Substance Abuse Intensive Outpatient – SA IOP

1. Department of Medical Assistance Services Substance Abuse Intensive Outpatient – SA IOP H2016 2013 www.dmas.virginia.gov 1

2. Department of Medical Assistance Services 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. www.dmas.virginia.gov 2

3. Department of Medical Assistance Services Substance Abuse Intensive Outpatient Objectives of this Training Are: • To define the criteria of Substance Abuse Intensive Outpatient (SA IOP) • 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. www.dmas.virginia.gov 3

4. Department of Medical Assistance Services SA IOPService Definition H2016 www.dmas.virginia.gov 4

5. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • SA Intensive Outpatient is provided to individuals who do not require the intensive level of care of inpatient, residential, or day treatment services, but do require more intensive services than outpatient services. • SA Intensive Outpatient is provided in a concentrated manner, and generally involve multiple outpatient visits per week over a period of time for individuals requiring stabilization • These services include monitoring and multiple group therapy sessions during the week, and individual and family therapy which are focused on the Medicaid eligible individual. www.dmas.virginia.gov 5

6. Department of Medical Assistance Services SA IOPLicensing H2016 www.dmas.virginia.gov 6

7. Department of Medical Assistance Services Substance Abuse Intensive Outpatient SA Intensive Outpatient providers must have a Department of Behavioral Health and Developmental Services (DBHDS) license to provide Outpatient Substance Abuse Services. www.dmas.virginia.gov 7

8. Department of Medical Assistance Services SA IOPStaff Qualifications H2016 www.dmas.virginia.gov 8

9. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • SA Intensive Outpatient 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 Chapter II of the CMHRS manual for supervision requirements for certain QSAPs. www.dmas.virginia.gov 9

10. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • 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. www.dmas.virginia.gov 10

11. Department of Medical Assistance Services SA IOPEligibility Criteria H2016 www.dmas.virginia.gov 11

12. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • In order for individuals to receive Medicaid-reimbursed SA IOP 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. www.dmas.virginia.gov 12

13. Department of Medical Assistance Services Substance Abuse Intensive Outpatient If an individual has co-occurring mental health and substance use disorder, integrated treatment for both disorders is allowed within Substance Abuse Intensive Outpatient Treatment. www.dmas.virginia.gov 13

14. Department of Medical Assistance Services SA IOPRequired Activities H2016 www.dmas.virginia.gov 14

15. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • SA IOP 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 www.dmas.virginia.gov 15

16. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • 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. www.dmas.virginia.gov 16

17. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • 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. • Progress notes for SA IOP Treatment Services 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. www.dmas.virginia.gov 17

18. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • 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 continuous hours in a 24-hour period. www.dmas.virginia.gov 18

19. Department of Medical Assistance Services SA IOPLimitations and Supervision Requirements H2016 www.dmas.virginia.gov 19

20. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • 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. Supervision may occur individually or in a group. • Documentation of supervision shall be in the individual’s clinical record and signed by the QSAP. www.dmas.virginia.gov 20

21. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • 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). www.dmas.virginia.gov 21

22. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • 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 in Ch. II must be documented and 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. www.dmas.virginia.gov 22

23. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • No more than 19 hours per week of service may be provided. • Individuals shall be discharged from this service when less intensive services may achieve stabilization. • Staff travel time is excluded. • SA IOP may not be provided at the same time as SA Day Treatment Services or Opioid Treatment. www.dmas.virginia.gov 23

24. Department of Medical Assistance Services SA IOPUnits and Reimbursement H2016 www.dmas.virginia.gov 24

25. Department of Medical Assistance Services Substance Abuse Intensive Outpatient • There is a maximum of 600 hours allowed per fiscal year. 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. www.dmas.virginia.gov 25

26. Department of Medical Assistance Services SA IOPService Authorization H2016 www.dmas.virginia.gov 26

27. Department of Medical Assistance Services Substance Abuse Intensive Outpatient Service authorization is not currently required. www.dmas.virginia.gov 27

28. Department of Medical Assistance Services Substance Abuse Intensive Outpatient Helpful Resources: • 12VAC30-50-228 & 12VAC30-60-180 – Community substance abuse treatment services • Virginia Medicaid Web Portal link www.virginiamedicaid.dmas.virginia.gov • DMAS Office of Behavioral Health: • Email Address CMHRS@dmas.virginia.gov • DMAS Helpline: 804-786-6273 Richmond Area 1-800-552-8627 All other www.dmas.virginia.gov 28

29. Department of Medical Assistance Services Substance Abuse Intensive Outpatient Thank you for attending this training and helping to serve Virginia’s Medicaid Recipients. www.dmas.virginia.gov 29