AlphaMCS Downtime | Medicaid-funded OBOT | Provider Info

Issued:  May 6, 2020

AlphaMCS 2.16 Build

The next AlphaMCS build is scheduled to occur today, Wednesday, May 6, 2020.  The system will be unavailable from 5:00 PM – 9:00 PM.  Please make sure you are logged out of the AlphaMCS system prior to 5:00 PM.

Included in this build are the following changes/corrections:

  • Enrollments ->Create Enrollment Request screen:
    • Living Arrangement field will now default to “Private Residence (house, apartment, mobile home, child living with family)”
  • Service Authorization Requests:
    • Correction to ensure daylight savings time start and end dates do not affect SAR unit calculation.
    • When printing a SAR to PDF, the following sections will now automatically expand and include all rows:  Substance Use grid, Medications grid, and Justification for Service Request comment fieldEntry of SAR
    • Substance Use records will now require the “Route” and “Frequency” fields to be completed.  Additionally, if “SA” is selected as the SAR type, the “Amount” field will also be required.  (This information is required to meet state reporting requirements for the Consumer Data Warehouse.)

Office-based Opioid Treatment (OBOT) Medicaid Prescriber Opportunity

Partners continues to focus on aggressively combatting the opioid epidemic by promoting the use of evidence-based practices. The gold standard for opioid use disorder is Medication Assisted Treatment. This treatment is most effective when provided for 180 days or longer to help establish a strong foundation in recovery.

Office-based Opioid Treatment (OBOT) is defined as “treatment of opioid use disorders in the clinical setting by a qualified provider as defined under Public Law 106-310 Section 3501(a)(G)(ii) to prescribe buprenorphine or buprenorphine-naloxone medications.” Opioid use disorder is considered a chronic condition, and the management of this disorder is incorporated into the overall care of the member. NC Clinical Coverage Policy 1A-41 specifies the rules that must be adhered to for Medicaid reimbursement. The treatment goals for OBOT are to reduce or stop opioid use, to improve the beneficiary’s overall health and social functioning, and to help the beneficiary avoid some of the more serious consequences of opioid addiction. Providing OBOT within integrated care settings and physician offices helps reduce stigma, treat the whole person and provide improved access in smaller counties.

In order to enhance access to this critical evidence-based treatment, Partners is offering a $5 per service premium to be added on the code when billed to each physician-based service. We will monitor engagement through service and pharmacy claims as well as study the member’s health outcomes.

As we study these outcomes, we would like to expand this agreement in a more comprehensive way, which could include a contract inclusive of shared savings or other value based methods with the goal of keeping our shared members engaged in OBOT while reducing engagement in less appropriate and less effective services. Currently, these savings are within our behavioral health capitation. We are seeking to partner and develop a solid baseline so that Value Based Contracting might quickly evolve and expand under the 1115 waiver.

Any buprenorphine-waivered provider who provides MAT to Partners Medicaid members in an office-based opioid treatment program with a taxonomy code allowable for LME-MCO billing may submit a request to add the codes 99212, 99213, or 99214 codes with “OU” as the modifier to their contract for each prescriber using the Provider Change Form. For each of these, the provider will add and be reimbursed an additional $5 beyond the current LME-MCO Medicaid rate when prescribing a buprenorphine product. This only applies to Medicaid.

If you have further questions, please contact pas@partnersbhm.org or call 1-877-864-1454, option 4, option 1.

Provider Information Sessions

Partners is continuing to host Provider Information Sessions that are focused on provider input and brainstorming. To register for a session, click on the date and time listed below. You may submit your questions to questions@partnersbhm.org in advance; we also recommend that you review the FAQs from past information sessions.