Harrisburg, PA – Today, the Department of Human Services (DHS) received approval from the federal government for a waiver amendment allowing DHS to continue to receive federal Medicaid funding to be used for the treatment of individuals in substance-use disorder (SUD) treatment facilities.
The Section 1115 Demonstration Waiver Amendment was developed in collaboration with the Department of Drug and Alcohol Programs to continue more than $55 million per year in federal funding to provide more than 12,000 individuals access to high-quality, medically necessary treatment for SUD across the commonwealth through more than 150 service providers.
“This waiver continues the funding that helps Pennsylvanians suffering from substance use disorder receive the full treatment continuum they need to recover,” Governor Tom Wolf said. “We would not have allowed anyone to be removed from treatment, but this goes a long way in relieving some of the financial burden of that care.”
“A full continuum of treatment services, including residential care, is essential to an individual’s ability to effectively fight addiction,” said DHS Secretary Teresa Miller. “We are excited to take these necessary steps to help provide quality, individualized care to more Pennsylvanians.”
In addition, the waiver approval recognizes the transition from the Pennsylvania Client Placement Criteria (PCPC) to the evidence-based American Society of Addiction Medicine (ASAM) criteria as a placement tool and guide for clinical care. The ASAM criteria was developed to establish a national standard for care by creating individualized, results-based treatment plans for those seeking treatment for SUD and is used by more than 30 other states. The ASAM also eases coordinated care for individuals needing treatment for a co-occurring behavioral health condition.
“As we battle the prescription drug and heroin epidemic, ensuring access to quality, evidence-based care is imperative to improving long-term health outcomes for Pennsylvanians with a substance use disorder,” said DDAP Secretary Jennifer Smith. “This waiver and the transition to ASAM expands the tools and resources available to Pennsylvania’s treatment providers and ensures that all Pennsylvanians can receive high-quality, patient-focused care that makes recovery possible.”
“I applaud Pennsylvania’s efforts to design this comprehensive strategy to combat substance abuse and improve the health and well-being of their Medicaid beneficiaries,” said CMS Administrator Seema Verma. “Under the Trump administration’s revised guidance issued last fall, CMS has approved eight additional states in the last seven months to help make Pennsylvania the 13th state to gain federal approval for this important tool in the fight against the opioid crisis.”
Effective treatment for SUD must incorporate a range of clinical and psychosocial components provided in a safe environment, as determined by appropriate guidelines.
This approval will allow the commonwealth to continue receiving more than $55 million per year in Medicaid funding for the treatment of individuals in SUD residential treatment facilities for more than 15 days in a month who had been adversely impacted by the changes in the federal Medicaid managed care rules in May 2016.
To learn more visit https://www.medicaid.gov/medicaid/section-1115-demo/about-1115/index.html
View the approved waiver amendment and the special terms and conditions here.
SOURCE: Governor Wolf’s office