Substance Use Disorder (SUD) Withdrawal Management Services

Revised: August 3, 2021

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Documentation of Covered Services

· Billing

· Legal References

Overview

Withdrawal management services are designed to assist patients in safely withdrawing from alcohol or other substances. American Society of Addiction Medicine (ASAM) defines multiple levels of withdrawal management. The following two ASAM-based levels of residential withdrawal management were added to the state’s Medicaid benefit set:

Level 3.2 Clinically Managed is defined as a residential setting with staff comprised of a medical director and a licensed practical nurse (LPN). An LPN must be on site 24 hours a day, seven days a week. A qualified medical professional must be available by telephone or in person for consultation 24 hours a day. Patients admitted to this level of service receive medical observation, evaluation and stabilization treatment services. A licensed staff administers medications for a successful withdrawal by conducting a comprehensive assessment pursuant to Minnesota Statutes 245G.05.

Level 3.7 Medically Monitored is defined as a residential setting with staff that includes a registered nurse and a medical director. A registered nurse must be on site 24 hours a day. A medical director must be on site seven days a week, and patients must have the ability to be seen by a medical director within 24 hours. Patients admitted to this level of service receive medical observation, evaluation and stabilization treatment services. During detoxification process, a licensed staff administers medications for a successful withdrawal and conducts a comprehensive assessment pursuant to section Minnesota Statutes 245G.05.

Eligible Providers

To provide, bill and receive payment for withdrawal management services a provider must:

· Be a licensed 245F withdrawal management program.

· Be enrolled as a Minnesota Health Care Programs (MHCP) provider for withdrawal management services.

· Each facility must be enrolled as an eligible provider of specific level of (3.2 or 3.7) withdrawal management services.

· Enroll and participate in the Drug and Alcohol Abuse Normative Evaluation System (DAANES). All withdrawal management patients need to be entered into DAANES for each admission episode. Email DHS.DAANES@state.mn.us to obtain the necessary training and documents required to participate in DAANES after your enrollment with MHCP is complete.

Providers applying for a withdrawal mangement license may also be:

· Chemial dependency licensed treatment facilities

· Detox providers

· Tribally licensed programs

· Hospital-based programs

· Intensive Residential Treatment Services facilities

· Mental Health Crisis facilities

Eligible Members

To access withdrawal management services, a patient may be on fee for service (MA), enrolled in a managed care organization (MCO), have private insurance or may be eligible for services through the Behavioral Health Fund (BHF) if they meet eligibility requirements. BHF financial and clinical eligibility is determined after services have been initiated.

Individuals enrolled with an MHCP-contracted MCO must contact their MCO for details on coverage and accessing SUD services.

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Covered Services

Providers are responsible to know and understand the rules and regulations of any services they submit for reimbursement. See the BHF Service Rate Grid with Dollar Amounts effective 7-1-2021 (DHS-7612) (PDF) for withdrawal management covered services.

· The following Clinically Managed (Level 3.2) covered services are included in the per diem rate:

· Individual or group motivational counseling sessions

· Individual advocacy and case management services

· Care coordination

· Peer recovery support services

· Patient education

· Referrals to mutual aid, self-help and support groups

· An initial health assessment conducted by a nurse upon admission

· Daily on-site medical evaluation by a nurse

· Comprehensive assessment

· Stabilization planning

· Standardized collection tool for collecting health-related information

· Written procedures for a nurse to assess and monitor patient health within the nurse’s scope of practice that:

· Are approved by the medical director, include a follow-up screening conducted between 4-12 hours after service initiation to collect information related to intoxiction, health complaints, and behavioral risk factors;

· Specify the physical signs and symptoms that, when present, require consultation with a registered nurse or physician;

· Specify those staff members responsible for monitoring patient health and provide hourly observation and more frequent observation if the initial assessment indicates a need.

· Have a licensed practicial nurse on site 24 hours and a medical director

· Provide an initial health assessment conducted by a nurse upon admission

· Provide daily on-site medical evaluation by a nurse

· Have a registered nurse available by telephone or in-person for consultation 24 hours per day

· Have a licensed practitioner available by telephone or in-person for consultation 24 hours per day

· Have appropriately licensed staff available to administer medications according to prescriber approved orders.

The following Medically Monitored (Level 3.7) covered services are included in the per diem rate:

· An initial health assessment conducted by a registered nurse upon admission

· Medical evaluation and consultation with a registered nurse 24 hours a day

· Availability of a licensed practitioner by telephone or in person for consultation 24 hours a day

· Ability to be seen within 24 hours or sooner by a licensed practitioner

· Availability of on-site monitoring of patient care seven days per week by a licensed practitioner

· Administer medications according to prescriber-approved orders

· Individual or group motivational counseling sessions

· Individual advocacy and case management services

· Care coordination

· Peer recovery support services

· Stabilization planning

· Comprehensive assessment

· Daily on-site medical evaluation by a nurse

· Referrals to mutual aid, self-help and support group

· Standardized collection tool for collecting health-related information

· Written procedures for a nurse to assess and monitor patient health within the nurse’s scope of practice that:

· Are approved by the medical director, include a follow-up screening conducted between 4-12 hours after service initiation to collect information related to intoxiction, health complaints and behavioral risk factors;

· Specify the physical signs and symptoms that, when present, require consultation with a registered nurse or physician;

· Specify those staff members responsible for monitoring patient health and provide hourly observation and more frequent observation if the initial assessment indicates a need.

Noncovered Services

The following are not covered services:

· Rule 25 chemical use assessments

· Room-and-board services not clinically or medically necessary

· Services delivered to MHCP members managed by an MCO, with the exception of room-and-board services billed directly to DHS and without service agreement

· Additional SUD treatment services or complexities added to the per diem rate

· Detoxification services

· MAT guest dosing

Services bundled in withdrawal management treatment and cannot be billed separately:

· Comprehensive Assessment

· Treatment coordination

· Peer support services

· MAT services, including MAT-methadone, MAT-all other, MAT-methadone plus and MAT-all other plus

Documentation of Covered Services

Progress notes must be entered in the patient’s file at least daily and immediately following any significant event. A progress note must be legible, signed and dated by the staff person completing the note. Each progress note must include:

· Patient involvement in stabilization planning, including type and amount of service

· Date of service

· Monitoring and observations of the patient’s medical needs

· Documentation of referrals made to other services or agencies

· Specification of the participation of others

Billing

For behavioral health fund authorized services, a county or tribe generated service agreement is not a requirement to bill MHCP. Providers create daily encounters using the Drug and Alcohol Abuse Normative Evaluation System (DAANES) Detox/Withdrawal Management system to create records for members to enable direct billing without a service agreement. Providers will then submit the claims through MN–ITS.

Bill MHCP for only the following services when approved for behavioral health fund:

· Withdrawal Management Clincally Managed level 3.2

· Withdrawal Management Medically Monitored level 3.7

· Per diem rates includes room and board

For withdrawal management room-and-board services, bill the following:

· Value code 80 and the number of inpatient covered days

· Enter Value Code 24 with correct five-digit rate code from the Value Code 24 Withdrawal Management Room and Board Billing (DHS-7312) (PDF) list corresponding to the listed service combinations.

See the MHCP MN–ITS User Manual for instructions on how to submit electronic claims.

Interim Billing

Bill withdrawal management services that span multiple months using interim billing method. Include the date of discharge on the final treatment claim along with appropriate patient status code.

Type of Bill frequency (three-digit) codes:

· xx1 – Admit through discharge claim

· xx2 – Interim-first claim (first claim in a series of continuous claims or interim billing)

· xx3 – Interim-continuing claim

· xx4 – Interim-last claim (discharge claim)

· xx7 – Replacement of prior claim

· xx8 – Void/cancel of prior claim

Billing codes

Service Description	Unit	Revenue Code	Claim format	Type of bill	Service Limitations
Withdrawal Management Clincally Managed level 3.2	Day	0900	837I	86X	Per diem
Withdrawal Management Medially Monitored level 3.7	Day	0919	837I	86X	Per diem
Room and Board Associated with Withdrawal Management	Day	1002	837I	86X	Per diem

Medicare

Medicare does not cover Withdrawal Management. Certified Medicare facilities serving Medicare-eligible clients must follow the MHCP Medicare policy found in the MHCP Provider Manual; see Medicare and Other Insurance under Billing Policy.

Third-Party Liability (TPL)

Individuals with private insurance may qualify for behavioral health fund if their insurance does not cover 100 percent of their treatment. MHCP TPL policy applies to all SUD treatment providers, including withdrawal management providers. When a member has private commercial insurance, you must first bill the private commercial insurance before billing MHCP. Bill doing the following:

· Verify member eligibility in MN–ITS before submitting bills to MHCP. If MN–ITS indicates that TPL exists for the dates that you would like to bill for, then you must first bill the third party displayed in MN–ITS for the dates. If you bill MHCP for dates of service when TPL exists, MHCP will deny the claim.

· Submit appropriate documentation to MHCP after billing the TPL. You must follow the MHCP TPL policy found in the Medicare and Other Insurance section of the MHCP Provider Manual under Billing Policy.

Legal References

Minnesota Statutes, 245F (Withdrawal Management Programs)
Minnesota Statutes, 254A.03 (Alcohol and Drug Abuse)
Minnesota Statutes, 254B (Consolidated Chemical Dependency Treatment Fund)
Minnesota Statutes, 256B.031 (Prepaid Health Plans)
Minnesota Statutes, 256L (MinnesotaCare)
Minnesota Rules, parts 9530.6600 to 9530.6655 (Rule 25)
Minnesota Rules, parts 9530.6800 to 9530.7030 (Rule 24)
Minnesota Rules, parts 9530.6510 to 9530.6590
Minnesota Rules, part 9530.6615, subpart 2 (Rule 25, Staff Performing Assessment)
Minnesota Rules, part 9530.6605, subpart 21a (Rule 25, Definitions, Placing Authority)
Code of Federal Regulations, title 42, section 440.130(d)