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.

Delaware Medicaid’s Management of Addictions in Routine Care Model 

Management of Addiction in Routine Care (MARC) is a vital initiative that supports DMMA’s goal to increase adoption of life-saving buprenorphine treatment in outpatient medical settings for Medicaid beneficiaries with opioid use disorders. After a national scan of best practices, DMMA has designed specifications for its MARC model, delineating eligible provider types, patient eligibility criteria, service descriptions, payment model, staffing requirements, performance measures, and other details. Please find those specifications in DMMA’s Concept Paper. If you have any questions or feedback, please contact DMMA's Behavioral Health Medical Director, Dr. Sherry Nykiel, at Sherry.Nykiel@delaware.gov. 

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. On April 20, 2022, additional details were presented about SUD rate model construction and assumptions. 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.

 

Service Description (HCPCS code and required modifier, if applicable)	Unit	Former Rate*	Updated Rate	ASAM Level of Care**
ASAM Level 1
Alcohol and/or drug assessment (H0001)	One session	$77.30	$141.79	1
Alcohol and/or drug assessment, home/community (H0001-U1)	One session	$90.26	$194.75	1
Behavioral health counseling and therapy (H0004)	Per 15 minutes	$19.33	$22.10	1
Group counseling by a clinician (H0005)	Per 45 minutes	$9.66	$13.25	1
Self-help/peer services, substance abuse program (H0038)	Per 15 minutes	$14.75	$16.38	1
Self-help/peer services, substance abuse program, home/community (H0038-U1)	Per 15 minutes	$14.75	$21.88	1
Self-help/peer services, substance abuse program, home/community (H0038-HQ)	Per 15 minutes	n/a	$3.69	1
ASAM Level 2
Subacute detoxification (residential addiction program outpatient, 23-hour) (H0012)	Per diem	$334.27	$334.27	2
Intensive outpatient (treatment program that provides at least 9 hours per week of service, but less than 20) (H0015)	Per diem	$126.79	$149.68	2.1
Partial hospitalization (treatment program that provides at least 20 hours per week of service) (H0035-HF)	Per diem	$190.18	$283.89	2.5
ASAM Level 3
Clinically managed low-intensity residential treatment (H2034)	Per diem	$150.53	$219.25	3.1
Clinically managed population-focused high-intensity residential services (H2036-HI)	Per diem	$189.44	$259.95	3.3
Clinically managed high intensity residential treatment (H2036)	Per diem	$189.44	$259.95	3.5
Medically monitored intensive inpatient residential (H2036-TG)	Per diem	$291.65	$377.60	3.7
Medically monitored intensive inpatient residential, acute withdrawal management (WM) (H0011)	Per diem	$354.67	$452.43	3.7-WM

 

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

In July 2022, DMMA 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