Access to Care (R95)

SUD systems are serving about 5% of people who need treatment because the other 95% of people who need SUD treatment are typically not interested in services. The Reaching the 95% Initiative (R95) is designed to ensure that SAPC’s specialty SUD system is designed not just for people who are already interested in services, but is also focusing on the 95% of people with SUDs who are not accessing care. Under R95, there are 6 Incentive Options in two Focus Areas that agencies can participate in and draw down by meeting specified benchmarks and activity-related deliverables:

• Focus Area 1: Outreach and engagement
• Focus Area 2: Establishing low barrier care
  

*2C-2 (Verified 30/60 -Day Policy Claims), *2D-1 (Admission Policy) and 2D-2 (Discharge Policy) must be completed to participate in R95 Capacity Building.

Capacity-Building

2A. Preparation and Planning for Outreach and Engagement
Capacity Building 2A is designed to prepare and implement an outreach and engagement plan to better reach and enroll the 95% of individuals by cultivating and educating partnerships within community and health/social service providers to outreach people at different stages of readiness.

• 2A-1 New Partner Entity Meetings
  • Invoice 1: Start Up Funds Attestation
    Due 07/15/23
  • Invoice 2-Deliverable Based Efforts
    Due 12/31/23
  • 2A-1 New Partner Log
    Due 02/29/24
• 2A-2 New Partnership Plan
  • Invoice 1: Start Up Funds Attestation
    Due 07/15/23
  • Invoice 2-Deliverable Based Efforts
    Due 01/12/24
  • 2A-2 New Partner Plan
    Due 01/12/24
• 2A-3 Executed MOUs (different from 2B and 2F)
  • Invoice 1: Start Up Funds Attestation
    Due 07/15/23
  • Invoice 2-Deliverable Based Efforts
    Due 03/31/24
  • 2A-3 New Partner MOU
    Due 03/31/24

2B. Field-Based Services for Outreach and Engagement
Capacity Building 2B can build upon relationships developed under 2A and leverages new community-based locations that already attract the focus population (individuals needing services without current abstinence goals) to establish FBS sites to divert staff from delivering direct services and instead cover some expenses.

• 2B-1 Establish FBS site- executed MOU and adding site to contract
  • Invoice 1: Start Up Funds Attestation
    Due 07/15/23
  • Invoice 2: Deliverable Based Efforts
    Due 03/31/24
  • New Partner Form
    Due 03/31/24
• 2B-2 Claims verification for delivery of appropriate FBS services
  • Invoice 2-Deliverable Based Efforts
    Due 06/30/24

2C. 30- and 60-Day Engagement Period for Outreach and Engagement
Capacity Building 2C leverages new State allowances to establish medical necessity and complete the ASAM assessment within 30-days for adults (21+), and 60-days for youth (12-20) and adults experiencing homelessness in non-residential facilities to engage individuals who need SUD services but who may be ambivalent or not ready to receive care in a more traditional treatment setting. Development and conducted trainings for staff to ensure understanding of changes throughout organization.

• 2C-1 Engagement Policy and Staff Training
  • Invoice 1: Start Up Funds Attestation
    Due 07/15/23
  • Invoice 2: Deliverable Based Efforts
    Due 02/29/24
  • 2C-1 Attestation Form for Initial Engagement Authorization Training
    Due 02/29/24
  • 2C-1 Engagement Policy Guidance
    Due 02/29/24
• 2C-2 Claims Verification under an approved 30-60 days authorization
  *Required to participate in R95 Initiatives
  
  • Invoice 2: Deliverable Based Efforts
    Due 06/30/24

2D. Establishing Lower Barrier Care Across the SUD System
Capacity Building 2D focus is on how agencies can more meaningfully attract and engage individuals who are not interested in or ready for complete abstinence into services by addressing barriers to care across the specialty SUD treatment system by establishing discharge policies that do not result in an automatic discharge if clients use substances during a treatment episode and facilitate a culture of treating SUDs as chronic conditions by allowing for clients who use substances during treatment an opportunity to continue with treatment; and that direct service staff and managers are trained and adopt changes.

• 2D-1 Updated Admission Policy and Procedure
  *Required to participate in other R95 initiatives
  
  • Invoice 2-Deliverable Based Efforts
    Due 03/15/24
  • 2D-1 Admission Policy Language Final
    Due 03/15/24
  • 2D-2 Discharge Policy Language Final
    Due 03/15/24
• 2D-2 Updated Discharge Policy and Procedure
  *required to participate in the R95 initiatives
  
  • Invoice 2-Deliverable Based Efforts
    Due 03/15/24
  • 2D-2 Discharge Policy Language
    Due 03/15/24
• 2D-3 Agency Training Presentations
  • Invoice 2-Deliverable Based Efforts
    Due 03/31/24
  • 2D-3 Admission/Discharge Policy Training Template-Final
    Due 03/31/24

2E. Service Design for Lower Barrier Care
Capacity Building 2E supports providers in adapting the program services to align with the treatment needs of individuals who want to participate in services but are not ready to maintain abstinence. Providers should develop a plan to monitor implementation of new changes to ensure staff adopt and embrace changes and that patients actually experience the new model from first contact and throughout journey.

• 2E-1 Service Design
  • Invoice 1: Start Up Funds Attestation
    Due 07/15/23
  • Invoice 2: Deliverable Based Efforts
    Due 06/30/24
  • 2E-1 Service Design Expectations Deliverable
    Due 06/30/24
• 2E-2 Customer Experience Assessment and Walk-Through
  • Invoice 1: Start Up Funds Attestation
    Due 07/15/23
  • Invoice 2: Deliverable Based Efforts
    Due 06/30/24
  • 2E-2 Service Design - Customer Walk-Through Guide
    Due 06/30/24
  • 2E-2 Service Design - Walk-Through Summary Template
    Due 06/30/24
• 2E-3 Improvement and Investment Plan
  • Invoice 1: Start Up Funds Attestation
    Due 07/15/23
  • Invoice 2: Deliverable Based Efforts
    Due 06/30/24
  • 2E-3 Improvement Investment Plan
    Due 06/30/24

2F. Bidirectional Referrals for Lower Barrier Care
Capacity Building 2F supports providers in establishing bidirectional referral relationships between their treatment sites and harm reduction agencies to promote new admissions in alignment with updated admission and discharge policies.

• 2F-1 Execute MOUs (different from 2A-3 and 2B-1) with harm reduction and overdose prevention hubs
  • Invoice 1: Start Up Funds Attestation
    Due 07/15/23
  • Invoice 2: Deliverable Based Efforts
    Due 03/31/24
  • New Partnership Form
    Due 03/31/24
  • 2F Guidance for Bidirectional Referrals SUD Tx and Harm Reduction Final
    Due 03/31/24
• 2F-2 Claim Verification for new Harm Reduction/Overdose prevention Hubs Admissions (non FBS)
  • Invoice 2-Deliverable Based Efforts
    Due 06/30/24