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Substance Use Disorder (SUD) Treatment

In response to the opioid crisis, Governor Eric Holcomb has prioritized attacking the drug epidemic on all fronts: prevention, treatment, and enforcement. The Indiana Family and Social Services Administration (FSSA) and Office of Medicaid Policy and Planning (OMPP) support this statewide priority and aim to ensure that all Hoosiers are provided the substance use disorder (SUD) treatment they need in the most accessible manner. Further resources and descriptions of FSSA-OMPP initiatives related to SUD are provided on this page.

If you have any questions or concerns, please contact the FSSA SUD Services inbox at SUD.Services@fssa.in.gov.

Section 1115 SUD Demonstration Waiver

Section 1115 of the Social Security Act gives states the flexibility to propose and implement innovative demonstration projects in an effort to better serve Medicaid populations. On February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) approved an extension to Indiana's existing Section 1115 Medicaid demonstration waiver. The waiver now expands coverage for a full-range of SUD treatment services to Indiana Health Coverage Programs (IHCP) members enrolled in Traditional Medicaid (full, fee-for-service coverage) or in any managed care program – including Healthy Indiana Plan (HIP), Hoosier Care Connect, and Hoosier Healthwise. Changes under the new SUD waiver include the following:

  • Expanding coverage of inpatient SUD treatment provided in institutions of mental disease (IMDs)
  • Adding coverage for short-term residential SUD treatment
  • Establishing a new provider type and specialty for residential treatment

Indiana's Section 1115 SUD demonstration waiver is effective through December 31, 2020.

Strengthening the SUD Delivery System: The SUD Work Group

Beginning in September 2018, the OMPP, in coordination with the Division of Mental Health and Addiction (DMHA), assembled an SUD work group to review the SUD demonstration waiver’s rollout, examine ways to improve upon delivery and coordination of new services, and engage providers and stakeholders on best practices and ways to strengthen the delivery system.

The OMPP and DMHA are in the process of implementing recommendations from that initial effort, while continuing to collaborate across FSSA divisions and with stakeholder groups to identify and address new challenges in the SUD service delivery system. For more information on this project or individual initiatives to improve SUD treatment and access, please see the following resources:

COVID-19 Related Documents and Guidance

The following resources provide guidance regarding behavioral health services during the coronavirus disease 2019 (COVID-19) public health emergency:

IHCP SUD Provider References

For details about IHCP coverage, billing, and reimbursement requirements for SUD services, see the bulletins, banner pages, provider references modules, and other materials posted in the provider references section of this website, including the following:

  • BT202082 – IHCP revises direct service provider requirement for IOT of members with SUD diagnosis (June 30, 2020)
  • BR201950 – IHCP will reimburse claims for NARCAN when billed on CMS-1500 or UB-04 claim form (December 10, 2019)
  • BR201935 – IHCP clarifies coverage qualifications for partial hospitalization (August 27, 2019)
  • BT201943 – More providers can supervise plan of treatment for outpatient mental health or SUD treatment (July 23, 2019)
  • BR201926 – Substance use disorder PA request attachments can be submitted on the Portal (June 25, 2019)
  • BR201925 – IHCP corrects published qualifications and supervision requirements for certain mental health providers (June 18, 2019)
  • BT201929 – IHCP to modify coverage of certain mental health services (May 30, 2019)
  • BR201908 – IHCP clarifies basic instructions for SUD billing of certain services (February 19, 2019)
  • BT201906 – IHCP establishes PA request and assessment forms for residential and inpatient SUD treatment (February 12, 2019)
  • BT201841 – IHCP corrects information published about residential SUD treatment benefits (August 7, 2018)
  • BT201827 – IHCP corrects information published about residential SUD treatment PA criteria (June 12, 2018)
  • BT201821 – IHCP responds to provider FAQs about residential SUD treatment benefits (May 22, 2018)
  • BT201801 – IHCP enhances coverage for substance use (January 4, 2018)
  • BT201755 – IHCP issues revised reimbursement policy and billing guidance for OTP-specific services (August 17, 2017)
  • Mental Health and Addiction Services provider reference module

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