https://files.nc.gov/ncdma/documents/Reports/Legislative_Reports/SL2016-94-Sec12F-10-and-SL2017-57-Sect11F-6_2018_01.pdf.

  28. See https://www.ncsappb.org/.

  29. See https://www.ncdhhs.gov/north-carolinas-opioid-action-plan.

  30. See https://files.nc.gov/ncdhhs/documents/ProviderTransition_PolicyPaper_FINAL_20180518.pdf.

  31. New York State Department of Health. (2014). A Plan to Transform the Empire State's Medicaid Program--Better Care, Better Health, Lower Costs: A Multi-Year Action Plan, p. 5 (emphasis in the original text). Retrieved from https://www.health.ny.gov/health_care/medicaid/redesign/docs/mrtfinalreport.pdf.

  32. See https://www.innovations.harvard.edu/medicaid-redesign-team.

  33. MRT Action Plan, p. 10.

  34. See https://www.congress.gov/bill/115th-congress/house-bill/3931.

  35. See https://www.oasas.ny.gov/treatment/health/locadtr/index.cfm.

  36. See https://www.ctacny.org/.

  37. See https://www.health.ny.gov/health_care/managed_care/docs/medicaid_managed_care_fhp_hiv-snp_model_contract.pdf.

  38. Falcone, A.J., & Berke, D.M. (2018). Medicaid Managed Care Contracting: An Advocacy Guide for State Associations of Behavioral Health Providers. Report prepared for the National Council for Behavioral Health. Retrieved from https://www.thenationalcouncil.org/wp-content/uploads/2018/08/Medicaid-Managed-Care-Contracting-Guide-for-State-Associations-FTLF-2018_Updated-8.8.2018.pdf.

  39. See https://www.health.ny.gov/health_care/managed_care/docs/medicaid_managed_care_fhp_hiv-snp_model_contract.pdf.

  40. See https://mhanys.org/mh-update-1-4-18-governors-press-release-transformation-grant-awards/.

  41. See https://fcscortland.org/SCBHCC+Receives+%241.6+Million+Award.

  42. See https://www.thenationalcouncil.org/wp-content/uploads/2017/11/New-York-CCBHC-Impact-Summary-11-28-17.pdf.

  43. See https://www.health.ny.gov/professionals/doctors/graduate_medical_education/doctors_across_ny/.

  44. See https://hhs.texas.gov/sites/default/files//documents/laws-regulations/policies-rules/1115-waiver/waiver-renewal/1115renewal-cmsletter.pdf.

  45. See https://hhs.texas.gov/sites/default/files/documents/laws-regulations/policies-rules/1115-docs/tool-guidelines/Evaluation-Texas-Demonstration-Waiver.pdf.

  46. Chapman, S.A., Blash, L.K., Mayer, K., & Spetz, J. (2018). Emerging roles for peer providers in mental health and substance use disorders. American Journal of Preventive Medicine, 54(6-S3), S267-S274. Retrieved from https://www.sciencedirect.com/science/article/pii/S0749379718316052.

  47. See https://socialwork.utexas.edu/dl/ari/recovery-support-services-report-2018.pdf.

  48. This term is sometimes used in place of "medication-assisted treatment" to underscore the importance of combining medications with other recovery services such as counseling and peer supports.

  49. See https://hhs.texas.gov/sites/default/files/documents/laws-regulations/reports-presentations/2018/hb-1486-primer-2-26-18.pdf.

  50. See https://lrl.texas.gov/legis/BillSearch/BillDetails.cfm?billFileID=280329&from=advancedsearch&startrow=1&number=50&IDlist=&unclickList.

  51. See https://hhs.texas.gov/sites/default/files/documents/laws-regulations/policies-rules/1115-docs/tool-guidelines/Evaluation-Texas-Demonstration-Waiver.pdf.

  52. See https://dnnsymkuj.blob.core.windows.net/portals/0/Images/Issues/BehavioralHealth/LCDC_Workforce_OnePager_tn.jpg?sr=b&si=DNNFileManagerPolicy&sig=nnSnE2PGTx38po4cQD4eABVKr%2FCfatb23iw7CesWw9U%3D.

  53. See http://www.hhloans.com/index.cfm?objectid=EC6C1C10-8982-11E5-A0840050560100A9.