Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Therapist Bulletin 14 August 2013 TO: Community Health Centers Participating in MassHealth FROM: Kristin L. Thorn, Acting Medicaid Director RE: Improving Treatment for Substance Use Disorders Purpose Improving initiation and engagement of patients who are diagnosed with substance dependency helps reduce drug-related illnesses and deaths, overuse of health care services, and economic and social difficulties associated with substance use disorders. MassHealth is working to improve the rate that members receive timely initiation and engagement of treatment for alcohol and other drug (AOD) dependencies, following identification of an AOD diagnosis. This bulletin offers practice tips and resources to help MassHealth providers support high-quality care and to ensure proper billing of the services they deliver. Background MassHealth managed care plans have collected Healthcare Effectiveness Data and Information Set (HEDIS) information since 1996. HEDIS performance rates provide a mechanism for MassHealth to compare scores across health plans and uncover health care quality improvement opportunities. Although MassHealth initiation and engagement HEDIS rates have improved from 2005 to 2011, the current performance rates of 52.7 percent for initiation and 19.9 percent for engagement suggest room for statewide improvement. When a member is diagnosed with AOD, the following two HEDIS rates are collected. 1. Initiation of Treatment: the percentage of members diagnosed with AOD that begin treatment either through an inpatient or outpatient admission or emergency department visit and any other AOD service within 14 days. 2. Engagement in Treatment: the percentage of members who complete two AOD services within 30 days after treatment initiation. (continued on next page) MassHealth Therapist Bulletin 14 August 2013 Page 2 Background (cont.) Exception: Care that includes a detox code (including those listed below) does not count toward the initiation or engagement of AOD treatment. HCPCS ICD-9-CM Procedure UB Revenue H0008-H0014 94.62, 94.65, 94.68 0116, 0126, 0136, 0146, 0156 Tips for Working with Your Patient Improving initiation and engagement of your patients who are diagnosed with substance dependency helps reduce drug-related illnesses and deaths, overuse of health care services, and economic and social difficulties associated with substance use disorders. Practice Tips * Include family members and other people whom your patient welcomes in support of his or her AOD care. * Provide written educational material. (For resources, see below.) * Use motivational interviewing techniques. o Express empathy with a warm, nonjudgmental stance, active listening, and reflecting back what is said. o Develop discrepancy between the patient’s choice to drink or use drugs and his or her goals, values, or beliefs. o Roll with resistance by acknowledging the patient’s viewpoint, avoiding a debate, and affirming autonomy. * Support the patient’s belief that he or she can succeed by expressing confidence and pointing to strengths and past successes of the patient. Tips for Your Practice Visits and Follow-up to Encourage Sobriety * Each time you identify a patient as having a primary or secondary diagnosis indicating dependence on alcohol or other drugs, schedule a follow-up visit within 14 days. * Contact the patient after the scheduled follow-up visits with a specialist to ensure that the appointments were kept. * When notified of a hospital discharge for a patient with an AOD diagnosis, schedule a follow-up visit within 14 days and refer the patient to a specialist, or schedule two additional visits within 30 days. (continued on next page) MassHealth Therapist Bulletin 14 August 2013 Page 3 Billing When treating a member for issues related to an AOD diagnosis, code the diagnosis on every claim using ICD-9 diagnosis codes from the series in the following chart. ICD-9-CM Diagnosis: Codes to Identify AOD 291-292, 303.00-303.02, 303.90-303.92, 304.00-304.02, 304.10-304.12, 304.20-304.22, 304.30-304.32, 304.40-304.42, 304.50-304.52, 304.60-304.62, 304.70-304.72, 304.80-304.82, 304.90-304.92, 305.00-305.02, 305.20-305.22, 305.30-305.32, 305.40-305.42, 305.50-305.52, 305.60-305.62, 305.70-305.72, 305.80-305.82, 305.90-305.92, 535.3, 571.1 Claims with dates of service on and after October 1, 2014, will require ICD-10 diagnosis codes. Best-Practice Resources * Massachusetts Department of Public Health, Bureau of Substance Abuse Services (BSAS) Principles of Care and Practice Guidance offers practice improvements in substance use disorder prevention, treatment, and recovery systems of care. www.mass.gov/eohhs/gov/departments/dph/programs/substance abuse/providers/program/-licencing/principles-of-care-and-practice- guidance.html * SAMHSA Treatment Improvement Protocol (TIP) Series are best- practice guidelines for the treatment of substance use disorders. www.kap.samhsa.gov/products/manuals/tips/index.htm#assessment Resources of National Organizations * National Institute on Drug Abuse (NIDA) supports research to prevent and treat drug abuse and addiction and mitigate the impact of their consequences. www.nida.nih.gov/ * National Institute on Alcohol Abuse & Alcoholism (NIAAA) leads the national effort to reduce alcohol-related problems by supporting research. www.niaaa.nih.gov/ (continued on next page) MassHealth Therapist Bulletin 14 August 2013 Page 4 Resources of National Organizations (cont.) * * Health and Human Services (HHS), in collaboration with other agencies, supports comprehensive prevention campaigns to educate the public about the dangers of illicit drug use, particularly among youth, and tracks national substance use disorder patterns through six major surveys to help the nation to identify potential drug problem areas and ensure that resources are targeted to areas of greatest need. www.hhs.gov/ * Substance Abuse and Mental Health Services (SAMHSA) works to improve the quality and availability of substance use disorder prevention, alcohol- and drug-addiction treatment, and mental health services. www.samhsa.gov/ Provider Survey We would appreciate your completion of a survey created to help us learn about the usefulness of this bulletin to our providers. www.surveymonkey.com/s/IET_BulletinSurvey Questions If you have questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax the inquiry to 617-988-8974.