DAS Needle Exchange Treatment Initiative (NETI): Overview and Training

1. DAS Needle Exchange Treatment Initiative (NETI):Overview and Training Thursday, December 4, 2008

2. NETI Overview • The NETI funds medication-assisted and other treatment services for indigent New Jersey residents with an opiate addiction • Particular emphasis is placed on providing access to treatment for individuals referred by Syringe Exhange Programs (SEP) • The NETI contract agencies are responsible for identifying other payer sources to which clients can be transitioned during the course of the program • If the client is determined to be ineligible for another payer source during the course of treatment, the client may continue to receive services under the NETI, but the NETI contracted agencies will continue working with the client to identify other payer sources

3. NETI Eligibility Criteria • In order for clients to receive treatment services and other support services through the NETI, the NETI contracted providers will ensure proper eligibility in the following areas: • Income Eligibility • Program Eligibility • Clinical Eligibility • Co-occurring Service Eligibility

4. Income Eligibility • On Day One of the admission process, the NETI contract service agency screens the client for financial eligibility using the NJSAMS Division of Addiction Services Income Eligibility (DASIE) module • NETI contract agencies will assist clients in the application and enrollment process for programs which may include: • Medicaid • Work First NJ SAI • NJ Family Care • DAS slot-funded services, if capacity allows

5. Income Eligibility (cont’d) • Client’s household income must be at or below 250% of the Federal Poverty Level (FPL) Guidelines to receive NETI services • Income eligibility will be based on completion of DASIE module and Medicaid’s definition of household size and income

6. Movement of Clients Through the System • If the client is eligible for another payer source, the client shall be re-directed to those services during the course of treatment • If the client is eligible for Medicaid, reimbursement through these sources shall be considered as program income and must be reported as such by NETI providers • No self-pay clients can receive services from the mobile unit or office-based services. Clients whose income is above 250% poverty must attain a referral to treatment at an agency that accepts self-pay and private insurance • If the client is eligible for SAI, the client shall become a SAI client. At any time, if the client is no longer eligible for SAI, the client may return to the NETI

7. Program Eligibility • To be eligible for the NETI, clients must: • Be a resident of New Jersey • Have a history of injectable drug use • Test positive for opiates or have a documented one year history of opioid dependence • Be able to provide proof of identification to prevent dual enrollment in medication-assisted treatment • NETI provider agencies should follow the same proof of identification standards that are required for OTPs • Not currently enrolled as a client in an OMT program or a client under the care of a physician prescribing Suboxone • Not previously enrolled as a client in an OMT program or a client under the care of a physician prescribing Suboxone within the past thirty (30) days

8. Clinical Eligibility • The NJSAMS ASI and ASAM LOCI, along with feedback from the client on readiness to engage in services, will be used to determine the most appropriate level of care for the client • If the client requires another level of care or support services not provided via the mobile unit or office-based program, the client may be eligible for a NETI voucher • Other level of care services must be requested by the NETI contract service Case Manager LCADC • If issued a DAS-approved voucher, the client will be able to receive services through a DAS NETI Network approved provider

9. The Encounter Module • Documents all face-to-face clinical contacts • Supports and evaluates all client activities • Provides a mechanism to request vouchers for billable services • Provides a mechanism to submit claims for billable services • All contracted services must be entered into the encounter module to properly document service delivery and support evaluation efforts • All vouchered services must be pre-approved through the encounter module • All vouchered services delivered by the treatment provider must be entered in the encounter module in order to create a claim

10. Treatment Services Eligible for Reimbursement Via the Voucher • Enhanced Detox (III.7D-E) • Long-term Residential • Short-term Residential • Intensive Outpatient • Outpatient • Methadone- under certain circumstances • Client placed in residential or supportive housing without access to local NETI provider • Other appropriate administrative or clinical circumstances

11. Recovery Support Services Eligible for Reimbursement Via the Voucher • Case Management (residential care only) • Continuing Care Assessment • Transportation to/from residential care/ supportive housing • Thirty (30) days of medication other than OMT (except when in III.7D-E)

12. Things to Remember when Requesting a Voucher • The LOCI needs to be completed on each client within thirty (30) days of the client being referred to another level of care • Allows treatment team time to plan and discuss options with the client • The Case Manager is responsible for ensuring that there is capacity available at the provider where the client may be referred • Upon a voucher being issued the agency has ten (10) days to activate it or it will expire • The voucher is activated when the agency reports in the Encounter Module that one of the approved services is rendered

13. Co-occurring Service Eligibility • To provide on-site reimbursable comprehensive co-occurring services, NETI programs must be accepted as eligible providers in the DAS Co-occurring Network • NETI clients may be eligible to obtain co-occurring services as an enhancement at either the mobile unit, office-based program, or other NETI-approved voucher program, as long as these agencies are eligible providers in the DAS Co-occurring Network • Co-occurring services can only be accessed as an enhancement to other treatment services within the NETI

14. NETI Client Care Options • The NETI client may receive services from: • The contracted mobile unit and/or office-based program ONLY (no services needed beyond the ones offered via the contract) • The contracted mobile unit and/or office-based program in addition to another level of care that is reimbursed through a voucher • Residential treatment services and MAT to support that placement which are both reimbursed through a voucher • Voucher services ONLY- no MAT

15. NETI Client Care Options (cont’d) • In all instances, the Case Manager from the NETI contract service provider agency continues to follow the client, manage their care, and request vouchers for clinically indicated services • The treatment provider providing services to the client should also maintain an on-going communication with the Case Manager from the NETI contract service provider agency regarding the client’s need for continuing care

16. Three Types of NETI Voucher Service Referrals • Client will continue Medication-Assisted Treatment (Methadone or Suboxone) at the MMU/OBS but be referred to concurrent care within the NETI Fee-for-Service Network • Client will not be discharged from MMU/OBS and will receive clinical services from two agencies • Client may be referred to residential care and receive Medication-Assisted Treatment (Methadone or Suboxone) via voucher through a NETI Fee-For-Service OMT program in close proximity to the residential program • Client will be discharged from the NETI MMU/OBS census (in order to allow more capacity for new clients) • When client is discharged from residential treatment, client may return to the NETI MMU/OBS, if appropriate • Client may be referred to another level of care via voucher but NOT receive Medication-Assisted Treatment (Methadone or Suboxone) • Client will not be admitted to the MMU/OBS but be referred to another level of care via a voucher • Case Manager from the NETI contract agency continues to follow ALL clients receiving vouchered services

17. Clinical Extension Requests • Agency must follow DAS Extension Policy parameters outlined below: • Treatment lengths of stay exceeding the following timeframes will not be authorized without an approved request for an extension from DAS: • Intensive Outpatient sixteen - (16) weeks of three units of service each week • Partial Care - eight (8) weeks of four units of service each week • Short Term treatment - thirty calendar (30) days • Long Term treatment - six (6) months • Halfway House treatment - nine (9) months

18. Clinical Extension Requests (cont’d) • In circumstances where it is clinically determined that a client needs additional treatment and the length of stay will exceed the timeframes, an extension request form must be completed and approved by the Division of Addiction Services (DAS) before DAS reimbursement will be authorized. • Extension request forms can be found at the following site: • http://www.state.nj.us/humanservices/das/index.htm • A NJSAMS LOCI for continued stay must be completed and submitted as part of the extension request

19. DAS Management Reports • DAS is in the process of creating management reports which would enable DAS providers to open clients via: • DASIE reports • Contract services entered into NJSAMS • Client rosters

20. NETI Client Services Flow Chart Referral Or Walk-in DASIE Completion Other DAS Service Initiatives NETI Program Eligibility (No) ASI & LOCI (Including screening for housing needs) (Referral) MHS & Other Housing initiatives (Yes) NJSAMS Admission Housing SHP Level B Intake Assessment ASI & LOCI (Including screening for Housing Needs) (Referral for Housing) Client accepts Tx SHP Level A Intake Assessment Referral for Housing (Client declines Tx) Ongoing Outreach/ Engagement Efforts Admission to NETI MMU Contracted Services CHART KEY DASIE = DAS Income Eligibility LOCI = Level of Care Index SHP = Supportive Housing Program NETI = Needle Exchange Treatment Initiative MMU = Mobile Medication Unit FFS = Fee for Service EM = Encounter Module MHS = Mental Health Services OBS = Office Based Services ASI = Addiction Severity Index ASAM = American Society of Addiction Medicine Receiving Treatment on Van and/or OBS Ongoing Assessment/ case management of client needs Referral to FFS NETI Voucher Agency, if clinically indicated

21. NETI Voucher Service Request Protocol Client receives treatment on van and/or OBS (ongoing ASAM assessment of client need) Treatment team recommends more services for client NETI Case Manager or LCADC requests voucher for other services from DAS Voucher Service Pre-approval from DAS DAS issues voucher for treatment services at Network Provider NETI FFS Agency renders treatment and enter services in NJSAMS Encounter Module NETI CM continues to manage client care and requests extension from DAS, if indicated FFS agency submits invoice to DAS Client D/C back to NETI van and/or OBS when other service is complete

22. Questions?