Form MMHSA Survey MMHSA Survey MMHSA Survey

OMB No. 0930-xxxx
Expiration Date xx/xx/xx
SURVEY OF EVIDENCE-BASED PRACTICES FOR MENTAL HEALTH AND SUBSTANCE USE
DISORDERS IN STATE MEDICAID PLANS:
COVERAGE STRUCTURES, ACCESS AND CHALLENGES
Dear [NAME]:
The U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services
Administration is conducting a voluntary survey to gather information about current and planned State
Medicaid activities and policies related to evidence-based practices (EBPs) for mental health and
substance use disorders. We are contacting you to help us obtain this information for [NAME OF
STATE]. It is important that all states participate in this survey, whether or not they currently support
EBPs for mental health and substance use disorders, so that SAMHSA can gain a better understanding
of coverage of these EBPs in state Medicaid plans, how states are providing the benefits, and the
challenges faced by states in including the EBPs in their state plans.
This survey is part of a five-year project by Abt Associates Inc., the National Academy for State Health
Policy (NASHP), and the National Association of State Medicaid Directors (NASMD) to increase attention
to and understanding of Medicaid mental health and substance use service issues among State Medicaid
and Mental Health/Substance Abuse Directors, as well as to improve the effectiveness of State Medicaid
mental health and substance use services.
The survey contains three parts: Part I covers general information about your state’s Medicaid and mental
health/substance use administration; Part II contains questions regarding your state’s coverage of specific
evidence-based practices for mental health and substance use disorders, including:









Medication Management Approaches in Psychiatry (MedMAP)
Assertive Community Treatment (ACT)
Supported Employment
Family Psycho-education
Illness Management and Recovery
Integrated Dual Diagnosis Treatment
Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Alcohol, Tobacco and/or
Opioid Dependence
Medication-Assisted Treatment for Alcohol, Tobacco and/or Opioid Dependence

Part III of the survey collects additional information on future EBP planning within your state. Please note
that the term “behavioral health services” is used in some questions, and refers to mental health and
substance use disorder services in general.
In completing the survey, we anticipate that you will want to consult with your state mental health director
and state substance abuse director in identifying specific information on the use of the EBPs in your state.
The information you provide will be vital to increasing awareness and understanding of Medicaid mental
health and substance use evidence-based practice activities. Your responses will be used in a nationally
disseminated report. This information will also be used to develop resources for those states that seek to
include mental health and substance use disorder EBPs in their state Medicaid plans. This project will
offer Medicaid, mental health and substance use disorder officials:





Publications describing model polices and best practices related to the provision of Medicaid
mental health and substance use disorder services;
Opportunities for state policy makers to engage in networking and peer-to-peer learning with
Medicaid as well as with mental health and substance use disorder officials;
An online toolbox with helpful resources about Medicaid mental health/substance use evidencebased practice activities; and

OMB No. 0930-xxxx
Expiration Date xx/xx/xx



Webinars featuring national experts and state officials to disseminate findings about promising
practices in Medicaid mental health/substance use evidence-based practice activities and
policies.

NASHP has conducted preliminary research and pre-completed several survey questions based on
existing information. Pre-completed questions are indicated with a note in bold that includes instructions
for how to edit the information if it is incorrect.
If you have any questions, please contact Mike Stanek of NASHP, at mstanek@nashp.org or by phone at
207-822-6524.
Thank you very much for your time and assistance.

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 2 of 36

SURVEY OF EVIDENCE-BASED PRACTICES FOR MENTAL HEALTH AND SUBSTANCE USE
DISORDERS IN STATE MEDICAID PLANS:
COVERAGE STRUCTURES, ACCESS AND CHALLENGES
PLEASE RETURN THIS SURVEY VIA EMAIL OR FAX BY [DATE] TO:
Mike Stanek, Research Assistant, NASHP
mstanek@nashp.org
Fax: 207-874-6527
If you have any questions, please contact Mike at the above e-mail, or by phone at 207-822-6524.

Part I
1. Lead Respondent’s Contact Information:
Name of Respondent:
State:
Title:
Agency and division/bureau:
Telephone #:
E-Mail:
2. Would you be willing to be contacted by Medicaid mental health peers in other states?
Yes, NASHP may share my contact information with other Medicaid mental health contacts.
No, NASHP may not share my contact information with other Medicaid mental health contacts.

Section 1: Management of Behavioral Health Services
3. Below is NASHP’s understanding of Medicaid’s delivery system in your state for behavioral health
services. If this information is incorrect, please uncheck the incorrect box, check the
appropriate box, and edit the information in the “description” text box as necessary.
Managed care organization
Does your MCO subcontract with another organization to manage behavioral health
services?
Yes
No
Fee-for-service
Behavioral health organization
Combination of systems (Description)
4. If Medicaid contracts for delivery of behavioral health services in your state, to what entity does it
contract? (Please check all that apply)
Managed care organization (MCO) that delivers a comprehensive set of services, including
some or all behavioral health services
MCO that delivers only behavioral health services
County/regional authority
5. What was the total number of state Medicaid beneficiaries at the end of your state’s most recently
completed fiscal year?
6. Does your state or Medicaid agency have any structure(s) in place to gather input from stakeholders
outside the Medicaid agency, to gather clinical advisory opinions, or to forge interagency agreements
to help shape Medicaid’s coverage of evidence-based practices (EBPs) for mental health and
substance use disorders?
Yes (Check all that apply)
Regular meetings with stakeholders that include discussion of EBPs
Internal (Medicaid) taskforce or work group dedicated to EBPs
Interagency taskforce or work group dedicated to EBPs
Clinical advisory committee that focuses on EBPs in mental health and/or substance
use
National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 3 of 36

Clinical advisory committee that focuses on a range of issues, including MH/SA EBP
Other (please describe):
If the structure is formal, please attach or include links to the structure’s membership and
charge.
No
7. (a) Please check the box next to the evidence-based practice if your state Medicaid agency covers it.
We understand that Medicaid may not cover all components of the evidence-based practice in
your state; however, please check the box if Medicaid covers any components of the EBP in a
braided/blended or otherwise coordinated funding strategy with other funding sources:
Medication Management Approaches in Psychiatry (MedMAP) is a set of practice
guidelines that includes the use of a systematic plan for medication management; thorough and
clear documentation; creation of objective measures of desired outcomes; and shared decisionmaking by consumers and practitioners.
Assertive Community Treatment (ACT) is a program that involves a multi-disciplinary team
that provides comprehensive, community-based services. Services are highly individualized and
tailored to meet the needs of each person. Services also have the following characteristics: a low
staff-to consumer ratio, assertive engagement, 24/7 availability, time-unlimited support, and
continuity of care.
Supported Employment is a specific set of practices and services, integrated with mental
health treatment, that achieves competitive employment for the consumer. Characteristics include
eligibility based on consumer choice, emphasis on consumer preferences, a job search process
that begins soon after a consumer expresses interest in working, and continuous follow-along
supports for employed consumers.
Family Psychoeducation is a curriculum-based program that includes introductory sessions,
an educational workshop, and problem-solving groups, all of which are designed to provide ongoing
education, problem-solving, and social support, as well as develop coping skills.
Illness Management and Recovery is a curriculum-based program that provides recovery
strategies, practical facts about schizophrenia, the stress-vulnerability model and treatment
strategies, and coping mechanisms for stress and persistent problems, along with client assistance
in building social support, using medication effectively, reducing relapses and getting their needs
met in the mental health system.
Integrated Dual Diagnosis Treatment (IDDT) is a comprehensive program in which one team
provides comprehensive mental health and substance use services in stages, along with
motivational interventions and substance use counseling (including education, problem-solving and
coping skills).
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive,
integrated public health approach to the identification, early intervention, and referral to treatment
services for persons at risk of developing alcohol, tobacco, and/or substance use disorders as well
as for those with the disorders. A key aspect of SBIRT is the integration and coordination of
screening, brief intervention, and treatment components into a system of services.
Medication Assisted Treatment (MAT) is the use of medications, in combination with
counseling and behavioral therapies, to provide a whole-patient approach to the treatment of
substance use disorders. MAT is clinically driven with a focus on individualized patient care.
For more information on these evidence-based practices, please see Appendix A.

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 4 of 36

(b)

 If you checked any of the above boxes, please skip to Part II, Page 6


If you did not check any of the above boxes, has Medicaid made a formal commitment to pay
for some or all of the components that are part of the above practices by January 1, 2012?
(Examples of a formal commitment include dedicated resources (funding or staff time), initial
development or completion of a work plan, and/or public statement of intent to implement
coverage).
Yes (Please skip to Part III (page 26)
No (Survey complete. Thank you! Please return survey to NASHP, c/o Mike Stanek,
Research Assistant, mstanek@nashp.org, or FAX 207-874-6527).

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 5 of 36

Part II
Section 2: Evidence-Based Practices – Medication Management Approaches in
Psychiatry (MedMAP)
8. As of January 1, 2011, does Medicaid cover Medication Management Approaches in Psychiatry
(MedMAP) or any components of MedMAP, either solely through Medicaid funding or in a
coordinated strategy with other funding sources?
Medicaid covers MedMAP
Medicaid covers some components of MedMAP listed in a coordinated strategy with other
funders
Medicaid does not cover MedMAP (Please skip to page 8, Section 3)
Don’t know
9. What federal authority does Medicaid use to cover MedMAP, and when was it implemented? (Check
all that apply)
State Plan Amendment:
Date implemented:
Please provide a web link here or attach a copy of the SPA:
1915(b) Managed Care Waiver to cover components of medication management that are not
normally covered under the State Plan:
Date implemented:
1915(c) Home and Community-Based Services Waiver to provide cost-effective medication
management services that will prevent a recipient from being institutionalized:
Date implemented:
1115 Demonstration Waiver to cover medication management services:
Date implemented:
10. If Medicaid contracts with one or more MCOs for delivery of services for mental health and/or
substance use disorders in your state, is there any language in the contract that specifically mentions
MedMAP? (Please note: the term MCO includes both those that deliver a comprehensive set of
services including physical and behavioral health and those that deliver only behavioral health
services.)
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not contract with MCOs.
11. If Medicaid has an agreement with a county to deliver or manage the delivery of mental health and/or
substance use services in your state, is there any language in the agreement that specifically
mentions MedMAP services?
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not have these types of agreements with counties.
12. Are you familiar with the SAMHSA Fidelity Scale for MedMAP?
Yes
No (please skip to question 14)
13. Was the Fidelity Scale used in the development of any of the following:
Provider Manual
Provider Certification
Contracts
Quality Oversight
Don’t know
National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 6 of 36

14. How do you manage access to MedMAP services?
Prior authorization
Surveillance and Utilization Review
Other (please describe):
15. Does Medicaid facilitate blending/braiding of Medicaid funding with other resources in order to
support MedMAP services?
Yes
Medicaid provides technical assistance to providers on how to pool funding to support
EBP.
Medicaid pools funding at the state level with other state agencies to support EBP.
Medicaid contracts with an MCO or county/regional entity that pools funding
Other (please describe):
No
Don’t know
16. Is there a specific billing code and/or modifier that distinguishes MedMAP from other medication
management units of service?
Yes (please provide code and/or modifier):
No
17. Please provide the following data about MedMAP claims paid (not denied or suspended) in the most
recently completed state fiscal year (SFY). (Please enter the dates of that year here:
) If
specific data is not available for MedMAP, please write “N/A”

Procedure code
(description)

Maximum fee
(e.g., $15 per
occurrence,
$25 per 15
minute
increment)

Total amount
paid

Number
procedures
paid

Number
beneficiaries
who received
the
procedure at
least once

Number
providers
who
submitted at
least one
claim for the
service

H2010
(comprehensive
medication services,
per 15 min)
Other (see question
16)
18. Does Medicaid offer providers any incentives to deliver MedMAP services?
Yes (check all that apply)
Enhanced reimbursement
Reduced caseload
Other (please describe):
No
Don’t know
19. Is your state engaged in any activities to promote MedMAP and/or improve access?
Yes (check all that apply):
Work force development/training
Outreach or other promotion to providers
Other (please describe):
No

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 7 of 36

20. What steps does Medicaid take to ensure fidelity to SAMHSA models or otherwise promote the
quality of MedMAP services?
Provider certification, contract, or billing requirements that mandate fidelity/EBP components.
Monitor MCO or county contract compliance to ensure that relevant terms of agreement
regarding MedMAP are being met
Conduct or require contractors to conduct performance improvement projects (e.g. measuring
and evaluating provider quality of care, then, if needed, developing and implementing a plan to
improve care)
Other (please describe):
None

Section 3: Evidence-Based Practices – Assertive Community Treatment (ACT)
21. As of January 1, 2011, does Medicaid cover Assertive Community Treatment (ACT) or any
components of ACT, either solely through Medicaid funding or in a coordinated strategy with other
funding sources?
Medicaid covers ACT
Medicaid covers some components of ACT listed in a coordinated strategy with other funders
Medicaid does not cover ACT (Please skip to page 10, Section 4)
Don’t know
22. What federal authority does Medicaid use to cover ACT, and when was this mechanism
implemented? (Check all that apply)
State Plan Amendment:
Date implemented:
Please provide a web link here or attach a copy of the SPA:
1915(b) Managed Care Waiver to cover components of ACT that are not normally covered
under the State Plan:
Date implemented:
1915(c) Home and Community-Based Services Waiver to provide cost-effective ACT services
that will prevent a recipient from being institutionalized:
Date implemented:
1115 Demonstration Waiver to cover ACT services:
Date implemented:
23. If Medicaid contracts with one or more MCOs for delivery of services for mental health and/or
substance use disorders in your state, is there any language in the contract that specifically mentions
ACT services? (Please note: the term MCO includes both those that deliver a comprehensive set of
services including physical and behavioral health and those that deliver only behavioral health
services.)
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not contract with MCOs.
24. If Medicaid has an agreement with a county to deliver or manage the delivery of mental health and/or
substance use services in your state, is there any language in the agreement that specifically
mentions ACT services?
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not have these types of agreements with counties.
25. Are you familiar with the SAMSHA Fidelity Scale for ACT?
Yes
No (please skip to question 27)
National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 8 of 36

26. Was the Fidelity Scale used in the development of any of the following:
Provider Manual
Provider Certification
Contracts
Quality Oversight
Don’t know
27. How do you manage access to ACT?
Prior authorization
Surveillance and Utilization Review (SURS)
Other (please describe):
28. Does Medicaid facilitate blending/braiding of Medicaid funding with other resources in order to
support ACT?
Yes
Medicaid provides technical assistance to providers on how to pool funding to support
EBP.
Medicaid pools funding at the state level with other state agencies to support EBP.
Medicaid contracts with an MCO or county/regional entity that pools funding
Other (please describe):
No
Don’t know
29. Is there a specific billing code or modifier that distinguishes ACT from other community support/case
management units of service?
Yes (please provide code and/or modifier):
No
30. Please provide the following data about ACT claims paid (not denied or suspended) in the most
recently completed state fiscal year (SFY). (Please enter the dates of that year here:
) If
specific data is not available, please write “NA”

Procedure code
(description)

Maximum fee
(e.g., $15 per
occurrence,
$25 per 15
minute
increment)

Total amount
paid

Number
procedures
paid

Number
beneficiaries
who received
the
procedure at
least once

Number
providers
who
submitted at
least one
claim for the
service

H0039 (ACT program,
per 15 min)
H0040
(ACT, per diem)
Other (see question
29)
31. Does Medicaid offer providers any incentives to deliver ACT services?
Yes (check all that apply)
Enhanced reimbursement
Reduced caseload
Other (please describe):
No
Don’t know

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 9 of 36

32. Is your state engaged in any activities to promote ACT and/or improve access?
Yes (check all that apply):
Work force development/training
Outreach or other promotion to providers
Other (please describe):
No
33. What steps does Medicaid take to ensure fidelity to SAMHSA models or otherwise promote quality of
ACT services?
Provider certification, licensing, or billing requirements that mandate fidelity/EBP components.
Monitor MCO or County contract compliance to ensure the relevant terms of agreement
regarding ACT services are being met
Conduct or require contractors to conduct performance improvement projects (e.g. measuring
and evaluating provider quality of care, then, if needed, developing and implementing a plan to
improve care)
Other (please describe):
None

Section 4: Evidence-Based Practices – Supported Employment
34. As of January 1, 2011, does Medicaid cover Supported Employment or cover any components of
Supported Employment, either solely through Medicaid funding or in a coordinated strategy with other
funding sources?
Medicaid covers Supported Employment
Medicaid covers some components of Supported Employment listed in a coordinated strategy
with other funders
Medicaid does not cover Supported Employment (Please skip to page 13, Section 5)
Don’t know
35. What federal authority does Medicaid use to cover Supported Employment, and when was this
mechanism implemented? (Check all that apply)
State Plan Amendment:
Date implemented:
Please provide a web link here or attach a copy of the SPA:
1915(b) Managed Care Waiver to cover components of Supported Employment that are not
normally covered under the State Plan:
Date implemented:
1915(c) Home and Community-Based Services Waiver to provide cost-effective supported
employment services that will prevent a recipient from being institutionalized:
Date implemented:
1115 Demonstration Waiver to cover supported employment services:
Date implemented:
36. If Medicaid contracts with one or more MCOs for delivery of services for mental health and/or
substance use disorders in your state, is there any language in the contract that specifically mentions
Supported Employment services? (Please note: the term MCO includes both those that deliver a
comprehensive set of services including physical and behavioral health and those that deliver only
behavioral health services.)
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not contract with MCOs.

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 10 of 36

37. If Medicaid has an agreement with a county to deliver or manage the delivery of mental health and/or
substance use services in your state, is there any language in the agreement that specifically
mentions Supported Employment services?
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not have these types of agreements with counties.
38. Are you familiar with the SAMHSA Fidelity Scale for Supported Employment services?
Yes
No (please skip to question 40)
39. Was the Fidelity Scale used in the development of any of the following:
Provider Manual
Provider Certification
Contracts
Quality Oversight
Don’t know
40. How do you manage Supported Employment?
Prior authorization
Surveillance and Utilization review (SURS)
Other (please describe):
41. Does Medicaid facilitate blending/braiding of Medicaid funding with other resources in order to
support Supported Employment services?
Yes
Medicaid provides technical assistance to providers on how to pool funding to support
EBP.
Medicaid pools funding at the state level with other state agencies to support EBP.
Medicaid contracts with an MCO or county/regional entity that pools funding
Other (please describe):
No
Don’t know
42. Is there a specific billing code or modifier that distinguishes the Medicaid-supported component of
Supported Employment from other community support or traditional vocational services?
Yes (please provide code and/or modifier):
No

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 11 of 36

43. Please provide the following data about Medicaid Supported Employment claims paid (not denied or
suspended) in the most recently completed state fiscal year (SFY). (Please enter the dates of that
year here:
) If specific data is not available, please write “NA”

Procedure code
(description)

Maximum
fee (e.g., $15
per
occurrence,
$25 per 15
minute
increment)

Total amount
paid

Number
procedures
paid

Number
beneficiaries
who
received the
procedure at
least once

Number
providers
who
submitted at
least one
claim for the
service

H2023 (supported
employment, per 15 min)
H2024 (supported
employment, per diem)
H2025 (Ongoing support
to maintain employment,
per 15 min)
H2026 )Ongoing support
to maintain employment,
per diem)
Other (see question 42)

44. Does Medicaid offer providers any incentives to deliver Supported Employment services?
Yes (check all that apply)
Enhanced reimbursement
Reduced caseload
Other (please describe):
No
Don’t know
45. Is your state engaged in any activities to promote Supported Employment and/or improve access?
Yes (check all that apply):
Work force development/training
Outreach or other promotion to providers
Other (please describe):
No
46. What steps does Medicaid take to ensure fidelity to SAMHSA models or otherwise promote quality of
Supported Employment services?
Provider certification, licensing, or billing requirements that mandate fidelity/EBP components.
Monitor MCO or County contract compliance to ensure the relevant terms of agreement are
being met
Conduct or require contractors to conduct performance improvement projects (e.g. measuring
and evaluating provider quality of care, then, if needed, developing and implementing a plan to
improve care)
Other (please describe):
None

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 12 of 36

Section 5: Evidence-Based Practices – Family Psychoeducation
47. As of January 1, 2011, does Medicaid cover Family Psychoeducation or any components of Family
Psychoeducation, either solely through Medicaid funding or in a coordinated strategy with other
funding sources?
Medicaid covers Family Psychoeducation
Medicaid covers some components of Family Psychoeducation listed in a coordinated strategy
with other funders
Medicaid does not cover Family Psychoeducation (Please skip to page 15, Section 6)
Don’t know
48. What federal authority does Medicaid use to cover Family Psychoeducation, and when was this
mechanism implemented? (Check all that apply)
State Plan Amendment:
Date implemented:
Please provide a web link here or attach a copy of the SPA:
1915(b) Managed Care Waiver to cover components of Family Psychoeducation that are not
normally covered under the State Plan:
Date implemented:
1915(c) Home and Community-Based Services Waiver to provide cost-effective Family
Psychoeducation services that will prevent a recipient from being institutionalized:
Date implemented:
1115 Demonstration Waiver to cover Family Psychoeducation services:
Date implemented:
49. If Medicaid contracts with one or more MCOs for delivery of services for mental health and/or
substance use disorders in your state, is there any language in the contract that specifically mentions
Family Psychoeducation services? (Please note: the term MCO includes both those that deliver a
comprehensive set of services including physical and behavioral health and those that deliver only
behavioral health services.)
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not contract with MCOs.
50. If Medicaid has an agreement with a county to deliver or manage the delivery of mental health and/or
substance use services in your state, is there any language in the agreement that specifically
mentions Family Psychoeducation services?
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not have these types of agreements with counties.
51. Are you familiar with the SAMHSA Fidelity Scale for Family Psychoeducation?
Yes
No (please skip to question 53)
52. Was the Fidelity Scale used in the development of any of the following:
Provider Manual
Provider Certification
Contracts
Quality Oversight
Don’t know

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 13 of 36

53. How do you manage access to Family Psychoeducation?
Prior authorization
Surveillance and Utilization Review (SURS)
Other (please describe):
54. Does Medicaid facilitate blending/braiding of Medicaid funding with other resources in order to
support Family Psychoeducation?
Yes
Medicaid provides technical assistance to providers on how to pool funding to support
EBP.
Medicaid pools funding at the state level with other state agencies to support EBP.
Medicaid contracts with an MCO or county/regional entity that pools funding
Other (please describe):
No
Don’t know
55. Is there a specific billing code or modifier that distinguishes Family Psychoeducation from other family
therapy or other psychoeducational intervention units of service?
Yes (please provide code and/or modifier):
No
56. Please provide the following data about Medicaid Family Psychoeducation claims paid (not denied or
suspended) in the most recently completed state fiscal year (SFY). (Please enter the dates of that
year here:
) If specific data is not available, please write “NA”

Procedure code
(description)

Maximum
fee (e.g., $15
per
occurrence,
$25 per 15
minute
increment)

Total amount
paid

Number
procedures
paid

Number
beneficiaries
who
received the
procedure at
least once

Number
providers
who
submitted at
least one
claim for the
service

H2027 (Psychoeducational service,
per 15 min)
Other (see question
55)
57. Does Medicaid offer providers any incentives to deliver Family Psychoeducation services?
Yes (check all that apply)
Enhanced reimbursement
Reduced caseload
Other (please describe):
No
Don’t know
58. Is your state engaged in any activities to promote Family Psychoeducation and/or improve access?
Yes (check all that apply):
Work force development/training
Outreach or other promotion to providers
Other (please describe):
No

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 14 of 36

59. What steps does Medicaid take to ensure fidelity to SAMHSA models or otherwise promote the
quality of Family Psychoeducation services?
Provider certification, licensing, or billing requirements that mandate fidelity/EBP components.
Monitor MCO or County contract compliance to ensure the relevant terms of agreement
regarding Family Psychoeducation services are being met
Conduct or require contractors to conduct performance improvement projects (e.g. measuring
and evaluating provider quality of care, then, if needed, developing and implementing a plan to
improve care)
Other (please describe):
None

Section 6: Evidence-Based Practices – Illness Management and Recovery
60. As of January 1, 2011, does Medicaid cover Illness Management and Recovery (IMR) or any
components of IMR, either solely through Medicaid funding or in a coordinated strategy with other
funding sources?
Medicaid covers IMR
Medicaid covers some components of IMR listed in a coordinated funding strategy
Medicaid does not cover IMR (Please skip to page 17, Section 7)
Don’t know
61. What federal authority does Medicaid use to cover IMR and when was this mechanism implemented?
(Check all that apply)
State Plan Amendment:
Date implemented:
Please provide a web link here or attach a copy of the SPA:
1915(b) Managed Care Waiver to cover components of IMR that are not normally covered
under the State Plan:
Date implemented:
1915(c) Home and Community-Based Services Waiver to provide cost-effective IMR services
that will prevent a recipient from being institutionalized:
Date implemented:
1115 Demonstration Waiver to cover IMR services:
Date implemented:
62. If Medicaid contracts with one or more MCOs for delivery of services for mental health and/or
substance use disorders in your state, is there any language in the contract that specifically mentions
IMR services? (Please note: the term MCO includes both those that deliver a comprehensive set of
services including physical and behavioral health and those that deliver only behavioral health
services.)
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not contract with MCOs.
63. If Medicaid has an agreement with a county to deliver or manage the delivery of mental health and/or
substance use services in your state, is there any language in the agreement that specifically
mentions IMR services?
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not have these types of agreements with counties.
64. Are you familiar with the SAMHSA Fidelity Scale for IMR?
Yes
No (please skip to question 66)
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Substance Use Disorders in State Medicaid Plans ♦ Page 15 of 36

65. Was the Fidelity Scale used in the development of any of the following:
Provider Manual
Provider Certification
Contracts
Quality Oversight
Don’t know
66. How do you manage access to IMR?
Prior authorization
Surveillance and Utilization Review (SURS)
Other (please describe):
67. Does Medicaid facilitate blending/braiding of Medicaid funding with other resources in order to
support IMR?
Yes
Medicaid provides technical assistance to providers on how to pool funding to support
EBP.
Medicaid pools funding at the state level with other state agencies to support EBP.
Medicaid contracts with an MCO or county/regional entity that pools funding
Other (please describe):
No
Don’t know
68. Is there a specific billing code or modifier that distinguishes IMR from other Psychoeducation/skill
building units of service?
Yes (please provide code and/or modifier):
No
69. Please provide the following data about Medicaid IMR claims paid (not denied or suspended) in the
most recently completed state fiscal year (SFY). (Please enter the dates of that year here:
) If
specific data is not available, please write “NA”

Procedure code
(description)

Maximum
fee (e.g.,
$15 per
occurrence,
$25 per 15
minute
increment)

Total
amount
paid

Number
procedures
paid

Number
beneficiaries
who received
the
procedure at
least once

Number
providers
who
submitted at
least one
claim for the
service

H2027 (Psychoeducational service,
per 15 minutes)
Other (please see
question 68)

70. Does Medicaid offer providers any incentives to deliver IMR services?
Yes (check all that apply)
Enhanced reimbursement
Reduced caseload
Other (please describe):
No
Don’t know

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Substance Use Disorders in State Medicaid Plans ♦ Page 16 of 36

71. Is your state engaged in any activities to promote IMR and/or improve access?
Yes (check all that apply):
Work force development/training
Outreach or other promotion to providers
Other (please describe):
No
72. What steps does Medicaid take to ensure fidelity to SAMHSA models or otherwise promote the
quality of IMR services?
Provider certification, licensing, or billing requirements that mandate fidelity/EBP components
Monitor MCO or County contract compliance to ensure the relevant terms of agreement
regarding IMR services are being met
Conduct or require contractors to conduct performance improvement projects (e.g. measuring
and evaluating provider quality of care, then, if needed, developing and implementing a plan to
improve care)
Other (please describe):
None

Section 7: Evidence-Based Practices – Integrated Dual Diagnosis Treatment
73. As of January 1, 2011, does Medicaid cover Integrated Dual Diagnosis Treatment (IDDT) or any
components of IDDT, either solely through Medicaid funding or in a coordinated strategy with other
funding sources?
Medicaid covers IDDT
Medicaid covers some components of IDDT listed in a coordinated strategy with other funders
Medicaid does not cover IDDT (Please skip to page 19, Section 8)
Don’t know
74. What federal authority does Medicaid use to cover IDDT and when was this mechanism
implemented? (Check all that apply)
State Plan Amendment:
Date implemented:
Please provide a web link here or attach a copy of the SPA:
1915(b) Managed Care Waiver to cover components of IDDT that are not normally covered
under the State Plan:
Date implemented:
1915(c) Home and Community-Based Services Waiver to provide cost-effective IDDT services
that will prevent a recipient from being institutionalized:
Date implemented:
1115 Demonstration Waiver to cover IDDT services:
Date implemented:
75. If Medicaid contracts with one or more MCOs for delivery of services for mental health and/or
substance use disorders in your state, is there any language in the contract that specifically mentions
IDDT services? (Please note: the term MCO includes both those that deliver a comprehensive set of
services including physical and behavioral health and those that deliver only behavioral health
services.)
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not contract with MCOs.

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Substance Use Disorders in State Medicaid Plans ♦ Page 17 of 36

76. If Medicaid has an agreement with a county to deliver or manage the delivery of mental health and/or
substance use services in your state, is there any language in the agreement that specifically
mentions IDDT services?
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not have these types of agreements with counties.
77. Are you familiar with the SAMHSA Fidelity Scale for IDDT?
Yes
No (please skip to question 79)
78. Was the Fidelity Scale used in the development of any of the following:
Provider Manual
Provider Certification
Contracts
Quality Oversight
Don’t know
79. How do you manage access to IDDT?
Prior authorization
Surveillance and Utilization Review (SURS)
Other (please describe):
80. Does Medicaid facilitate blending/braiding of Medicaid funding with other resources in order to
support IDDT?
Yes
Medicaid provides technical assistance to providers on how to pool funding to support
EBP.
Medicaid pools funding at the state level with other state agencies to support EBP.
Medicaid contracts with an MCO or county/regional entity that pools funding
Other (please describe):
No
Don’t know
81. Is there a specific billing code or modifier that distinguishes IDDT from other outpatient treatment
units of service?
Yes (please provide code and/or modifier):
No
82. Please provide the following data about Medicaid IDDT claims paid (not denied or suspended) in the
most recently completed state fiscal year (SFY). (Please enter the dates of that year here:
) If
specific data is not available, please write “NA”

Procedure code
(description)

Maximum fee
(e.g., $15 per
occurrence,
$25 per 15
minute
increment)

Total amount
paid

Number
procedures
paid

Number
beneficiaries
who received
the
procedure at
least once

Number
providers
who
submitted at
least one
claim for the
service

H0036 (Community
Psychiatric Supportive
Treatment)
Other (see question
81)
National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 18 of 36

83. Does Medicaid offer providers any incentives to deliver IDDT services?
Yes (check all that apply)
Enhanced reimbursement
Reduced caseload
Other (please describe):
No
Don’t know
84. Is your state engaged in any activities to promote IDDT and/or improve access?
Yes (check all that apply):
Work force development/training
Outreach or other promotion to providers
Other (please describe):
No
85. What steps does Medicaid take to ensure fidelity to SAMHSA models or otherwise promote the
quality of IDDT services?
Provider certification, licensing, or billing requirements that mandate fidelity/EBP components
Monitor MCO or County contract compliance to ensure the relevant terms of agreement
regarding IDDT services are being met
Conduct or require contractors to conduct performance improvement projects (e.g., measuring
and evaluating provider quality of care, then, if needed, developing and implementing a plan to
improve care)
Other (please describe):
None

Section 8: Evidence-Based Practices – Screening, Brief Intervention and Referral to
Treatment (SBIRT) for Individuals with Alcohol, Tobacco and/or Opioid Dependence
86. As of January 1, 2011, does Medicaid cover SBIRT or any components of SBIRT, either solely
through Medicaid funding or in a coordinated strategy with other funding sources?
Medicaid covers SBIRT
Medicaid covers some components of SBIRT listed in a coordinated strategy with other
funders
Medicaid does not cover SBIRT (Please skip to page 22, Section 9)
Don’t know
87. What federal authority does Medicaid use to cover SBIRT, and when was it implemented? (Check all
that apply)
State Plan Amendment:
Date implemented:
Please provide a web link here or attach a copy of the SPA:
1915(b) Managed Care Waiver to cover components of SBIRT that are not normally covered
under the State Plan:
Date implemented:
1915(c) Home and Community-Based Services Waiver to provide cost-effective SBIRT
services that will prevent a recipient from being institutionalized:
Date implemented:
1115 Demonstration Waiver to cover SBIRT services:
Date implemented:

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 19 of 36

88. If Medicaid contracts with one or more MCOs for delivery of services for mental health and/or
substance use disorders in your state, is there any language in the contract that specifically mentions
SBIRT? (Please note: the term MCO includes both those that deliver a comprehensive set of
services including physical and behavioral health and those that deliver only behavioral health
services.)
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not contract with MCOs.
89. If Medicaid has an agreement with a county to deliver or manage the delivery of mental health and/or
substance use services in your state, is there any language in the agreement that specifically
mentions SBIRT services?
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not have these types of agreements with counties.
90. Does your state require or recommend any particular screening tool in connection with SBIRT Billing
(e.g., Alcohol Use Disorder Identification Test (AUDIT); Drug Abuse Screening Test (DAST); The
Alcohol, Smoking and Substance Involvement Screening Test (ASSIST); The 5A’s Model for Treating
Tobacco Use and Dependence (Ask, Advise, Assess, Assist, Arrange))
Yes (please specify screening tool):
No
91. How do you manage access to SBIRT services?
Prior authorization
Surveillance and Utilization Review
Service is restricted to certain populations/settings
Other (please describe):
92. Does Medicaid facilitate blending/braiding of Medicaid funding with other resources in order to
support SBIRT services?
Yes
Medicaid provides technical assistance to providers on how to pool funding to support
SBIRT.
Medicaid pools funding at the state level with other state agencies to support SBIRT.
Medicaid contracts with an MCO or county/regional entity that pools funding
Other (please describe):
No
Don’t know

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 20 of 36

93. Please provide the following data about SBIRT claims paid (not denied or suspended) in the most
recently completed state fiscal year (SFY). (Please enter the dates of that year here:
) If
specific data is not available for SBIRT, please write “N/A”

Procedure code
(description)

Maximum fee
(e.g., $15 per
occurrence,
$25 per 15
minute
increment)

Total amount
paid

Number
procedures
paid

Number
beneficiaries
who received
the
procedure at
least once

Number
providers
who
submitted at
least one
claim for the
service

H0049 Alcohol and/or
drug screening
H0050 Alcohol and/or
drug service, brief
intervention, per 15
minutes
CPT 99408 Alcohol
and/or substance
abuse structured
screening and brief
intervention services;
15 to 30 minutes
CPT 99409 Alcohol
and/or substance
abuse structured
screening and brief
intervention services;
greater than 30
minutes
CPT 99406
Smoking and tobaccouse cessation
counseling visit;
intermediate, greater
than 3 minutes up to
10 minutes.
CPT 99407
Smoking and tobaccouse cessation
counseling visit;
intensive, greater than
10 minutes.
Other

94. Does Medicaid offer providers any incentives to deliver SBIRT services?
Yes (check all that apply)
Enhanced reimbursement
Other (please describe):
No
Don’t know

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 21 of 36

95. Is your state engaged in any activities to promote SBIRT and/or improve access?
Yes (check all that apply):
Work force development/training
Outreach or other promotion to providers
Other (please describe):
No

Section 9: Evidence-Based Practices – Medication-Assisted Treatment (MAT) for Alcohol,
Tobacco and/or Opioid Dependence
96. As of January 1, 2011, does Medicaid cover MAT or any components of Medication-Assisted
Treatment, either solely through Medicaid funding or in a coordinated strategy with other funding
sources?
Medicaid covers MAT
Medicaid covers some components of MAT listed in a coordinated strategy with other funders
Medicaid does not cover MAT (Please skip to page 25, Section 10)
Don’t know
97. What federal authority does Medicaid use to cover MAT, and when was it implemented? (Check all
that apply)
State Plan Amendment:
Date implemented:
Please provide a web link here or attach a copy of the SPA:
1915(b) Managed Care Waiver to cover components of MAT that are not normally covered
under the State Plan:
Date implemented:
1915(c) Home and Community-Based Services Waiver to provide cost-effective MAT services
that will prevent a recipient from being institutionalized:
Date implemented:
1115 Demonstration Waiver to cover MAT services:
Date implemented:
98. If Medicaid contracts with one or more MCOs for delivery of services for mental health and/or
substance use disorders in your state, is there any language in the contract that specifically mentions
Medication-Assisted Treatment? (Please note: the term MCO includes both those that deliver a
comprehensive set of services including physical health and behavioral health and those that deliver
only behavioral health services.)
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not contract with MCOs.
99. If Medicaid has an agreement with a county to deliver or manage the delivery of mental health and/or
substance use services in your state, is there any language in the agreement that specifically
mentions Medication-Assisted Treatment?
Yes (please provide a link to (or attach) the pertinent contract language):
No
Not applicable. Medicaid does not have these types of agreements with counties.
100. Does your state Medicaid program provide reimbursement for any of the following MAT:
Tobacco Dependence:
a. Nicotine Gum
Yes
No

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 22 of 36

b. Nicotine Patch
Yes
No
c. Nicotine Nasal Spray
Yes
No
d. Nicotine Inhaler
Yes
No
e. Nicotine Lozenge
Yes
No
f. Varenicline (Chantix®)
Yes
No
g. Bupropion SR (Zyban®, Wellbutrin SR®)
Yes
No
Alcohol Dependence:
h. Disulfiram (Antabuse®)
Yes
No
i. Naltrexone (ReVia®, Vivitrol®, Depade®)
Yes
No
j. Acamprosate Calcium (Campral®)
Yes
No
Opioid Dependence:
k. Buprenorphine (Suboxone®, Subutex®)
Yes
No
l. Methadone
Yes
No
101. Does your state provide a bundled rate that includes counseling (individual or group) for substance
abuse/dependence in addition to MAT?
Yes: please describe
No
102. How do you manage access to MAT services?
Prior authorization
Surveillance and Utilization Review (SURS)
Service is restricted to certain populations/settings (please describe):
Other (please describe):
103. Does Medicaid facilitate blending/braiding of Medicaid funding with other resources in order to
support MAT services?
Yes
Medicaid provides technical assistance to providers on how to pool funding to support
MAT.
Medicaid pools funding at the state level with other state agencies to support MAT.
Medicaid contracts with an MCO or county/regional entity that pools funding
Other (please describe):
No
Don’t know
National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 23 of 36

104. Please provide the following data about Medicaid MAT claims paid (not denied or suspended) in the
most recently completed state fiscal year (SFY). (Please enter the dates of that year here:
) If
specific data is not available, please write “NA”

Procedure code
(description)

Maximum fee
(e.g., $15 per
occurrence,
$25 per 15
minute
increment)

Total
amount
paid

Number
procedures
paid

Number
beneficiaries
who received
the
procedure at
least once

Number
providers
who
submitted at
least one
claim for the
service

CPT 90804-09 (Individual
psychotherapy, with
medical evaluation and
management services)
CPT 99406 (tobacco-use
cessation counseling;
intermediate, 3-10 min)
CPT 99407 (tobacco-use
cessation counseling;
intensive, > 10 min)
S9075 Smoking
Cessation Medications
H0016 (Alcohol and/or
drug; medical intervention
including physical exam
and prescriptions or
supervision of medication)
H2035 (Alcohol and/or
drug treatment program,
per hour—individualized
treatment, including
medication administration)
H2036 (Alcohol and/or
drug treatment program,
per diem—individualized
treatment, including
medication administration)
H0020 (Pharmacologic
Support—Methadone;
provision of drug by
licensed program)
H0033 (Pharmacologic
Support—Buprenorphine
(Suboxone® or
Subutex®); oral
medication administration,
direct observation)
HCPCS J8499
(Prescription drug, oral,
non-chemotherapeutic)
Other

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 24 of 36

105. Does Medicaid offer providers any incentives to deliver MAT services combined with counseling?
Yes (check all that apply)
Enhanced reimbursement
Reduced caseload
Other (please describe):
No
Don’t know
106. Is your state engaged in any activities to promote MAT and/or improve access?
Yes (check all that apply):
Work force development/training
Outreach or other promotion to providers
Other (please describe):
No

Section 10: EBP Promotion and Impact
107. How are Medicaid providers informed about Medicaid’s coverage of EBP services for mental health
and/or substance use disorders? Please check all that apply:
Medicaid Provider handbook or manual
In-person training session (specify frequency, e.g., annual or when changes occur)
On-line training or curriculum
Medicaid Provider bulletin or memorandum explaining changes
Joint Communication or training from Medicaid and Mental Health and/or Substance Use
Disorders Agencies
Other (please specify):
108. Has your state Medicaid agency produced any analyses or reports that document cost savings or
improved care associated with EBPs for mental health and/or substance use disorders?
Yes (please attach or provide a link to the document(s)):
No
109. Has your state legislature passed any legislation in support or in furtherance of a specific EBP, or in
support of EBPs generally?
Yes (please attach or provide a link to documents):
No

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 25 of 36

Part III
110. Please check the appropriate boxes in the table below to indicate which EBPs Medicaid has made a
formal commitment to cover (or cover certain components of) by January 1, 2012, the nature of the
commitment, and the estimated implementation date for coverage:

EBP

Dedicated
Staff Time

Type of Formal Commitment
Initial
Public Statement
Dedicated
Development or
of Intent to
Funding
Completion of
Implement
Work plan
Coverage

Other
(Please
describe)

Estimated
Implementation Date

Medication
management
Assertive
Community
Treatment (ACT)
Supported
employment
Family
psycho-education
Illness
management and
recovery
Integrated
Dual Diagnosis
Treatment
Screening,
Brief Intervention,
and Referral to
Treatment
Medication
Assisted
Treatment
111. Has Medicaid made a formal commitment to cover any additional EBPs besides those indicated
above?
Yes (please specify the EBP):
No
112. Considering your state’s efforts to implement evidence-based practices,
a. Name your two greatest achievements. (e.g. Facilitated multi-agency collaboration about
EBPs by creating a workgroup to discuss Medicaid coverage of EBPs)
1.
2.
b. Name your two greatest challenges. (e.g., mental health practitioner shortages in rural
areas).
1.
2.
c.

Name any practices that you think are unique or innovative.

113. Is there anything else you would like to say about your state’s efforts to support evidence-based
practices for mental health and substance use disorders?

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 26 of 36

114. Was your state Mental Health Director and/or state Substance Abuse Director involved in supplying
information for responses to this survey?
Yes
No
Survey complete! Please return survey to NASHP, c/o Mike Stanek, Research Assistant,
mstanek@nashp.org, or FAX 207-874-6527).
Thank you for your participation.

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Substance Use Disorders in State Medicaid Plans ♦ Page 27 of 36

Appendix A: Additional Information on Evidence-based Practices

Medication Management Approaches in Psychiatry (MedMAP)
MedMAP is a practice involving the systematic use of medications as a part of the treatment for
schizophrenia. MedMAP provides research-based guidelines and algorithms to help practitioners and
consumers achieve the best possible recovery outcomes. MedMAP was designed specifically to address
medication management for persons diagnosed with schizophrenia.
The goal of MedMAP in the treatment of schizophrenia is to improve care through the optimal use of
medications. Medication use can be optimized through implementation of the following principles:
(1) utilization of a systematic approach to medication management
(2) objective assessment of the symptoms that the medications are supposed to affect
(3) clear, concise documentation of the treatments and their outcomes
(4) enhancement of medication adherence through consumer education and involvement in medication
decisions.
Thorough, evidence-based medication management helps practitioners determine the best treatments for
consumers in an efficient fashion, thereby reducing pain, suffering, and the costs of inadequate treatment.
Adapted from:
http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/community/workbook/appendixd.asp

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 28 of 36

Assertive Community Treatment
ACT is a service-delivery model, not a case management program. It is a way of delivering
comprehensive and effective services to consumers who have needs that have not been well met by
traditional approaches to delivering services. At the heart of ACT is a trans-disciplinary team of 10 to 12
practitioners who provide services to about 100 people. ACT teams directly deliver services to consumers
instead of brokering services from other agencies or providers. For the most part, to ensure that services
are highly integrated, team members are cross-trained in one another’s areas of expertise.
ACT team members collaborate on assessments, treatment planning, and day-to-day interventions.
Instead of practitioners having individual caseloads, team members are jointly responsible for making
sure that each consumer receives the services needed to support recovery from mental illness.
ACT services are highly individualized. No arbitrary time limits dictate the length of time consumers
receive services. The primary goal of ACT is recovery through community treatment and habilitation. ACT
is characterized by:










A team approach — Practitioners with various professional training and general life skills work
closely together to blend their knowledge and skills.
in vivo services — Services are delivered in the places and contexts where they are needed.
A small caseload — An ACT team consists of 10 to 12 staff members who serve about 100
consumers, resulting in a staff-to-consumer ratio of approximately 1 to 10.
time-unlimited services — A service is provided as long as needed,
A shared caseload — Practitioners do not have individual caseloads; rather, the team as a
whole is responsible for ensuring that consumers receive the services they need to live in the
community and reach their personal goals.
A flexible service delivery — The ACT team meets daily to discuss how each consumer is
doing. The team members can quickly adjust their services to respond to changes in consumers’
needs.
A fixed point of responsibility — Rather than sending consumers to various providers for
services, the ACT team provides the services that consumers need. If using another provider
cannot be avoided (e.g., medical care), the team makes certain that consumers receive the
services they need.
24/7 crisis availability — Services are available 24 hours a day, 7 days a week. However, team
members often find that they can anticipate and avoid crises.

ACT is for consumers with the most challenging and persistent problems. Programs that adhere most
closely to the ACT model are most likely to get the best outcomes
Adapted from:
http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/community/

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 29 of 36

Supported Employment
Supported employment programs assist people in finding competitive employment—community jobs
paying at least minimum wage, which any person can apply for according to their choices and
capabilities. Supported employment programs do not screen people for work readiness, unlike other
vocational approaches, but help all who say they want to work. Extensive pre-employment assessment
and training, or intermediate work experiences, such as prevocational work units, transitional
employment, or sheltered workshops are not required.
Programs are staffed by employment specialists who help consumers look for jobs soon after entering the
program and facilitate job acquisition. For example, they may assist with application forms or accompany
consumers on interviews. Employment specialists support consumers as long as they want the
assistance, usually outside of the work place. Support can include help from other practitioners, family
members, coworkers, and supervisors.
In addition:






Eligibility for the service is based on consumer choice. No one is excluded who wants to
participate.
Supported employment is integrated with treatment. Employment specialists coordinate plans
with the treatment team, e.g., case manager, therapist, psychiatrist, etc.
Competitive employment is the goal.
Follow-along supports are continuous. Individualized supports to maintain employment continue
as long as consumers want the assistance.
Consumer preferences are important. Choices and decisions about work and support are
individualized based on the person’s preferences, strengths, and experiences.

Supported employment programs:





are effective for helping people to obtain competitive employment
address one of the top priorities of people with severe mental illness and their families
help people to move beyond the patient role and develop new employment-related roles as part
of their recovery process
help to decrease stigma around mental illness by helping people become integrated into
community life through competitive employment

Adapted from:
http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/employment/SEpmhainfo.asp

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Substance Use Disorders in State Medicaid Plans ♦ Page 30 of 36

Family Psychoeducation
Family psychoeducation is a method of working in partnership with families to impart current information
about the illness and to help them develop coping skills for handling problems posed by mental illness in
one member of the family. The goal is that practitioner, consumer, and family work together to support
recovery. Psychoeducation can be used in a single family or multi-family group format, depending on the
consumers and family’s wishes, as well as empirical indications. Single family and multi-family group
versions will have different outcomes over the long term, but there are similar components. The approach
has several phases, each with a specific format:
Introductory sessions
Family members meet with a practitioner, together or separately, and begin to form a partnership.
Educational workshop
Families come together in a classroom format for at least four hours to learn the most current information
about the psychobiology of the illness. They learn important information about normal reactions,
managing stress, and safety measures. Families choosing single family psychoeducation may also wish
to attend this session.
Problem-solving sessions
Consumers and families meet every two weeks for the first few months in a single or multi-family format
while learning to deal with problems in a pragmatic, structured way. The best results occur when the work
proceeds for at least nine months. Additional time of up to two years promotes improved outcomes.
The American Psychiatric Association and the Agency for Health Care Policy and Research cite family
psychoeducation as one of the most effective ways to manage schizophrenia. Research has shown that
there is a significant reduction in relapse rates (by at least 50% of previous rates) when family
intervention, multi-family groups, and medication are used concurrently. Recent studies show promising
results for bipolar disorder, major depression, and other severe mental illnesses.
Adapted from:
http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/family/

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Substance Use Disorders in State Medicaid Plans ♦ Page 31 of 36

Illness Management and Recovery
The Illness Management and Recovery Program consists of a series of weekly sessions where
practitioners help people who have experienced psychiatric symptoms to develop personal strategies for
coping with mental illness and moving forward in their lives. This is a model for people who have
experienced symptoms of schizophrenia, bipolar disorder, or depression. It is appropriate for people at
various stages of the recovery process. The program can be provided in an individual or group format and
generally lasts between three to six months.
Practitioners for Illness Management and Recovery can come from a wide range of clinical backgrounds,
including but not restricted to the following: social work, occupational therapy, counseling, case
management, nursing, and psychology. All practitioners providing the program need training and ongoing
supervision.
What is provided in the Illness Management and Recovery Program?
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Educational Handouts for Illness Management and Recovery, written for people who have
experienced psychiatric symptoms. These handouts contain practical information, summaries,
check lists, and planning sheets for nine topic areas.
The Practitioner’s Guide for Illness Management and Recovery which includes how to help
people develop and practice coping strategies, how to help people develop and pursue recovery
goals, and tips for responding to problems that may arise during sessions.
A fifteen minute introductory video.
Informational brochures for people who have experienced psychiatric symptoms, family members
and practitioners.
A fidelity scale to measure whether the program is being implemented as designed.
Outcome measures to assess whether the program is having a positive impact on participants.

Educational handouts are provided for the following topics:
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Recovery strategies
Practical facts about mental illness
The stress-vulnerability model and treatment strategies
Building social support
Reducing relapses and using medication effectively
Coping with stress
Coping with problems and symptoms
Getting your needs met in the mental health system

Adapted from:
http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/illness/

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 32 of 36

Co-Occurring Disorders: Integrated Dual Diagnosis Treatment
Integrated dual diagnosis treatment differs from traditional approaches in several ways. The most
important is the integration of mental health and substance use treatments. One practitioner or one team
in one agency provides both mental health and substance use treatments so that the consumer does not
get lost, excluded, or confused going back and forth between two different programs.
Integrated dual diagnosis treatments also blend mental health and substance use treatments. For
example, substance use treatments focus more on motivating people with two severe disorders to pursue
abstinence, and mental health treatments are modified in light of the consumer's vulnerability to
psychoactive substances.
Other features
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Stage-wise treatment. People go through a process over time to recover, and different services
are helpful at different stages of recovery.
Assessment. Consumers collaborate with clinicians to develop an individualized treatment plan
for both substance use disorder and mental illness.
Motivational treatment. Clinicians use specific listening and counseling skills to help consumers
develop awareness, hopefulness, and motivation for recovery.
Substance use counseling. Substance use counseling helps people with dual disorders to
develop the skills and find the supports needed to pursue recovery from substance use disorder.

Adapted from:
http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/cooccurring/

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 33 of 36

Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Alcohol, Tobacco and/or
Opioid Dependence
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive, integrated, public
health approach to the delivery of early intervention services that include brief screening, brief
intervention, and referral to treatment for person who are at risk of developing these disorders, and for
those with substance use disorders. Primary care centers, hospital emergency rooms, trauma centers,
and other community settings provide opportunities for early intervention with at-risk substance users
before more severe consequences occur.
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Screening is a quick, simple way to identify individuals who may need further assessment and
treatment for alcohol, tobacco and/or drug dependence. The goal of SBIRT is to make screening
a routine part of standard medical care.
Brief intervention can consist of a single or multiple sessions of motivational discussion focused
on increasing insight and awareness regarding alcohol, tobacco and/or drug use and motivation
for behavioral change. Brief intervention can be used as a stand-alone treatment for individuals
at-risk as well as a means of engaging those in need of more extensive levels of care.
Referral to specialized treatment identifies those in need of more extensive treatment than
offered by SBIRT. The effectiveness of the referral process to specialty treatment is a strong
measure of SBIRT success and involves a proactive and collaborative effort between SBIRT
clinicians and those providing specialty treatment to ensure access to the appropriate level of
care.

A key aspect of SBIRT is the integration and coordination of screening, brief intervention, and treatment
components into a system of services. This system links a community's specialized treatment programs
with a network of early intervention and referral activities that are conducted in medical and social service
settings.
Adapted from:
http://sbirt.samhsa.gov/
Additional reference
http://www.hipaa.samhsa.gov/pdf/2007_SA_HCPCS_CodeDefinitons.pdf

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 34 of 36

Medication-Assisted Treatment for Alcohol, Tobacco and/or Opioid Dependence
Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and
behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders.
Research shows that when treating substance-use disorders, a combination of medication and behavioral
therapies is most successful. MAT is clinically driven with a focus on individualized patient care.
MAT programs can be tailored to address one or more of the following addictions:
Tobacco/Nicotine Dependence
MAT for tobacco dependence combines medication (e.g. nicotine patches, gums, or other
pharmacotherapies such as Chantix®) with counseling and behavioral therapies. This may include:

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Providing smokers with practical counseling (giving advice on successful ways to quit) and
Providing support and encouragement as part of treatment.

Alcohol Dependence
MAT for alcohol dependence involves a comprehensive approach combining detoxification (if needed,)
counseling, medications (e.g., disulfiram), and participation in mutual-help support groups (e.g.,
Alcoholics Anonymous).
Opioid Dependence
MAT for opioid dependence combines pharmacotherapy with a full program of assessment, psychosocial
intervention, and support services.
A typical MAT intervention may include:
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Patient evaluation, prescription of the appropriate medication combined with counseling, and
relapse prevention strategies.
Medication maintenance combined with counseling, and relapse prevention strategies

Adapted from:
http://www.dpt.samhsa.gov/patients/mat.aspx
http://www.guideline.gov/content.aspx?id=12520
http://www.guidelines.gov/content.aspx%3Fid=8355
kap.samhsa.gov/products/trainingcurriculums/pdfs/tip43_curriculum.pdf

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 35 of 36

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid OMB control number. The
OMB control number for this project is 0930-xxxx. Public reporting burden for this collection of
information is estimated to average 1 hour, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to SAMHSA Reports
Clearance Officer, 1 Choke Cherry Road, Room 8-1099, Rockville, Maryland, 20857.

National Academy for State Health Policy: Survey of Evidence-Based Practices for Mental Health and
Substance Use Disorders in State Medicaid Plans ♦ Page 36 of 36