In October of 2019, Delaware’s Division of Medicaid and Medical Assistance (DMMA) was one of 15 states nationally to be awarded a planning grant from the Centers for Medicare and Medicaid Services (CMS) under section 1003 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. In October of 2021, DMMA was one of five states to be awarded a SUPPORT Act Demonstration Project, a 36-month initiative beginning September 30, 2021, and running through September 30, 2024. DMMA is using this funding to assess and improve the capacity of Medicaid substance use disorder (SUD) providers to serve Medicaid beneficiaries with SUD.

SUD Prevalence Study

With funding from the SUPPORT Act Planning Grant, DMMA contracted with the University of Delaware Center for Community Research and Service to produce the Annual Prevalence Report (2014-2019) for Substance Use Disorder Among Medicaid Clients. The report includes statewide SUD and opioid use disorder (OUD) prevalence rates among Delaware Medicaid beneficiaries, as well as other key indicators such as demographics and subpopulations impacted by SUD/OUD, rates of co-occurring mental illness and polysubstance use, and county- and zip code-level OUD prevalence rates. To view the report, click here.

Medicaid SUD Rate Study

In December 2020, DMMA contracted with Health Management Associates to release a structured survey to Delaware SUD providers to collect information on the costs associated with delivering SUD services. Data from returned surveys, qualitative feedback from providers, and data from other external sources (e.g., Bureau of Labor Statistics’ data) were used to inform draft rate models. Draft rate models were presented to SUD providers on January 26, 2022; find webinar recording here and slides here. On April 20, 2022, additional details were presented about SUD rate model construction and assumptions; find the webinar recording here, the slides here, and the updated draft rate models here. DMMA released draft SUD rates for public comment in September 2022.

Effective January 1, 2023, Medicaid SUD payment rates were updated as detailed in the table below. DMMA instituted these payment rate changes within the Medicaid fee-for-service (FFS) program.

Please contact Jacob.Bowling@delaware.gov if you have any questions about the updated SUD payment rates.

Notes: DMMA increased the Medicaid fee-for-service payment rate for methadone administration (H0020) from $4.00 to $12.00 effective March 1, 2022.

*The former payment rates as listed are from the “Delaware Adult Behavioral Health DHSS Service Certification and Reimbursement Manual”, November 1, 2016. Available at: https://www.dhss.delaware.gov/dhss/dsamh/files/ReimbursementManual.pdf.

**Indicates how a given service aligns with American Society of Addiction Medicine (ASAM) levels of care as outlined in the third edition of “The ASAM Criteria: Treatment Criteria for Addictive Substance-Related and Co-Occurring Conditions.”

Office-Based Opioid Treatment Resources

As part of DMMA's efforts to expand access to Office-Based Opioid Treatment (OBOT) programs, in June 2021, DMMA created quick reference guides on available OBOT billing and coding options, prescriber and dispensing site regulations, and medication coverage options. Formal DMMA policy documents supersede any information in these guides. In July 2022, DMMA also developed a summary of clinical guidance on incorporating opioid use disorder treatment for pregnant and postpartum people into standard medical care. 

SUPPORT Act Provider Survey

IBM Consulting is conducting a SUPPORT Act Provider Survey for providers who likely prescribe buprenorphine or administer methadone or other medication for opioid use disorder to Medicaid beneficiaries in the following states that received SUPPORT Act funding: Alabama, Connecticut, Delaware, District of Columbia, Illinois, Indiana, Kentucky, Maine, Michigan, Nevada, New Mexico, Rhode Island, Virginia, Washington, and West Virginia. Findings from this survey will help federal government partners understand how SUPPORT Act-related activities are working to improve provider capacity to prevent and treat opioid use disorder among vulnerable populations across the country. IBM Consulting obtained contact information for survey distribution from the SAMHSA Buprenorphine Practitioner Locator, the state Medicaid agency, or from the State Opioid Treatment Authority.

Invitations to participate in the web survey will be mailed (via USPS) or emailed during the first week of January. The letter or email will contain a URL and QR code for the survey website and a Personal Identification Number (PIN) that has been assigned to each respondent. If you receive an email, it will be from SUPPORT-Act@norc.org; please check your spam filter. All responses to the survey are strictly confidential and no individual responses will be shared with any of the sponsoring agencies. If you have any questions about the forthcoming survey, or experience technical difficulties taking the survey, please e-mail SUPPORT-Act@norc.org or call toll free at 1-877-368-6572. You can learn more about the SUPPORT Act Provider Survey here.