Summit Community Care Coverage for Addiction Treatment Services

Summit Community Care is an Arkansas Medicaid provider serving people with behavioral health needs and/or developmental or intellectual disabilities in Arkansas.

They’re one of four companies that have the specialty program called Provider Led Arkansas Shared Savings Entity (PASSE). PASSE involvement and the Medicaid services that are accessed through PASSE are managed for patients by a care coordinator.

The personal care coordinator for a patient oversees their needs and accesses services to help them maintain their independence.

Each patient of a care coordinator receives a person centered service plan that outlines what kinds of services they will receive and when and how often each service will be utilized.

Does Summit Community Care Cover Addiction Treatment?

Does Summit Community Care cover addiction treatment and drug rehab services? Yes. In compliance with the 2008 Mental Health Parity Act, Medicaid insurance offers mental health and substance abuse treatment in addition to medical care.

Their PASSE program provides substance abuse treatment for patients when it is requested by their care coordinator. The specific amount of time treatment is covered will depend on the plan and the medical needs of the individual.

What Types of Inpatient Addiction Treatment Are Covered by Summit Community Care?

When a person is treated in a hospital or home like environment for a period of time, that’s known as inpatient or residential care. You can get multiple types of treatment in an inpatient rehab.

The detoxification process to remove drugs from the patient’s body is often medically monitored to ensure safety and comfort. PASSE patients are eligible for drug detox services if requested by their care coordinator.

Inpatient treatment in a clinic or hospital for crisis stabilization and/or drug or alcohol rehab is covered by Summit Community Care’s PASSE Medicaid program. Your care coordinator will request services and work with other staff to develop your treatment plan.

What Types of Outpatient Rehab Are Covered by Summit Community Care?

When you live at home or a sober living facility and attend treatment a few hours a week, that’s known as outpatient care. There are several types of outpatient rehab.

PHP drug programs, known as day programs typically have sessions several times a week that last about six hours a day.

Clients return home each evening. PHPs are covered by Summit Community Care, but patients would have to be recommended by their care coordinator to participate in a PHP program. Higher functioning PASSE patients might be offered PHP treatment services.

General outpatient drug rehab treatment programs that provide individual and group counseling a few hours a week can be accessed through Summit Community Care. Outpatient treatment is available at Federally Qualified Health Centers and other community-based rehab facilities.

The PASSE patient’s care coordinator would locate an appropriate facility for the patient, and would make arrangements for treatment, including transportation to and from the facility.

What Special Programs Does Summit Community Care Offer?

The company works hard to ensure members have the specialized care they need. That’s why there are a variety of unique programs available to those with a Summit Community Care plan.

For eligible members, the Summit Community Care Healthy Rewards program offers monetary rewards of $10 to $50 to patients who meet certain health service goals, such as attending sessions with their behavioral health provider.

The company has recovery Support Partners/Coaches that work one on one with patients to help them meet their recovery goals and maintain sobriety. For those interested in a supported drug free living environment, Summit Community Care offers Therapeutic Community Residency. These shared homes help you build community and work on your recovery skills in daily life.

They offer Supportive Life Skills Development to help patients learn and practice skills for daily living. Behavioral Assistance is also available as needed to help patients appropriately manage their emotional and behavioral interactions.

Does Summit Community Care Cover Methadone & Suboxone (MAT)?

Medication assisted treatment is a comprehensive approach to addressing challenges with substance use disorders and addiction. MAT is particularly helpful with opioid and alcohol addiction. The treatment combines FDA approved medications with counseling and behavioral therapies. Medications can include methadone, buprenorphine, Suboxone, and Naltrexone.

Using medications helps to reduce withdrawal symptoms and prevent dangerous side effects that can occur during the withdrawal of certain medications. MAT also helps reduce cravings and provides a foundation for your recovery journey. MAT also helps to increase treatment retention and decrease the risk of overdoses and relapse.

This is one step in a holistic and evidence-based treatment plan aimed at your long-term recovery. Most state Medicaid programs reimburse for some forms of MAT. However, they may also impose certain constraints, such as limiting the medications used or the length of time medications can be prescribed. State programs often have requirements such as prior authorization to reduce costs and ensure that the drug is part of a customized treatment program.

Most State programs also limit quantities or doses to avoid potential misuse. As part of the Arkansas Medicaid program Summit Community Care offers coverage for Methadone and Suboxone medication assisted treatment. However your plan may require a referral from your care coordinator and documentation for prior authorization.

How to Verify Coverage With Summit Community Care

Your coverage with Summit Community Care may vary based on several factors. These include whether the treatment center is in network and if you have prior authorization for care. Your plan may also place limits on aspects of your treatment. Verification of coverage helps ensure that you do not receive an unexpected bill.

To verify your coverage you can contact the Summit Community Care customer service line to ask questions about your plan. You also have an online membership platform where you can get information about your benefits and coverage.

Most treatment centers can help verify your insurance coverage and can tell you if they are in network with your Summit Community Care plan. You can also speak with your care coordinator to get more details about coverage and to discuss a necessary referral before you begin treatment.

Can I Travel Out of State For Treatment With Summit Community Care?

Generally, Medicaid plans do not cover out of state care unless it is a life threatening emergency. Medicaid plans use state and federal funds but are administered by your state. This means that the plans can vary from state to state and your coverage does not extend into other states even those that border Arkansas.

In certain circumstances such as to see a specialist that is not available in your state you may have coverage for treatment. However it’s important to ensure you have prior authorization and approval from your care coordinator before you receive treatment or you may have to pay for everything out of pocket.

Does Addiction Treatment Need to Be In Network

Summit Community Care insurance plans are structured to provide medical care and substance use disorder treatment within their network. Summit has developed a wide range of high quality providers within the area to help address your needs and, including addiction treatment and treatment for co occurring mental health conditions.

You must work with your care coordinator to find an in network rehab treatment center that is capable of addressing your unique needs. Your care coordinator has access to a list of resources within the state that meet the criteria for coverage under Summit Community Care. Working together with your coordinator you can receive the care you need in a timely and efficient fashion.