DAS Needle Exchange DAS Needle Exchange Treatment Initiative (NETI):Treatment Initiative (NETI):

Overview and TrainingOverview and Training

Thursday, December 4, 2008Thursday, December 4, 2008

NETI OverviewNETI Overview

The NETI funds medication-assisted and other The NETI funds medication-assisted and other treatment services for indigent New Jersey residents treatment services for indigent New Jersey residents with an opiate addictionwith an opiate addiction

Particular emphasis is placed on providing access to Particular emphasis is placed on providing access to treatment for individuals referred by Syringe Exhange treatment for individuals referred by Syringe Exhange Programs (SEP)Programs (SEP)

The NETI contract agencies are responsible for identifying The NETI contract agencies are responsible for identifying other payer sources to which clients can be transitioned other payer sources to which clients can be transitioned during the course of the programduring the course of the program

If the client is determined to be ineligible for another payer If the client is determined to be ineligible for another payer source during the course of treatment, the client may source during the course of treatment, the client may continue to receive services under the NETI, but the NETI continue to receive services under the NETI, but the NETI contracted agencies will continue working with the client to contracted agencies will continue working with the client to identify other payer sourcesidentify other payer sources

NETI Eligibility CriteriaNETI Eligibility Criteria

In order for clients to receive treatment In order for clients to receive treatment services and other support services services and other support services through the NETI, the NETI contracted through the NETI, the NETI contracted providers will ensure proper eligibility in the providers will ensure proper eligibility in the following areas:following areas:

Income EligibilityIncome Eligibility Program EligibilityProgram Eligibility Clinical EligibilityClinical Eligibility Co-occurring Service EligibilityCo-occurring Service Eligibility

Income EligibilityIncome Eligibility

On Day One of the admission process, the NETI contract On Day One of the admission process, the NETI contract service agency screens the client for financial eligibility service agency screens the client for financial eligibility using the NJSAMS Division of Addiction Services Income using the NJSAMS Division of Addiction Services Income Eligibility (DASIE) moduleEligibility (DASIE) module

NETI contract agencies will assist clients in the application NETI contract agencies will assist clients in the application and enrollment process for programs which may include:and enrollment process for programs which may include:

MedicaidMedicaid Work First NJ SAIWork First NJ SAI NJ Family CareNJ Family Care DAS slot-funded services, if capacity allowsDAS slot-funded services, if capacity allows

Income Eligibility (cont’d)Income Eligibility (cont’d)

Client’s household income must be at or Client’s household income must be at or below 250% of the Federal Poverty Level below 250% of the Federal Poverty Level (FPL) Guidelines to receive NETI services(FPL) Guidelines to receive NETI services

Income eligibility will be based on Income eligibility will be based on completion of DASIE module and Medicaid’s completion of DASIE module and Medicaid’s definition of household size and incomedefinition of household size and income

Movement of Clients Through the SystemMovement of Clients Through the System

If the client is eligible for another payer source, the If the client is eligible for another payer source, the client shall be re-directed to those services during the client shall be re-directed to those services during the course of treatmentcourse of treatment

If the client is eligible for Medicaid, reimbursement through If the client is eligible for Medicaid, reimbursement through these sources shall be considered as program income and these sources shall be considered as program income and must be reported as such by NETI providersmust be reported as such by NETI providers

No self-pay clients can receive services from the mobile No self-pay clients can receive services from the mobile unit or office-based services. Clients whose income is unit or office-based services. Clients whose income is above 250% poverty must attain a referral to treatment at above 250% poverty must attain a referral to treatment at an agency that accepts self-pay and private insurancean agency that accepts self-pay and private insurance

If the client is eligible for SAI, the client shall become a SAI If the client is eligible for SAI, the client shall become a SAI client. At any time, if the client is no longer eligible for SAI, client. At any time, if the client is no longer eligible for SAI, the client may return to the NETIthe client may return to the NETI

Program EligibilityProgram Eligibility

To be eligible for the NETI, clients must:To be eligible for the NETI, clients must: Be a resident of New JerseyBe a resident of New Jersey Have a history of injectable drug useHave a history of injectable drug use Test positive for opiates or have a documented one year history Test positive for opiates or have a documented one year history

of opioid dependenceof opioid dependence Be able to provide proof of identification to prevent dual Be able to provide proof of identification to prevent dual

enrollment in medication-assisted treatmentenrollment in medication-assisted treatment– NETI provider agencies should follow the same proof of NETI provider agencies should follow the same proof of

identification standards that are required for OTPsidentification standards that are required for OTPs Not currently enrolled as a client in an OMT program or a client Not currently enrolled as a client in an OMT program or a client

under the care of a physician prescribing Suboxoneunder the care of a physician prescribing Suboxone Not previously enrolled as a client in an OMT program or a Not previously enrolled as a client in an OMT program or a

client under the care of a physician prescribing Suboxone within client under the care of a physician prescribing Suboxone within the past thirty (30) daysthe past thirty (30) days

Clinical EligibilityClinical Eligibility

The NJSAMS ASI and ASAM LOCI, along with feedback The NJSAMS ASI and ASAM LOCI, along with feedback from the client on readiness to engage in services, will from the client on readiness to engage in services, will be used to determine the most appropriate level of care be used to determine the most appropriate level of care for the clientfor the client

If the client requires another level of care or support If the client requires another level of care or support services not provided via the mobile unit or office-based services not provided via the mobile unit or office-based program, the client may be eligible for a NETI voucherprogram, the client may be eligible for a NETI voucher

Other level of care services must be requested by the NETI Other level of care services must be requested by the NETI contract service Case Manager LCADCcontract service Case Manager LCADC

If issued a DAS-approved voucher, the client will be If issued a DAS-approved voucher, the client will be able to receive services through a DAS NETI Network able to receive services through a DAS NETI Network approved providerapproved provider

The Encounter ModuleThe Encounter Module Documents all face-to-face clinical contactsDocuments all face-to-face clinical contacts Supports and evaluates all client activitiesSupports and evaluates all client activities Provides a mechanism to request vouchers for billable Provides a mechanism to request vouchers for billable

servicesservices Provides a mechanism to submit claims for billable Provides a mechanism to submit claims for billable

servicesservices All contracted services must be entered into the encounter All contracted services must be entered into the encounter

module to properly document service delivery and support module to properly document service delivery and support evaluation effortsevaluation efforts

All vouchered services must be pre-approved through the All vouchered services must be pre-approved through the encounter moduleencounter module

All vouchered services delivered by the treatment provider All vouchered services delivered by the treatment provider must be entered in the encounter module in order to create must be entered in the encounter module in order to create a claim a claim

Enhanced Detox (III.7D-E)Enhanced Detox (III.7D-E) Long-term ResidentialLong-term Residential Short-term ResidentialShort-term Residential Intensive OutpatientIntensive Outpatient OutpatientOutpatient Methadone- under certain circumstancesMethadone- under certain circumstances

– Client placed in residential or supportive housing without Client placed in residential or supportive housing without access to local NETI provideraccess to local NETI provider

– Other appropriate administrative or clinical circumstancesOther appropriate administrative or clinical circumstances

Treatment Services Eligible for Treatment Services Eligible for Reimbursement Via the VoucherReimbursement Via the Voucher

Recovery Support Services Eligible Recovery Support Services Eligible for Reimbursement Via the Voucherfor Reimbursement Via the Voucher

Case Management (residential care only)Case Management (residential care only) Continuing Care AssessmentContinuing Care Assessment Transportation to/from residential care/ Transportation to/from residential care/

supportive housingsupportive housing Thirty (30) days of medication other than Thirty (30) days of medication other than

OMT (except when in III.7D-E)OMT (except when in III.7D-E)

Things to Remember when Things to Remember when Requesting a VoucherRequesting a Voucher

The LOCI needs to be completed on each client within The LOCI needs to be completed on each client within thirty (30) days of the client being referred to another thirty (30) days of the client being referred to another level of carelevel of care– Allows treatment team time to plan and discuss options Allows treatment team time to plan and discuss options

with the clientwith the client The Case Manager is responsible for ensuring that there is The Case Manager is responsible for ensuring that there is

capacity available at the provider where the client may capacity available at the provider where the client may be referred be referred

Upon a voucher being issued the agency has ten (10) Upon a voucher being issued the agency has ten (10) days to activate it or it will expire days to activate it or it will expire

The voucher is activated when the agency reports in The voucher is activated when the agency reports in the Encounter Module that one of the approved services the Encounter Module that one of the approved services is renderedis rendered

Co-occurring Service EligibilityCo-occurring Service Eligibility

To provide on-site reimbursable comprehensive co-To provide on-site reimbursable comprehensive co-occurring services, NETI programs must be accepted as occurring services, NETI programs must be accepted as eligible providers in the DAS Co-occurring Networkeligible providers in the DAS Co-occurring Network

NETI clients may be eligible to obtain co-occurring services NETI clients may be eligible to obtain co-occurring services as an enhancement at either the mobile unit, office-based as an enhancement at either the mobile unit, office-based program, or other NETI-approved voucher program, as program, or other NETI-approved voucher program, as long as these agencies are eligible providers in the DAS long as these agencies are eligible providers in the DAS Co-occurring NetworkCo-occurring Network

Co-occurring services can Co-occurring services can onlyonly be accessed as an be accessed as an enhancement to other treatment services within the NETIenhancement to other treatment services within the NETI

NETI Client Care OptionsNETI Client Care Options

The NETI client may receive services from:The NETI client may receive services from:1)1) The contracted mobile unit and/or office-based The contracted mobile unit and/or office-based

program ONLY (no services needed beyond the ones program ONLY (no services needed beyond the ones offered via the contract) offered via the contract)

2)2) The contracted mobile unit and/or office-based The contracted mobile unit and/or office-based program in addition to another level of care that is program in addition to another level of care that is reimbursed through a voucherreimbursed through a voucher

3)3) Residential treatment services and MAT to support Residential treatment services and MAT to support that placement which are both reimbursed that placement which are both reimbursed through a voucherthrough a voucher

4)4) Voucher services ONLY- no MATVoucher services ONLY- no MAT

NETI Client Care Options NETI Client Care Options (cont’d)(cont’d)

In all instances, the Case Manager from the NETI In all instances, the Case Manager from the NETI contract service provider agency continues to contract service provider agency continues to follow the client, manage their care, and request follow the client, manage their care, and request vouchers for clinically indicated servicesvouchers for clinically indicated services

The treatment provider providing services to the The treatment provider providing services to the client should also maintain an on-going client should also maintain an on-going communication with the Case Manager from the communication with the Case Manager from the NETI contract service provider agency regarding NETI contract service provider agency regarding the client’s need for continuing carethe client’s need for continuing care

Three Types of NETI Voucher Three Types of NETI Voucher Service ReferralsService Referrals

1)1) Client will continue Medication-Assisted Treatment (Methadone or Suboxone) Client will continue Medication-Assisted Treatment (Methadone or Suboxone) at the MMU/OBS but be referred to concurrent care within the NETI Fee-for-at the MMU/OBS but be referred to concurrent care within the NETI Fee-for-Service NetworkService Network Client will not be discharged from MMU/OBS and will receive clinical services from Client will not be discharged from MMU/OBS and will receive clinical services from

two agenciestwo agencies

2)2) Client may be referred to residential care and receive Medication-Assisted Client may be referred to residential care and receive Medication-Assisted Treatment (Methadone or Suboxone) via voucher through a NETI Fee-For-Service Treatment (Methadone or Suboxone) via voucher through a NETI Fee-For-Service OMT program in close proximity to the residential programOMT program in close proximity to the residential program Client will be discharged from the NETI MMU/OBS census (in order to allow more Client will be discharged from the NETI MMU/OBS census (in order to allow more

capacity for new clients)capacity for new clients) When client is discharged from residential treatment, client may return to the NETI When client is discharged from residential treatment, client may return to the NETI

MMU/OBS, if appropriateMMU/OBS, if appropriate

3)3) Client may be referred to another level of care via voucher but NOT receive Client may be referred to another level of care via voucher but NOT receive Medication-Assisted Treatment (Methadone or Suboxone)Medication-Assisted Treatment (Methadone or Suboxone) Client will not be admitted to the MMU/OBS but be referred to another level of care Client will not be admitted to the MMU/OBS but be referred to another level of care

via a vouchervia a voucher

Case Manager from the NETI contract agency continues to follow ALL clients receiving Case Manager from the NETI contract agency continues to follow ALL clients receiving vouchered services vouchered services

Clinical Extension RequestsClinical Extension Requests

Agency must follow DAS Extension Policy Agency must follow DAS Extension Policy parameters outlined below:parameters outlined below:– Treatment lengths of stay exceeding the following Treatment lengths of stay exceeding the following

timeframes will not be authorized without an approved timeframes will not be authorized without an approved request for an extension from DAS:request for an extension from DAS: Intensive Outpatient sixteen - (16) weeks of three units of Intensive Outpatient sixteen - (16) weeks of three units of

service each weekservice each week Partial Care - eight (8) weeks of four units of service each weekPartial Care - eight (8) weeks of four units of service each week Short Term treatment - thirty calendar (30) daysShort Term treatment - thirty calendar (30) days Long Term treatment - six (6) monthsLong Term treatment - six (6) months Halfway House treatment - nine (9) monthsHalfway House treatment - nine (9) months

Clinical Extension Requests (cont’d)Clinical Extension Requests (cont’d)

In circumstances where it is clinically determined In circumstances where it is clinically determined that a client needs additional treatment and that a client needs additional treatment and the length of stay will exceed the the length of stay will exceed the timeframestimeframes, , an extension request form must be completed an extension request form must be completed and and approved by approved by the Division of Addiction the Division of Addiction Services (DAS)Services (DAS) before DAS reimbursement before DAS reimbursement will be authorizedwill be authorized..

Extension request forms can be found at the Extension request forms can be found at the following site: following site: – http://www.state.nj.us/humanservices/das/index.htmhttp://www.state.nj.us/humanservices/das/index.htm

A NJSAMS LOCI for continued stay must be completed and A NJSAMS LOCI for continued stay must be completed and submitted as part of the extension request submitted as part of the extension request

DAS Management ReportsDAS Management Reports

DAS is in the process of creating DAS is in the process of creating management reports which would enable management reports which would enable DAS providers to open clients via:DAS providers to open clients via:– DASIE reportsDASIE reports– Contract services entered into NJSAMSContract services entered into NJSAMS– Client rostersClient rosters

ReferralOr Walk-in

DASIE Completion

NETI ProgramEligibility

SHP Level BIntake Assessment

ASI & LOCI(Including screening for

Housing Needs)

ASI & LOCI(Including screening

for housingneeds)

Admission toNETI MMU

Contracted Services

Receiving Treatment on Van

and/or OBSOngoing

Assessment/case management

of client needs

Other DASService Initiatives

(No)

CHART KEYDASIE = DAS Income Eligibility

LOCI = Level of Care IndexSHP = Supportive Housing Program

NETI = Needle Exchange Treatment InitiativeMMU = Mobile Medication Unit

FFS = Fee for ServiceEM = Encounter Module

MHS = Mental Health ServicesOBS = Office Based Services

ASI = Addiction Severity IndexASAM = American Society of Addiction Medicine

MHS & OtherHousing initiatives

NETI Client Services Flow Chart

(Referral)

Referral for Housing(Client declines Tx)

SHP Level AIntake Assessment

(Referral for Housing)Client accepts Tx

Ongoing Outreach/Engagement

Efforts

Housing

NJSAMSAdmission

(Yes)

Referral to FFS NETIVoucher Agency, ifclinically indicated

NETI FFS Agency renders treatment and enter services in NJSAMS Encounter Module

NETI CM continues to manage client care and requests extension from DAS, if indicated

FFS agency submits invoice to DAS

Client D/C back to NETI van and/or OBS when other service is complete

Treatment team recommends more services for client

NETI Case Manager or LCADC requests voucher for other services from DAS

Voucher Service Pre-approval from DAS

DAS issues voucher for treatment services at Network Provider

Client receives treatment on van and/or OBS (ongoing ASAM assessment of client need)

NETI Voucher Service Request Protocol

Questions?Questions?