Pennsylvania’s Department of Drug and Alcohol Program announced on Thursday, March 9, that the state would begin using the nationally recognized ASAM Criteria to determine the appropriate level of care for an individual seeking addiction treatment or already within the Pennsylvania treatment system. Previously, a customized tool, the PCPC (Pennsylvania Client Placement Criteria), was required by the state for treatment decisions. Full implementation of the ASAM Criteria is expected to occur by July 2018.
The Acting Secretary of the Department of Drug and Alcohol Programs, Jennifer S. Smith, stated in an email notice that the “transition stems from the Centers for Medicare & Medicaid Services (CMS) Medicaid Managed Care Final Rule that was issued last summer, which will limit federal reimbursement for residential treatment of Medicaid recipients to 15 days. In response to that rule, and specifically the provision related to the IMD exclusion, Pennsylvania aims to better position ourselves in submitting a 1115 waiver to CMS related to the IMD exclusion. The 1115 waiver application requires the use of the ASAM tool.” (Click here to learn more about the 1115 waiver)
Other benefits mentioned in the email included aligning the Pennsylvania treatment system with the ASAM Criteria, which is currently utilized for placement decisions in many settings across the state and by many commercial insurance providers. The ASAM Criteria is used in more than 30 states and by more than ten insurers. (Click here to learn more about The ASAM Criteria).
ASAM is helping states and counties meet requirements like the 1115 waiver with an endorsed ASAM Criteria assessment tool called the ASAM CONTINUUM®. The ASAM CONTINUUM is a standardized ASAM Criteria implementation. The ASAM CONTINUUM assessment is being used and piloted in several settings including treatment centers, hospitals and even justice systems. By providing a standardized assessment, the ASAM CONTINUUM tool helps implement, demonstrate, and perform ASAM assessments. For more information about the ASAM CONTINUUM, click here.