H Department of Medical Assistance Services Substance Abuse Day Treatment 2013

2 Disclaimer These slides contain only highlights of the Virginia Medicaid Community Mental Health Rehabilitative Services Manual (CHMRS) and are not meant to substitute for the comprehensive information available in the manual or state and federal regulations. *Please refer to the manual, available on the DMAS website portal, for in-depth information on Community Mental Health Rehabilitative Services criteria. Providers are responsible for adhering to related state and federal regulations Department of Medical Assistance Services

3 Substance Abuse Day Treatment Objectives of this Training Are: To define the criteria of Substance Abuse (SA) Day Treatment To identify staff qualifications; To clarify eligibility criteria; To identify required activities; To review limitations of the service; To outline service units and reimbursement; and To review service authorization requirements Department of Medical Assistance Services

H Department of Medical Assistance Services Substance Abuse Day Treatment Service Definition

5 Substance Abuse Day Treatment  SA Day Treatment is provided to individuals who do not require the intensive level of care of inpatient or residential services but require more intensive services than outpatient.  SA Day Treatment is the provision of coordinated, intensive, comprehensive, and multidisciplinary treatment to individuals through a combination of diagnostic, medical, psychiatric, and psychosocial interventions.  These services are provided in a non-residential setting and must be provided in sessions of two or more consecutive hours per day, which may be scheduled multiple times per week Department of Medical Assistance Services

H Department of Medical Assistance Services Substance Abuse Day Treatment Licensing

7 Substance Abuse Day Treatment SA Day Treatment providers must have a Department of Behavioral Health and Developmental Services (DBHDS) license to provide Day Treatment Services Department of Medical Assistance Services

H Department of Medical Assistance Services Substance Abuse Day Treatment Staff Qualifications

9 Substance Abuse Day Treatment  SA Day Treatment may be provided by the following:  Qualified Substance Abuse Professional* (QSAP)  Paraprofessional (peer support specialist)  Qualification requirements may be found in Chapter II of the Community Mental Health Rehabilitative Services (CMHRS) Manual * Please see Ch. II of the CMHRS manual for supervision requirements for certain QSAPs Department of Medical Assistance Services

10 Substance Abuse Day Treatment  Individual and group counseling, family therapy, and occupational and recreational therapy must be provided by at least a QSAP.  A QSAP or a paraprofessional, under the supervision of a QSAP, may provide education about the effects of alcohol and other drugs on the physical, emotional, and social functioning of the individual; relapse prevention; and occupational and recreational activities.  A QSAP must be onsite when a paraprofessional is providing services Department of Medical Assistance Services

H Department of Medical Assistance Services Substance Abuse Day Treatment Eligibility Criteria

12 Substance Abuse Day Treatment  In order for individuals to receive Medicaid-reimbursed Substance Abuse Day Treatment Services, individuals must demonstrate a clinical necessity for the service by meeting the Diagnostic Statistical Manual diagnostic criteria for an Axis I Substance Use Disorder, with the exception of nicotine or caffeine abuse or dependence.  A diagnosis of nicotine or caffeine abuse or dependence, which includes Tobacco Use, shall not be sufficient for approval for these services.  American Society of Addiction Medicine (ASAM) criteria will be used to determine the appropriate level of treatment Department of Medical Assistance Services

13 Substance Abuse Day Treatment If an individual has co-occurring mental health and substance use disorder, integrated treatment for both disorders is allowed within Substance Abuse Day Treatment Department of Medical Assistance Services

H Department of Medical Assistance Services Substance Abuse Day Treatment Required Activities

15 Substance Abuse Day Treatment  SA Day Treatment shall provide major substance abuse treatment and psychiatric, psychological and psycho- educational modalities to include:  Individual, group, and family therapy;  Education about the effects of alcohol and other drugs on the physical, emotional, and social functioning of the individual;  Relapse prevention;  Occupational and recreational therapy;  Or other therapies Department of Medical Assistance Services

16 Substance Abuse Day Treatment  Psycho-education refers to education on mental health and substance abuse topics to improve the individual’s behavioral, mental or emotional condition and may include communication, problem solving, anger management, and interpersonal communication skills.  A QSAP must perform a face-to-face evaluation/diagnostic service-specific provider assessment and authorize the services prior to initiation of services.  An Individual Service Plan (ISP) must be completed by a QSAP within 30 days of the initiation of services and cosigned by the individual receiving services Department of Medical Assistance Services

17 Substance Abuse Day Treatment  Services must be provided in accordance with the ISP.  The service provider must notify or document the attempts to notify the primary care provider of the individual’s receipt of Community Mental Health Rehabilitative Services (which includes this service).  Progress notes for SA Day Treatment must be completed when services are delivered.  Documentation must include the date of the service, the service or activity provided, the units provided, the provider rendering the service, and a dated staff signature with credentials Department of Medical Assistance Services

18 Substance Abuse Day Treatment  A QSAP must perform a face-to-face evaluation and re- authorize services that are provided longer than 90 continuous days.  If case management is being provided there must be coordination with the case management agency.  The program must operate a minimum of two consecutive hours per day.  A minimum of 20 hours, up to a maximum of 30 hours, per week of skilled treatment services must be provided Department of Medical Assistance Services

H Department of Medical Assistance Services Substance Abuse Day Treatment Limitations and Supervision Requirements

20 Substance Abuse Day Treatment  A QSAP must be onsite when a paraprofessional is providing services.  The QSAP must supervise the paraprofessional at least twice a month.  Supervision shall include documented face-to-face meetings between the supervisor and the paraprofessional providing the services.  Documentation of supervision shall be in the individual’s clinical record and signed by the QSAP Department of Medical Assistance Services

21 Substance Abuse Day Treatment  A QSAP that has a bachelor’s degree and is certified as  A Substance Abuse Counselor by the Board of Counseling; or  An Addictions Counselor by the Substance Abuse Certification Alliance of Virginia; or  A Level II Addiction counselor by the National Association of Alcoholism and Drug Abuse Counselors or from the International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse, Inc must also be supervised by a QSAP listed in Chapter II of the CMHRS manual under provider qualifications for Medicaid reimbursed Substance Abuse Day Treatment 1(a)- 1(e) Department of Medical Assistance Services

22 Substance Abuse Day Treatment  Paraprofessional who do not meet the experience requirements listed in Chapter II of the CMHRS manual may provide services for Medicaid reimbursement if they are working directly with a qualified paraprofessional on- site and supervised by a QSAP.  Monthly supervision of a paraprofessional who does not meet the requirements must include:  On site observation of services;  Face-to-face consultation with the paraprofessional;  A review of progress notes;  Review of the individual’s progress towards achieving ISP goals and objectives; and  Recommendations for ISP change based on the individual’s status Department of Medical Assistance Services

23 Substance Abuse Day Treatment  Individuals shall be discharged from this service when less intensive services may achieve stabilization.  Staff travel time is excluded.  SA Day Treatment may not be provided at the same time as SA Intensive Outpatient or Opioid Treatment Department of Medical Assistance Services

H Department of Medical Assistance Services Substance Abuse Day Treatment Units and Reimbursement

25 Substance Abuse Day Treatment  There is a maximum of 1,300 hours allowed annually. A claim edit is in place that will cut back payment or deny claims for services beyond the maximum number of units allowed.  One unit = 15 minutes  Reimbursement is based on the level of professional providing the service.  A fiscal year is July 1 to June 30. All units will reset to zero on July 1 of each year Department of Medical Assistance Services

H Department of Medical Assistance Services Substance Abuse Day Treatment Service Authorization

27 Substance Abuse Day Treatment Service authorization is not currently required Department of Medical Assistance Services

28 Substance Abuse Day Treatment Helpful Resources: 12VAC & 12VAC – Community substance abuse treatment services Virginia Medicaid Web Portal link DMAS Office of Behavioral Health: – Address DMAS Helpline: Richmond Area All other Department of Medical Assistance Services

29 Substance Abuse Day Treatment Thank you for attending this training and helping to serve Virginia’s Medicaid Recipients Department of Medical Assistance Services