The 1115 Demonstration Waiver Substance Use Disorder (SUD) Medicaid withdrawal management policies have been rescheduled to promulgate on May 1, 2024. The delay in promulgation is provided to allow service providers the opportunity to align with new and amended policies and applicable licensure rule waivers. This article applies to NC Medicaid Direct and NC Medicaid Managed Care.
The clinical coverage policies impacted include:
CCP 8A-7, Ambulatory withdrawal management without extended on-site monitoring (ambulatory detox), 1-WM
Ambulatory Withdrawal Management (WM) without Extended On-Site Monitoring is an organized outpatient service that provides medically supervised evaluation, withdrawal management and referral in a licensed facility. Services are provided in regularly scheduled sessions to be delivered under a defined set of policies and procedures or medical protocols.
This is an American Society of Addiction Medicine (ASAM) Criteria, Third Edition, Level 1 WM service for a beneficiary who is assessed to be at minimal risk of severe withdrawal, free of severe physical and psychiatric complications, and can be safely managed at this level. These services are designed to treat the beneficiary’s level of clinical severity and to achieve safe and comfortable withdrawal from alcohol and other substances to effectively facilitate the beneficiary’s transition into ongoing treatment and recovery.
This standalone policy will supersede the Ambulatory Detox policy included in CCP 8A, Enhanced Mental Health and Substance Abuse Services.
CCP 8A -8, Ambulatory withdrawal management with extended on-site monitoring, 2-WM
Ambulatory WM with Extended On-Site Monitoring is an organized outpatient service that provides medically supervised evaluation, withdrawal management, and referral in a licensed facility. Services are provided in regularly scheduled sessions and should be delivered under a defined set of policies, procedures, or medical protocols.
This ASAM Criteria, Third Edition, Level 2 WM service is for a beneficiary who is assessed to be at moderate risk of severe withdrawal, free of severe physical and psychiatric complications and would safely respond to several hours of monitoring, medication, and treatment.
These services are designed to treat the beneficiary’s level of clinical severity and to achieve safe and comfortable withdrawal from alcohol and other substances to effectively facilitate the beneficiary’s transition into ongoing treatment and recovery.
This is a new substance use disorder treatment service/policy added to the Medicaid service array.
CCP 8A-10, Clinically managed residential withdrawal management (Social setting Detox), 3.2-WM
Clinically Managed Residential WM Service is an organized facility-based service that is delivered by trained staff who provide 24-hour supervision, observation and support for a beneficiary who is intoxicated or experiencing withdrawal.
This is an ASAM Criteria, Third Edition, Level 3.2 WM service intended for a beneficiary who is not at risk of severe withdrawal symptoms or severe physical and psychiatric complications. Moderate withdrawal symptoms can be safely managed at this level of care.
This service emphasizes the utilization of peer and social supports to safely assist a beneficiary through withdrawal. Programs must have established clinical protocols developed and supported by a physician who is available 24 hours a day.
Support systems must include direct coordination with other levels of care. This service is designed to achieve safe and comfortable withdrawal from alcohol and other substances to effectively facilitate the beneficiary’s transition into ongoing treatment and recovery.
This is a new substance use disorder treatment service/policy added to the Medicaid service array.
CCP 8A-11, Medically monitored inpatient withdrawal management (non-hospital medical detox), 3.7-WM
Medically Monitored Inpatient WM Service is an organized facility-based service that is delivered by medical and nursing professionals who provide 24-hour medically directed observation, evaluation, monitoring, and withdrawal management in a licensed facility.
Services are delivered under a defined set of physician-developed and approved policies; physician-monitored procedures; and clinical protocols by medical professionals, clinicians, and support staff.
This is an ASAM Criteria, Third Edition, Level 3.7 WM for a beneficiary whose withdrawal signs and symptoms are sufficiently severe to require 24-hour observation, monitoring and treatment in a medically monitored inpatient setting. A beneficiary at this level of care does not need the full resources of an acute care general hospital or a medically managed intensive inpatient treatment program.
This standalone policy will supersede the Non-Hospital Medical Detoxification policy included in CCP 8A, Enhanced Mental Health and Substance Abuse Services.
Contact
NC Medicaid Contact Center: 888-245-0179