Arkansas Addictions System Reform: Project 95 Update

1. Arkansas Addictions System Reform: Project 95 Update November 5, 2010 Department of Human Services

2. History of Project 95 In September 2007, DHS formed the Project 95 Committee. The “95” refers to the percent of individuals that need, but do not get treatment. The Committee, comprised of legislators, state officials, providers, and community leaders, charged DHS with identifying the types of services and funding necessary to close the addiction treatment gap.

3. History of Project 95 (cont.) In the fall of 2007, DHS initially contracted with John O’Brien to assist with developing a plan for designing and financing a continuum of publicly funded substance abuse treatment services for adults, children and their families in Arkansas. To kickoff the new initiative, DHS held the first Project 95 stakeholder meeting in March 2008.

4. Project Goals Identify the potential substance abuse treatment and support services Develop consistent definitions for these services and supports across purchasers Develop provider and practitioner qualifications for services Develop a process for certifying qualified providers Identify/develop reimbursement methodologies to support these services Identify the potential funding streams for these services and supports Services recommended by SAMHSA and the National Quality Forum Other jurisdictions that have been identified as model systems Services covered or purchased by federal funding sources Identifying current Arkansas formats for defining services Reviewing other jurisdictions and funding source approaches to defining services Proposing a template for service definitions Review current practice acts—who is allowed to provide the service Review current processes to license or certify providers Identify federal regulations that may impact on who can provide services Review how services are currently purchased Identify how other jurisdictions purchase services (methodology and rate) Develop draft rates for new services Identify which agencies purchase services Identify funding streams currently used to purchase services Identify federal funding streams not accessed or leveraged Services recommended by SAMHSA and the National Quality Forum Other jurisdictions that have been identified as model systems Services covered or purchased by federal funding sources Identifying current Arkansas formats for defining services Reviewing other jurisdictions and funding source approaches to defining services Proposing a template for service definitions Review current practice acts—who is allowed to provide the service Review current processes to license or certify providers Identify federal regulations that may impact on who can provide services Review how services are currently purchased Identify how other jurisdictions purchase services (methodology and rate) Develop draft rates for new services Identify which agencies purchase services Identify funding streams currently used to purchase services Identify federal funding streams not accessed or leveraged

5. Service Definition Work Group DHS formed the Project 95 Service Definition Work Group consisting of public and private mental health and substance abuse providers, advocates, and agency staff to develop a taxonomy of treatment services across multiple payers.

6. Work Group Members Dixie Wallace, Div. of Medical Services Joie Wallis, Div. of Medical Services Carol Lee, Child Development Inc. Tammy Alexander, Div. of Beh. Health Services Kenny Whitlock/Pam Christie, Mental Health Council Carole Baxter, Recovery Centers of Arkansas Dr. Larry Miller, Div. of Beh. Health Services Dr. Rob Covington, Horizon Treatment Center Joyce Soularie, Consumer Advocate Elbert Grimes, Div. of Youth Services Calvin Wilbon/Linda Robinson, Div. of Children & Family Services Gary Morgan, DaySpring Beh. Health Services Joe Hill, Div. of Beh. Health Services OADAP Sonny Ferguson, Div. of Beh. Health Services OADAP Fran Flener, State Drug Director

7. Recommended Services In collaboration with John O’Brien, the Work Group recommended a core package of substance abuse services for adults and adolescents which included the following components: elements of the service, provider requirements, staffing requirements, description of the service setting, specific programming requirements, unit measurement, utilization management including authorization process, entrance/continued stay/discharge criteria, anticipated outcomes, exclusions and limitations of each service.

8. Substance Abuse Treatment Services (SATS) Program The Work Group’s recommended outpatient services comprise the core treatment package available in the new SATS Program initially for Medicaid eligible pregnant/post-partum women and adolescents (ages 9-21). Addiction Assessment Treatment Planning Care Coordination Multi-Person (Family) Group Counseling Individual Counseling Group Counseling Marital/Family Group Medication Management Additional information is available in the SATS Treatment Manual.Additional information is available in the SATS Treatment Manual.

9. Certification Requirements Current CARF, JCAHO, or COA, that includes accreditation of the pertinent outpatient alcohol and/or other drug abuse treatment component (OADAP Licensure Standards for Alcohol and/or Other Drug Abuse Treatment Programs. Must be licensed by the Division of Behavioral Health Services, Office of Alcohol and Drug Abuse Prevention (OADAP). Providers must adhere to evidence-based practices as approved by DBHS for specific populations and services provided and meet the necessary staffing requirements for each of the covered services.

10. Accreditation Training and Technical Assistance In preparation for the new SATS Program, DHS contracted with Life Management Counseling and Consulting, Inc. to offer CARF accreditation training and technical assistance initially to the 6 providers participating in the Arkansas NIATx Implementation Grant with plans to expand through a competitive process to 7 additional providers. Jennifer Glover Gallagher Janice ReeseJennifer Glover Gallagher Janice Reese

11. Training and Technical Assistance (cont.) Decision Point, Bentonville Gateway House, Fort Smith Harbor House, Fort Smith Freedom House, Russellville Quapaw House, Hot Springs South AR Substance Abuse, El Dorado Additional information regarding the upcoming CARF accreditation training and technical assistance application process is forthcoming.

12. Next Steps On November 5, the Div. of Beh. Health Services (DBHS) will hold a public hearing to receive feedback on the proposed rules for the new SATS Program. On November 15, the Div. of Medical Services (DMS) will provide an update to the Public Health Committee on the new SATS Program. Both DBHS’s and DMS’s proposed rule changes are on the December Rules and Regulations Committee agenda in preparation for the initial implementation of the new SATS Program scheduled for March 2011.

13. Questions? The current draft of the Div. of Beh. Health Services rules of practice and procedures manual for the new SATS Program is available at http://www.arkansas.gov/dhs/dmhs/. The Div. of Medical Services State Plan Amendment information for the new SATS Program is available at https://www.medicaid.state.ar.us/InternetSolution/General/comment/comment.aspx.