Technical Assistance forHealth Resources and

Services Administration (HRSA)Rural Communities Opioid Response Program-Implementation (RCORP-

Implementation) GranteesModule 2

Program Guidance: Sustainability

Developed by JBS International, Inc.

March 2020

Table of ContentsProgram Guidance: RCORP-Implementation Sustainability Deliverables.....................1

Technical Assistance Resources for Achieving Programmatic and Financial Sustainability.................................................................................................................3

Sustainability Through Healthcare Financing................................................................4

ACA Marketplace Plans/Third-Party Insurance....................................................................................4

Medicare.............................................................................................................................................4

Medicaid..............................................................................................................................................5

Tips for Leveraging Medicaid Reimbursement....................................................................................6

Understand the Medicaid Managed Care Landscape..........................................................................6

Identify Common Billing Hurdles.........................................................................................................7

Understand Administrative Requirements for SUD Providers in Your State........................................8

State Laws............................................................................................................................................9

Program Licensure.............................................................................................................................10

Regulations........................................................................................................................................11

Workforce..........................................................................................................................................11

Appendix A..................................................................................................................13

RCORP-Implementation Sustainability Plan Part I: Defining Sustainability Template13

Attachment B: Medicaid Flexibilities and Minimal and Optional Benefits....................16

Appendix C..................................................................................................................18

RCORP Onboarding Packet

Program Guidance: RCORP-Implementation Sustainability Deliverables

Although RCORP only spans three years, one of the primary goals of the program is to develop sustainable prevention, treatment, and recovery infrastructure and services to enhance rural communities’ ability to access care. RCORP grant recipients are expected to sustain their services and consortium infrastructure beyond the grant period, and to ensure that services remain accessible and affordable to individuals who need them the most, including uninsured and underinsured populations. Because of the challenges and complexities inherent in sustaining services without grant funding, particularly in areas with workforce shortages and/or limited resources, it is important to begin thinking about and planning for sustainability from Day 1 of your grant.

Over the course of the three-year project period, your consortium will complete a three-part Sustainability Plan. Each part builds on the preceding part and is designed to help your consortium strategically and methodically develop and implement concrete action steps to sustain the consortium itself and the services they provide to the community. All partners should be engaged in the development of each deliverable.

A summary of the three components of the Sustainability Plan is below:

Part 1: Defining Sustainability (due in EHB 9/30/2020)—TEMPLATEa. Complete second iteration of Sustainability Assessmentb. Define what sustainability means for your consortium;c. Identify internal and external assets and challenges that you anticipate will

aid or hinder your ability to sustain services (it is recommended you use the results of your Sustainability Assessment to inform this process);

d. Identify which challenges and assets you will prioritize during the grant period;

e. Designate individuals within the consortium who will be responsible for implementing activities designed to sustain consortium services and membership (it is recommended that you divide these individuals into two subcommittees—one focused on financial sustainability and another focused on consortium sustainability).

Part 2: Developing Sustainability Work Plan (due in EHB 9/30/2021)—TEMPLATE FORTHCOMING

a. Complete third iteration of Sustainability Assessmentb. Develop a sustainability work plan that details how your consortium will

ensure financial sustainability and the sustainability of the consortium itself after the grant period ends. At a minimum, the work plan should detail the timeline and responsible individuals/organizations for each activity, including:

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i. Activities intended to help the consortium “break even” by the end of the three-year grant period, including optimizing reimbursement for services;

ii. Activities intended to secure community trust and support; andiii. Activities intended to maintain consortium commitment and buy-in.

c. Calculate the percentage of services provided that are or could be covered through reimbursement (e.g., Medicaid, Medicare, private insurance) or non-grant funding sources.

Part 3: Implementing Sustainability Work Plan (due in EHB9/30/2022)—TEMPLATE FORTHCOMING

a. Complete fourth iteration of Sustainability Assessmentb. Implement the activities proposed in your sustainability work plan;c. Update sustainability work plan to reflect progress toward completing

activities;d. Highlight lessons learned and successes from the sustainability planning

process;e. Indicate which activities will sustain after the grant period and how they

will be sustained;f. Calculate the percentage of services provided that are covered through

reimbursement (e.g., Medicaid, Medicare, private insurance, etc.) or non-grant funding sources.

Each year, you should aim to submit a draft of your RCORP sustainability deliverable for initial review to your Health Resources and Services Administration (HRSA) Project Officer (PO) and JBS Technical Expert Lead by August 31. After receiving comments on your draft submission, you will submit the final deliverable in the HRSA Electronic Handbook by September 30.

Technical Assistance Resources for Achieving Programmatic and Financial Sustainability The following sections contain resources designed to help your consortium build the requisite policies and procedures, staffing levels, and revenues to sustain services after federal funding ends. An important component of sustainability is ensuring that, where possible, services delivered align with payer (state Medicaid, Medicare, commercial insurer) reimbursement policies. RCORP grantees and their partners should have systems in place to bill for all services covered by available payers, and should make every reasonable effort to obtain payment for all services rendered. At the same time, RCORP grantees must make every effort to provide services to an individual who does not have the ability to pay.

RCORP Onboarding Packet 4

Sustainability Through Healthcare FinancingACA Marketplace Plans/Third-Party Insurance

All plans offered via Affordability Care Act (ACA) marketplaces (either state-administered or via healthcare.gov) must include coverage for 10 Essential Health Benefits, one of which is mental health and substance use disorder (SUD) treatment. Each state adopts an Essential Health Benefits (EHB) Benchmark Plan to define those services more precisely. You can find out what is covered by your state’s current benchmark plan at https://www.cms.gov/cciio/resources/data-resources/ehb.html#ehb.

For third-party payers, the Mental Health Parity and Addiction Equity Act of 2008 requires health plan policies and practices to cover behavioral health services and that these services not be more restrictive than policies and practices for medical or surgical services. Some states have enacted additional parity laws. Neither federal nor state parity laws apply to all insurance plans or apply in the same way.

For additional information and key resources, see the text box below. For resources and other information about parity in your state, visit https://www.paritytrack.org/parity-reports/state-reports/.

Medicare

Medicare Part A will often pay for medically necessary inpatient services related to SUD/opioid use disorder (OUD), and Part B generally reimburses for physician and counseling services. The Centers for Medicare & Medicaid Services (CMS) has also recently issued a final rule on Part B payments for services provided as part of Opioid Treatment Programs (OTP). OTPs must be enrolled as Medicare providers to participate and will receive bundled payments for treatment services. A fact sheet on billing OTP services to Medicare is available on the CMS website. In addition, the final rule establishes new monthly bundled billing codes that can be used in office-based settings:

HCPCS code G2086: Office-based treatment for OUD, including development of the treatment plan, care coordination, individual therapy, and group therapy and counseling; at least 70 minutes in the first calendar month.

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According to a recently published report, Uncovering Coverage Gaps II: A Review and Comparison of Addiction Benefits in ACA Plans, in 2017 more than half of states that offered ACA plans did not comply with requirements for SUD benefits and 20 percent of states offered ACA plans that violated parity requirements. In addition, discriminatory coverage of methadone among these plans had worsened.

The report can be downloaded athttps://www.centeronaddiction.org/addiction-research/reports/uncovering-coverage-gaps-ii-review-and-comparison-addiction-benefits-aca

HCPCS code G2087: Office-based treatment for OUD, including care coordination, individual therapy, and group therapy and counseling; at least 60 minutes in a subsequent calendar month.

HCPCS code G2088: Office-based treatment for OUD, including care coordination, individual therapy, and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (list separately in addition to code for primary procedure).

Medicaid

Medicaid is the largest funder of behavioral health services in the United States (https://www.medicaid.gov/medicaid/benefits/bhs/index.html). More than half of patients at safety net clinics such as Federally Qualified Health Centers (FQHCs) are insured by their state Medicaid programs (https://www.macpac.gov/wp-content/uploads/2017/12/Medicaid-Payment-Policy-for-Federally-Qualified-Health-Centers.pdf). Because Medicaid is designed as a state‒federal partnership, each state develops its own set of Medicaid benefits, service systems, and payment approaches. As a result, state systems can look very different, each with their own set of rules and requirements. Moreover, many states use managed care organizations (MCOs) to manage Medicaid benefits, and then “carve out” behavioral health care from these managed care plans. As a result, care coordination across “physical” and “behavioral” health services and systems can often be challenging. (https://www.medicaidinnovation.org/_images/content/2019-IMI-Behavioral_Health_in_Medicaid-Report.pdf).

States oversee delivery of care through a range of different Medicaid authorities and models. Understanding how your state funds SUD services, such as screening, assessment, care coordination, counseling, and access to specific medications, can help you develop a realistic plan for sustainability:

Medicaid Managed Care: Many states pay for services by contracting with MCOs that receive a per-person fee to deliver a set of services to enrolled Medicaid beneficiaries. Increasingly, states are contracting with MCOs to deliver an integrated set of benefits that includes both behavioral health services and physical health services. However, many states still contract with specialty MCOs to deliver some or all SUD services and mental health treatment. How your state arranges these contracts can be important for providers interested in getting paid by Medicaid for SUD services. Providers may need to contract with new plans to ensure they are in-network for Medicaid patients seeking both physical and behavioral health treatment.

1115 Waivers: Many states are in the process of redesigning their SUD systems, using Medicaid 1115 waivers as a way to expand and improve services. Some states have used this federal funding authority to expand the types of providers who can deliver SUD treatment and have added new ways to pay for care. Many waivers focus on the delivery of medication assisted treatment (MAT) and

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expansion of residential treatment capacity, and can provide an important vehicle for sustaining other SUD services.

Critical Access Hospitals (CAH): CMS has a provision in the CAH statutory requirements allowing the addition of CAH distinct part units (DPUs) for psychiatric and rehabilitation services. See https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/scletter04-48.pdf. A CAH may add DPU(s) on the beginning date of a CAH cost reporting period and new provider numbers for the CAH DPUs billing will be effective on approval of the CAH DPU. For more information about CAH reimbursement and payment benefits, see the Medicare Learning Network: Critical Access Hospital booklet from CMS, the Small Rural Hospital and Clinic Finance 101 manual from the Technical Assistance and Services Center (TASC), or the Critical Access Hospitals Payment System payment basics sheet from the Medicare Payment Advisory Commission (MedPAC), as well as their Report to Congress Medicare Payment Policy at http://www.medpac.gov/docs/default-source/reports/mar19_medpac_entirereport_sec.pdf

Fee-for-Service Billing: States can manage their SUD services directly using a number of different Medicaid options to pay for this care. In some states, the behavioral health agency or single state agency for SUD services manages the funding for this care, whereas other states oversee this funding within the Medicaid program. Regardless of where oversight is situated within state government, specific rules and regulations describe what providers need to do to bill the state Medicaid program for SUD services.

Review of your state’s Medicaid provider manuals covering SUD services is imperative. The office of your state Medicaid director can help you understand how your state’s Medicaid plan influences access to SUD treatment services. Medicaid program flexibilities and minimal and optional benefits are summarized in Attachment B. Below are some common challenges to billing that community organizations may want to consider as they explore payment for MAT through their state’s Medicaid program.

Tips for Leveraging Medicaid Reimbursement

Understand the Medicaid Managed Care Landscape

Only 11 states in the United States operate their Medicaid programs through a purely fee-for-service system. Most states have some level of Medicaid managed care penetration, but systems and designs can vary greatly. Providers may need to contract with multiple managed care plans to ensure billing for all individuals receiving care.

Integrated plans: States may contract with managed care plans that pay for both physical and behavioral health services. Some Medicaid-enrolled individuals may still be covered under fee for service.

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Behavioral health organizations (BHOs) or carve-outs: Under a carved-out system, some or all behavioral health services may be delivered through a separate BHO or managed care entity. Behavioral health providers may face barriers to billing for physical healthcare services, while primary care, emergency departments, and other settings can encounter additional hurdles in billing for SUD treatment and related services. In some states, the BHO or BH carve-out pays for specialty care for higher-needs populations; in other states all services related to behavioral health are delivered through these contracts.

Integrated specialty plans: States may create managed care plans specifically to address the integrated care needs of certain complex populations, including those with significant SUD or mental health needs. In integrated specialty plans, a subset of the state’s enrollees receive behavioral health services along with integrated physical health services.

Identify Common Billing Hurdles

Even in states that have identified pathways for providers to be reimbursed for a full range of SUD services, billing hurdles may remain, especially for safety net providers such as FQHCs. The National Academy for State Health Policy (NASHP) has developed key steps that safety net providers can take to prepare for third-party reimbursement. See https://nashp.org/wp-content/uploads/sites/default/files/SNP.tips.billing.capacities.pdf. However, FQHCs operate under more specialized Medicaid payment rules:

Same-Day Billing: FQHCs, which typically are paid on a per-encounter basis, may face obstacles in billing for the various components of their MAT model if delivered on the same day. Review state regulations for same-day billing restrictions and think about how these may affect your current clinic model.

Group Services: Billing for group services within FQHCs can sometimes be problematic. Check regulations to make sure this has been incorporated into rules for your setting.

Common Billing Codes: Review the ability of your organization to use the following codes within your state’s Medicaid program:

- Health and behavioral assessment - Screening, Brief Intervention, and Referral to Treatment (SBIRT)- Chronic care management- Distinct codes for depression screening and other mental health/SUD

assessment tools- Case management- Telehealth

Bundled Payments: Bundled billing (a fixed reimbursement, usually weekly, for providing a suite of services to a covered patient) can hinder provision of buprenorphine if the reimbursement rate does not adequately cover the cost of

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this medication. Fee-for-service billing can also be a challenge, if services like care coordination or peer services are not available.

Understand Administrative Requirements for SUD Providers in Your State

States take a range of approaches to regulating the delivery of SUD services, including MAT. Common issues that should be explored include:

Is a facility license required? States may require additional facility licensing to deliver SUD services, and that licensing may conflict with or be duplicative of current licensing for primary care or other settings. Grantees will also want to identify Medicaid and/or licensing language that limits behavioral health services or the use of certain behavioral health codes to specific settings, such as community mental health clinics or SUD facilities.

What does Medicaid require for providers to deliver and receive payment for SUD services? State Medicaid programs may require specific licensure types, processes, or documentation for providers to deliver SUD services. Licensing or credentialing language may limit the types of staff that can be paid for certain functions or services. Peers and non-licensed counselors often have specific training and supervision requirements.

Does the state Medicaid program support a specific model? Medicaid regulation may include specific staffing configurations or requirements (e.g., for team-based care, specific behavioral health services, delivering counseling in addition to medication services) that may need to be built into your clinical design. States may incentivize providers to deliver SUD services within a health home model or have specific requirements to receive payment for enhanced office-based opioid treatment delivery. Understanding and mapping your work to these models may help in long-term sustainability.

Since state systems can look very different and state Medicaid programs are highly variable, communities and providers seeking to build SUD prevention, treatment, and recovery programs may encounter different challenges and different opportunities. However, states (as the safety net insurers for underserved, low-income, and complex populations) are generally interested in expanding access to SUD services, particularly in rural areas. Grantee communities and providers can help states meet their goals by identifying and aligning across critical issues. Most states, for instance, have developed opioid response plans or convened high-level opioid response task forces. Identifying how grantee work supports specific state goals (and barriers that need to be removed to do so) can be an important conversation starter with the state in understanding how it administers Medicaid.

For an overview and summary of Medicaid coverage of MAT in each state, visit http://www.ncsl.org/research/health/mat-opiate-50-state-table-medicaid.aspx.

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Key ResourcesEssential Health Benefits Benchmark Plans: https://www.cms.gov/cciio/resources/data-resources/ehb.html#ehb

SUPPORT for Patients and Communities Act Requirements (you can sign up for updates via a link at the bottom of the page): https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Group-Health-Plans/Whats-New/Whats-New.html.

State Laws

State laws can influence the ability of a person with SUD/OUD to access care and services. In 2016, the National Governors Association produced a roadmap for states to respond to the opioid epidemic. The box below provides a summary of their recommendations regarding state actions that you can use to gauge possible challenges in your state.

Change payment policies to expand access to evidence-based MAT and recovery services Ensure that Medicaid and other state health programs adequately cover Food and Drug

Administration-approved medications and evidence-based behavioral interventions; encourage or require commercial health plans to adopt similar policies. • Provide reimbursement for components of comprehensive evidence-based treatment and recovery, including medication, office visits, behavioral interventions, and wraparound services. • Review and remove managed care and pharmacy barriers to medication for OUD (e.g., fail non-MAT treatment first, then enter MAT program and inappropriate prior authorization protocols to access MAT). • Work with the department of insurance to enforce federal parity laws. • Use payment strategies (e.g., pay for performance, quality metrics, separating behavioral health from payment bundles) to increase access to evidence-based treatment and promote integration of behavioral health and primary care.

Increase access to naloxone Review and remove Medicaid barriers to naloxone, such as prior authorization, and place naloxone

on the preferred drug list. • Pass “Good Samaritan” laws to protect prescribers, first responders, and bystanders from liability when prescribing or administering naloxone. • Enact legislation allowing naloxone dispensing via standing orders, collaborative practice agreements, statewide protocols, or pharmacist prescriptive authority. • Train first responders to recognize signs of opioid overdose and administer naloxone. • Partner with professional associations to promote co-prescribing of naloxone when clinically appropriate. • Permit third-party prescribing of naloxone. • Create a centralized naloxone procurement and distribution process at the state level and consider negotiating with manufacturers to obtain a competitive pricing agreement.

Expand and strengthen the workforce and infrastructure for providing evidence-based MAT and recovery services Require buprenorphine waiver training in primary care and other select medical residency programs.

• Establish a coordinated treatment system in which specialty treatment centers stabilize patients and refer to community providers for ongoing care (e.g., hub-and-spoke model). • Provide ongoing education and support to primary care providers and other buprenorphine prescribers to expand treatment capacity. • Increase the number of office- and community-based opioid treatment programs (OTPs) through collaboration and new state funding. • Expand the reach of peer and family support organizations (e.g., Learn to Cope) through Medicaid and other state funding.

Create new linkages to evidence-based MAT and recovery services Begin medication for OUD in emergency departments following an opioid overdose and ensure

immediate linkages to behavioral health services and community supports. • Establish peer-based recovery programs in emergency departments to support individuals following an opioid overdose or related drug event. • Train first responders to refer patients to high-quality MAT and harm reduction services following an overdose reversal. • Provide information and assistance to help healthcare providers and the public identify treatment and recovery options in their communities (e.g., a call line).

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Key ResourcesEssential Health Benefits Benchmark Plans: https://www.cms.gov/cciio/resources/data-resources/ehb.html#ehb

SUPPORT for Patients and Communities Act Requirements (you can sign up for updates via a link at the bottom of the page): https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Group-Health-Plans/Whats-New/Whats-New.html.

Consider authorizing and providing support to syringe service programs

Work with state health experts to assess the benefits of authorizing syringe service programs and providing state funding and technical assistance. • Where syringe service programs are authorized, consider linking individuals accessing such programs to services such as HIV and hepatitis C testing, SUD treatment, and overdose prevention.

Reduce stigma by changing the public’s understanding of SUD

Develop targeted public awareness campaigns with messaging to reframe SUD as a chronic medical disease that requires ongoing treatment. • Ensure that messaging focuses on MAT and behavioral health services as effective, evidence-based strategies for treating SUD.

Source: https://classic.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf

Program Licensure

Most treatment programs require licensure. This may be overseen in the state department of health or elsewhere. Often states require a specific license for a program to be an OTP and a separate license to provide addiction counseling. As a result, patients can no longer be seen by their counselor at the OTP if they successfully taper off of medication and must start over to receive behavioral health services at a new program and with different staff. Each license requires adherence to specific requirements. The requirements for an OTP versus an outpatient program that does not offer medication are often different. Typically, each license requires a separate inspection visit. Both can be burdensome to the program. Many rural communities don’t have direct access to an OTP and require significant travel to access these services.

Behavioral health programs, in rural communities, may be licensed as an integrated part of primary care services delivered by individual providers or through rural health clinics. Understanding how services are licensed and delivered will help with implementation and sustainability planning.

Engaging all components of the healthcare system in rural areas can be critical for success. However, safety net providers such as FQHCs may not have, and will need to acquire, the requisite licensing to deliver the full range of SUD treatment. States have different positions on whether additional licensure may be allowed, so exploring these issues with your project’s diverse provider types will be important.

Regulations

Medications used to treat OUD are subject to significant regulation. Methadone in particular is heavily regulated at the federal level, and many states choose to promulgate additional regulations on its provision.

Buprenorphine is subject to a lesser degree of federal regulation, but again, there may be additional regulations that vary by state for the use of this medication.

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Regulations at any level can deter provision of these medications by programs, and healthcare professionals may find them onerous to adhere to in the practice of providing care. Regulations can also be perceived as stigmatizing, as they are specific to SUD treatment. Understanding the regulatory requirements in your state will help in planning and to support providers as they implement services for individuals with OUD.

Workforce

Multiple types of professionals make up the SUD treatment workforce. These include those in traditional behavioral health roles that are necessary to the psycho-social interventions for SUD, but increasingly, states are relying on non-licensed, non-master’s-level professionals as well, as state licensure and credentialing requirements for various professionals who deliver SUD treatment-related services can limit access to a qualified workforce. These roles vary significantly but include counselors, peers, and other qualified staff. The National Academy for State Health Policy developed a 50-state scan that outlines those professions and their requirements. Additionally, the National Conference of State Legislatures and the Association of State and Territorial Health Officials designed a scope of practice website, found here, which also includes information on nurse practitioners and physician assistants, who continue to play an increasing role in delivering MAT to individuals in treatment for OUD.

Peers play a distinct role in the treatment of SUD. Many states have begun reimbursing for peer services in their Medicaid programs, not only to address the workforce shortage in responding to the SUD crisis, but also because peers are able to relate to individuals in active addiction and early treatment at a distinctly personal level. Peer services, while not clinical by definition, are evidence-based practices that rely on individuals with lived experience to deliver. Peers can provide an array of reimbursable services and can serve as key members of care teams alongside clinicians and other providers.

Individuals who are qualified to provide SUD services may also be limited in their ability to practice because of limitations in licensure portability if they move across state lines. Professional licensure is “portable” among some states but not all. Professionals who are required to relocate, such as military spouses, may be confronted with the need to retrain or obtain additional training to resume their career in a new state. This is a challenge for nurses and physicians as well.

Low salaries, especially when compared with the cost of required education, are another deterrent to entering a behavioral health career path.

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Key Resources3RNet connects health professionals searching for jobs in rural areas with health care facilities https://www.3rnet.org

Scope of Practice Policy provides state level insight on relevant health professionals and their scopes of practice. ( http://scopeofpracticepolicy.org/practitioners/behavioral-health-providers/ )

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Program Guidance: Sustainability

Appendix AGrantee Name: XGrant Number: XDUE DATE: September 30, 2020, in EHB

It is recommended that you submit a draft to your HRSA Project Officer and JBS Technical Expert Lead by August 15, 2020, for an initial review.

RCORP-Implementation Sustainability Plan Part I: Defining Sustainability Template1

Instructions:Please complete the second iteration of your Sustainability Assessment prior to completing this template. It is recommended that you use the results of the Sustainability Assessment, and input from your RCORP Consortium, to inform your responses to this deliverable. Please contact your HRSA Project Officer and JBS Technical Expert Lead with any questions or concerns.

DEFINING SUSTAINABILITYRCORP Program Title:Cohort number:HRSA RCORP Grant Number:State(s):Funding Year: 2019-2020Consortium Definition of Sustainability: [Briefly describe how your consortium defines sustainability in the context of the RCORP grant. Your consortium is encouraged to address both financial sustainability and the sustainability of the consortium itself.] Sustainability Assessment Analysis: [Briefly compare and contrast the results of the two Sustainability Assessments your consortium completed in this project period.]

1 Adapted from https://sustaintool.org/wp-content/uploads/2018/04/Sample-Plans-EvaluationPartnersCommunications.pdf.

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Program Guidance: Sustainability

DEFINING SUSTAINABILITYDescription of Internal Challenges and Assets Hindering/Aiding Sustainability: [E.g., organizational or intra-consortium barriers or assets. It is recommended that you use the results of the Sustainability Assessment to inform this process.]Description of External Challenges and Assets Hindering/Aiding Sustainability: [E.g., policies and regulations, insurance coverage. It is recommended that you use the results of the Sustainability Assessment to inform this process.] Description of Internal Challenges and Assets the Consortium Will Address During Grant Period: [Of the internal challenges and assets described above, identify which challenges and assets your consortium will prioritize during the grant period. Justify each selection and detail your consortium’s proposed methodology for addressing each challenge and asset.]Description of External Challenges and Assets the Consortium Will Address During Grant Period: [Of the external challenges and assets described above, identify which challenges and assets your consortium will prioritize and address during the grant period. Justify each selection and detail your consortium’s proposed methodology for addressing each challenge or asset.]Consortium: [List RCORP partners who will be actively

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Program Guidance: Sustainability

DEFINING SUSTAINABILITYinvolved in implementing activities designed to promote sustainability.]

SUSTAINABILITY STAFFING PLANResponsible Individual(s)/Consortium Member(s)

Timeframe for Addressing Challenge/Asset

Anticipated Outcome

Challenge/Asset #1Challenge/Asset #2Challenge/Asset #3Challenge/Asset #4 Challenge/Asset #5

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Program Guidance: Sustainability

Attachment B: Medicaid Flexibilities and Minimal and Optional Benefits

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Program Guidance: Sustainability

From http://files.kff.org/attachment/Issue-Brief-Current-Flexibility-in-Medicaid-An-Overview-of-Federal-Standards-and-State-Options

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Program Guidance: Sustainability

Appendix CRCORP Sustainability Self-Assessment

RESULTS ORIENTATION Essential Element 1 of Sustainability: Vision—All partners understand what is being sustained, for how long, and at what level of activity.

Uses processes that guide the consortium’s direction, goals, and strategies.

Review task descriptions below and criteria to the right to self-assign a rating on progress.

Have not begun

Are in the planning phases

Have begun to

implement

Have made solid progress in

implementing

Notes

0 1 2 3

The consortium plans for future resource needs.

The consortium has a sustainability plan that includes a long-term financial plan.

The consortium’s goals are understood by all stakeholders.

The consortium clearly outlines roles and responsibilities for all stakeholders.

RESULTS ORIENTATION Essential Element 2 of Sustainability: Sustainable Outcomes—Focus is on sustaining health and well-being benefits for individuals being served.

Assesses the consortium’s focus on quality improvement, evaluation, and utilization of data to inform program and system/infrastructure planning and information dissemination to the public.

Review task descriptions below and criteria to the right to self-assign a rating on progress.

Have not begun

Are in the planning phases

Have begun to

implement

Have made solid progress in

implementing

Notes

0 1 2 3

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Program Guidance: Sustainability

RESULTS ORIENTATION Essential Element 2 of Sustainability: Sustainable Outcomes—Focus is on sustaining health and well-being benefits for individuals being served.

The consortium includes local-, state-, and national-validated metrics to identify community needs and inform updates to the program’s needs assessment.

The consortium includes local-, state-, and national-validated metrics and process indicators to measure short-, medium-, and long-term impacts.

The consortium routinely assesses patient outcomes to inform the implementation of evidence-based practices.

The consortium has an evaluation plan to determine progress toward meeting short- and long-term goals.

The consortium uses data to inform program planning and quality improvement.

The consortium includes a data feedback plan to inform systems/infrastructure planning.

The consortium includes a communication strategy for sharing program results with the public.

RESULTS ORIENTATION Essential Element 3 of Sustainability: Sustainable Financial Base—Short- and long-term approaches to tapping diverse sources of revenue and efficiently managing resources have been developed.

Establishes a consistent financial base for program continuation beyond project period.

Review task descriptions below and criteria to the right to self-

Have not begun

Are in the planning

Have begun to

Have made solid progress in

Notes

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Program Guidance: Sustainability

RESULTS ORIENTATION Essential Element 3 of Sustainability: Sustainable Financial Base—Short- and long-term approaches to tapping diverse sources of revenue and efficiently managing resources have been developed.

assign a rating on progress. phases implement implementing

0 1 2 3

The consortium has identified legislative and/or other policy initiatives that can impact implementation of program prevention, treatment, and recovery services.

The consortium leverages technology and other infrastructure developments, as needed, to enhance health service delivery.

The consortium ensures compliance with federal, state, and local requirements for delivering prevention, treatment, and recovery services.

The consortium remains up to date with professional associations and licensing board activities that impact the cost of healthcare services delivery (e.g., medical association, board of pharmacy, board of medicine, healthcare financial management association).

The consortium engages with state agencies (e.g., Medicaid; state departments/divisions of behavioral health, public health, labor, education).

The consortium assesses local, state, and federal funding opportunities for ongoing support of staff and operations.

The consortium has assessed the extent to which integration

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Program Guidance: Sustainability

RESULTS ORIENTATION Essential Element 3 of Sustainability: Sustainable Financial Base—Short- and long-term approaches to tapping diverse sources of revenue and efficiently managing resources have been developed.

of primary care and behavioral health services will promote collaboration and create efficiencies.

The consortium routinely assesses the governance, infrastructure, funding, and staffing necessary to continue program activities beyond the performance period.

. .

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Program Guidance: Sustainability

RESULTS ORIENTATIONEssential Elements 4 & 5 of Sustainability: Broad-based Community Support and Key Champions—Community members show solid support through volunteerism, donations, advocacy, and other forms of involvement; visible champions include business, political, media, and community leaders.

Cultivates connections with key champions and between the consortium and the community to gain support.

Review task descriptions below and criteria to the right to self-assign a rating on progress.

Have not begun

Are in the planning phases

Have begun to

implement

Have made solid progress in

implementing

Notes

0 1 2 3

The consortium has identified key champions (internal and external leaders) to support program activities.

The consortium develops a plan to address community awareness of the opioid crisis and community-based stigma toward persons misusing or abusing opioids.

The consortium has a plan for acquiring broad-based community support for prevention, treatment, and recovery activities.

The consortium has established collaborative relationships with community-based partners (e.g., first responders, law enforcement, criminal justice programs).

The consortium includes persons with lived experience and their families in planning and implementation activities.

The consortium partners with healthcare providers (e.g., hospitals, federally qualified health centers, rural health centers).

The consortium partners with local nonprofit and service

RCORP Onboarding Packet 23

Program Guidance: Sustainability

RESULTS ORIENTATIONEssential Elements 4 & 5 of Sustainability: Broad-based Community Support and Key Champions—Community members show solid support through volunteerism, donations, advocacy, and other forms of involvement; visible champions include business, political, media, and community leaders.

organizations (e.g., YMCA, Boys & Girls Club, 4H, Rotary).

The consortium develops messages and distributes them to key audiences through social media and other communication outreach strategies.

RESULTS ORIENTATION Essential Element 6 of Sustainability: Ability to Adapt to Changing Conditions—Flexibility exists to change strategies, services, systems, and other components over time without losing sight of the end results sought.

Takes actions that adapt elements of the program to ensure its ongoing effectiveness.

Review task descriptions below and criteria to the right to self-assign a rating on progress.

Have not begun

Are in the planning phases

Have begun to

implement

Have made solid progress in

implementing

Notes

0 1 2 3

The consortium periodically reviews the evidence base.

The consortium proactively adapts strategies to accommodate and address external (e.g., policy, legislative, demographic, scientific) changes in the environment.

The consortium makes decisions about which components are ineffective and should not be continued.

RCORP Onboarding Packet 24

Program Guidance: Sustainability

RESULTS ORIENTATION Essential Element 7 of Sustainability: Workforce Development—Strong internal/organizational functions in human resources are developed and remain in place.

Assesses current and emerging workforce capacity for meeting the goals and objectives of the program.

Review task descriptions below and criteria to the right to self-assign a rating on progress.

Have not begun

Are in the planning phases

Have begun to

implement

Have made solid progress in

implementing

Notes

0 1 2 3

The consortium used validated local, state, and federal workforce capacity data to assess community need.

The consortium partners with educational institutions (e.g., state universities, community colleges).

The consortium assesses the viability of recruiting and using volunteers to support activities.

The consortium has assessed the extent to which recruitment and retention programs can build workforce capacity in rural communities.

The consortium has assessed services provided by the National Health Service Corps and Nurse Corps for building workforce capacity in rural areas.

Reference: Social Entrepreneurs, Inc. Sustainability Planning Overview and Rationale: 8 Essential Elements. Available at http://alliancefornevadanonprofits.com/wp-content/uploads/2011/08/Sustainability-Planning-Overview-Brochure.pdf .

RCORP Onboarding Packet 25