Indiana Medicaid Pharmacy “Gold Card” Program Gold Card... · 2019-11-20 · Indiana Medicaid...
Transcript of Indiana Medicaid Pharmacy “Gold Card” Program Gold Card... · 2019-11-20 · Indiana Medicaid...
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7th Annual Prescription Drug Abuse and Heroin Symposium
John Ross, RPh, RN
Pharmacy Clinical Programs Manager
Indiana Medicaid Pharmacy “Gold Card”
Program
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Objective:
Increase access for Indiana Medicaid members to
medication assisted treatments (MAT), provided by
certified addiction specialist providers, by reducing
provider administrative burden
Indiana Health Care Programs (IHCP) “Gold Card” Program
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Overview:
Exempting qualified providers from PA submission
requirements of preferred buprenorphine and
buprenorphine/naloxone drugs for the treatment of IHCP
members with opioid dependence
Indiana Health Care Programs (IHCP) “Gold Card” Program
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“Gold Card” Prescriber Licensure
and Certifications
• Licensed to practice medicine in Indiana.
• Addiction Certifications:
– American Board of Medical Specialties (ABMS)
• American Board of Psychiatry and Neurology, Addiction
Psychiatry
– American Board of Addiction Medicine (ABAM)
• American Society of Addiction Medicine (ASAM)
– American Osteopathic Association (CAQ)
• Addiction Medicine
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“Gold Card” Prescriber Provider
Requirements
• IHCP enrolled
• Provides direct care to member
• Certified to prescribe buprenorphine or
buprenorphine/naloxone
• Meets Federal and State requirements for prescribing
controlled substances and buprenorphine products
• Agrees to the program requirements
• Receives approval from FSSA
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“Gold Card” Prescriber Provider
Requirements (continued)
• Remains current on criteria
• Maintains member documentation of criteria
compliance
• Consents to IHCP audits
• Informs FSSA of qualification changes
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Related Websites
www.indianamedicaid.com
http://www.samhsa.gov/medication-
assisted-treatment/buprenorphine-waiver-
management/qualify-for-physician-waiver
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Questions
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Presented by:
Sara Cozad, LCSW - Assistant Deputy Director Adult Services
Division of Mental Health and Addiction
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Prevalence Rates of SMI & SUD
in the Forensic Population
• General Public
– Serious Mental
Illness: 5.4%
– Substance Use
Disorder: 8.8%
• Prisons
– SMI: 16%
– SUD: 53% (state)
45% (federal)
• Returning to Prison
– SUD: 75%• Jails
– SMI: 14.5% (men) & 31% (women)
– SUD: 68%
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HEA 1006 – Mental Health &
Addiction Forensic Treatment Fund
House Enrolled Act 1006 – July 1, 2015
Funds to DMHA:
– Target individuals affected by criminal code
revisions being diverted to the community
– Support treatment and recovery services
– Available to Individuals meeting statutory
eligibility
• Over 18, resident of Indiana, current or prior
felony, low income
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HEA 1006 Services
– Mental Health & Substance Use Assessment
– Psychiatric Evaluation
– Individual, Family and Group Therapy
– Individual, Family and Group Skills Training
– Case Management
– Medication Evaluation, Training and Support
– Medication Assisted Treatment
– Psych Medications
– Detoxification
– Supportive Employment
– Transitional Housing Assistance
– Community Support Services
– Recovery Supports
– Transportation
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HEA 1006 Treatment Providers
• Certified/Licensed DMHA Providers
• Designated Recovery Works Treatment
Agencies
– Application process – Quality Assurance and
Competency
– Training and education/licensure
requirements
– Provider list - www.recoveryworks.fssa.in.gov
• Agencies added ongoing
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Recovery Works Program
Development, Rollout & Ramp-up
• Maximize funds for treatment, reduce
administrative overhead
• Voucher-based system wherein Money-
Follows-The-Person
• Wraparound, comprehensive treatment
• Payer Source of Last Resort -provides gap
coverage for treatment and recovery
services not covered by insurance
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Recovery Works
Eligibility Criteria
Eligibility Questions Yes No
Is the individual a resident of Indiana? Eligible Ineligible
Is the individual at least 18 years old? Eligible Ineligible
Is the individual a member of a household with an annual
income not exceeding 200% of the federal income poverty level?
Eligible Ineligible
Has the individual entered the criminal justice system as a felon
or with a prior felony conviction?
Eligible Ineligible
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Process Flow
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Recovery Works Funding
It is…
• A funding source for
treatment for those
involved with the
criminal justice system
• A supplement to
community supervision
strategies that will
decrease recidivism
• Access to individualized
treatment and recovery
services
It is not…
• A Diversion or Re-entry
Program
• A stand-alone solution to
community placement
for forensic populations
• A punitive measure as
discipline for criminal
acts
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Recovery Works Program
Development, Rollout & Ramp-up
• Provided training and webinars to DMHA
Certified Providers and Criminal Justice
Partners
• Began services November 3, 2015
• Began with small pool of providers in
select Counties with paper voucher
• Began electronic voucher system (WITS)
January, 2016
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Recovery Works Program
Development, Rollout & Ramp-up
• Ongoing Statewide Training:
– County stakeholder meetings on referral
process and collaboration between providers
– Provide support, education, and Technical
Assistance for Designated Treatment Agencies
• Adding services, removed participant cap
and medication PA, increasing rates
• Focus Group with Designated Recovery
Works Providers
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• Serving
92 counties
• 64 Designated
Providers
• Over 4800+
Individuals
enrolled
• 2.5mil in
vouchered
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1510
6318
282 173
83
9
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1016
1559
1
40119
4
4
9 80310
32
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3
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7120
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HUNTINGTO
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Next Steps
• Continued JRAC discussions and
developments
• Minimize administrative burden
• Grow provider pool
• Continued support and training for
Criminal Justice Partners w/targeted TA
• Jail Re-entry Services
• Independent program evaluation