RD180 - Report on Intent to Apply for 1115 Demonstration Waiver for Addiction Treatment Services - June 13, 2016


Executive Summary:
Virginia is experiencing a substance use crisis of overwhelming proportions. The human cost and financial impact of this epidemic are significant. In 2013, Virginia’s Medicaid program spent $26 million on opioid abuse and misuse and an additional $28 million on Medicaid members diagnosed with Substance Use Disorder (SUD) who were admitted to hospitals or Emergency Departments. DMAS identified 216,555 members with a claim that included a substance use disorder (SUD) diagnosis in state fiscal year 2015.

In response, Governor Terry McAuliffe proposed and the General Assembly approved decisive action to support implementation of a comprehensive addiction treatment benefit to address the substance use crisis and reverse the opioid epidemic across the Commonwealth.

Core components of this benefit include:

• Expanded coverage of inpatient detox and inpatient substance abuse treatment for up to 15 days for all full-benefit Medicaid members.

• Expanded coverage of residential detox and residential substance abuse treatment for all full-benefit Medicaid members.

• Increased rates for existing substance abuse treatment services currently covered by Medicaid.

• Added coverage of Peer Supports for individuals with SUD and/or mental health conditions.

DMAS, in collaboration with the Department of Behavioral Health and Developmental Services, Managed Care Organizations, and stakeholders, has designed a transformed model for addiction treatment which is based on the American Society of Addiction Medicine (ASAM) standards and which ensures the integration of addiction treatment, physical health, and mental health services for Virginia’s Medicaid members.