Common use of Access to Substance Use Disorder Services Clause in Contracts

Access to Substance Use Disorder Services. 3.1. In collaboration with the COUNTY, CONTRACTOR will work to ensure that individuals to whom the CONTRACTOR provides SUD services meet access criteria and medical necessity requirements, as per DHCS guidance specified in BHIN 23-001. Specifically, the CONTRACTOR will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time of service provision as specified below. 3.2. CONTRACTOR shall have written admission criteria for determining the client’s eligibility and suitability for treatment and services. All clients admitted shall meet the admission criteria and this shall be documented in the client’s record. 3.3. Programs shall ensure that their policies, procedures, practices, and rules and regulations do not discriminate against the above special populations. Whenever the needs of the client cannot be reasonably accommodated, efforts shall be made to make referral(s) to appropriate programs. 3.4. CONTRACTOR should recognize and educate staff and collaborative partners that Parole and Probation status is not a barrier to SUD services. 3.5. CONTRACTOR will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time-of-service provision as outlined in this Agreement. 3.6. The initial assessment shall be performed face-to-face, by telehealth or by telephone by an Licensed Practitioner of the Healing Arts (LPHA) or registered or certified counselor and may be done in the community or the home, except for residential treatment services and narcotic treatment programs (NTPs). If the assessment of the client is completed by a registered or certified counselor, then an LPHA shall evaluate that assessment with the counselor and the LPHA shall make the final diagnosis. The consultation between the LPHA and the registered or certified counselor can be conducted in person, by video conferencing, or by telephone. 3.7. CONTRACTOR shall comply with beneficiaries’ access criteria and services provided during the initial assessment process requirements: 3.7.1. For beneficiaries 21 years of age and older, a full assessment using the ASAM Criteria shall be completed within 30 days of the beneficiary’s first visit with an LPHA or registered or certified counselor, or Peer Support Specialist (except for residential treatment services) 3.7.2. For beneficiaries under the age of 21, a full assessment using the ASAM Criteria shall be completed within 60 days of the beneficiary’s first visit with an LPHA or registered or certified counselor (except for residential treatment services). 3.7.3. For beneficiaries experiencing homelessness and where the provider documents that due to homelessness additional time is required to complete the assessment, a full assessment using the ASAM Criteria shall be completed within 60 days of the beneficiary’s first visit with an LPHA or registered or certified counselor (except for residential treatment services). 3.7.4. If a client withdraws from treatment prior to completion of the assessment or prior to establishing a DSM diagnosis for Substance-Related and Addictive Disorder, and later returns, the 30-day or 60-day time period starts over. 3.8. CONTRACTOR shall comply with beneficiaries’ access criteria after initial assessment requirements: 3.8.1. Beneficiaries 21 years of age and older, to qualify for DMC-ODS services after the initial assessment, must meet one of the following criteria: 3.8.1.1. Have at least one diagnosis from the most current edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders for Substance-Related and Addictive Disorders, except for Tobacco-Related Disorders and Non- Substance-Related Disorders, OR 3.8.1.2. Have had at least one diagnosis from the most current edition of the DSM for Substance-Related and Addictive Disorders, except for Tobacco-Related Disorders and Non-Substance-Related Disorders, prior to being incarcerated or during incarceration, determined by substance use history. 3.8.2. Beneficiaries under the age of 21, qualify for DMC-ODS medically necessary services after the initial assessment, in the following circumstances: 3.8.2.1. All services that are Medi-Cal-coverable, appropriate, and medically necessary, needed to correct and ameliorate health conditions shall be provided, as per federal Early & Periodic Screening, Diagnostic and Treatment (EPSDT) statutes and regulations. 3.8.2.2. Services need not be curative or completely restorative to ameliorate a health condition, including substance misuse and SUDs, consistent with federal guidance. 3.8.2.3. Services that sustain, support, improve, or make more tolerable substance misuse or an SUD are considered to ameliorate the condition and are thus covered as EPSDT services.

Access to Substance Use Disorder Services. 3.1. a. In collaboration with the COUNTYCounty, CONTRACTOR Contractor will work to ensure that individuals to whom the CONTRACTOR Contractor provides SUD services meet access criteria and medical necessity requirements, as per DHCS guidance specified in BHIN 23-001. Specifically, the CONTRACTOR Contractor will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time of service provision as specified below. 3.2. CONTRACTOR b. Contractor shall have written admission criteria for determining the client’s eligibility and suitability for treatment and services. All clients admitted shall meet the admission criteria and this shall be documented in the client’s record. 3.3. c. Programs shall ensure that their policies, procedures, practices, and rules and regulations do not discriminate against the above special populations. Whenever the needs of the client cannot be reasonably accommodated, efforts shall be made to make referral(s) to appropriate programs. 3.4. CONTRACTOR d. Contractor should recognize and educate staff and collaborative partners that Parole and Probation status is not a barrier to SUD services. 3.5. CONTRACTOR e. Contractor will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time-of-service provision as outlined in this Agreement. 3.6. f. The initial assessment shall be performed face-to-face, by telehealth or by telephone by an Licensed Practitioner of the Healing Arts (LPHA) or registered or certified counselor and may be done in the community or the home, except for residential treatment services and narcotic treatment programs (NTPs). If the assessment of the client is completed by a registered or certified counselor, then an LPHA shall evaluate that assessment with the counselor and the LPHA shall make the final diagnosis. The consultation between the LPHA and the registered or certified counselor can be conducted in person, by video conferencing, or by telephone. 3.7. CONTRACTOR g. Contractor shall comply with beneficiaries’ access criteria and services provided during the initial assessment process requirements: 3.7.1. i. For beneficiaries 21 years of age and older, a full assessment using the ASAM Criteria shall be completed within 30 days of the beneficiary’s first visit with an LPHA or registered or certified counselor, or Peer Support Specialist (except for residential treatment services) 3.7.2ii. For beneficiaries under the age of 21, a full assessment using the ASAM Criteria shall be completed within 60 days of the beneficiary’s first visit with an LPHA or registered or certified counselor (except for residential treatment services). 3.7.3iii. For beneficiaries experiencing homelessness and where the provider documents that due to homelessness additional time is required to complete the assessment, a full assessment using the ASAM Criteria shall be completed within 60 days of the beneficiary’s first visit with an LPHA or registered or certified counselor (except for residential treatment services). 3.7.4iv. If a client withdraws from treatment prior to completion of the assessment or prior to establishing a DSM diagnosis for Substance-Related and Addictive Disorder, and later returns, the 30-day or 60-day time period starts over. 3.8. CONTRACTOR h. Contractor shall comply with beneficiaries’ access criteria after initial assessment requirements: 3.8.1. i. Beneficiaries 21 years of age and older, to qualify for DMC-ODS services after the initial assessment, must meet one of the following criteria: 3.8.1.1. 1) Have at least one diagnosis from the most current edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders for Substance-Related and Addictive Disorders, except for Tobacco-Related Disorders and Non- Substance-Related Disorders, OR 3.8.1.2. 2) Have had at least one diagnosis from the most current edition of the DSM for Substance-Related and Addictive Disorders, except for Tobacco-Tobacco- Related Disorders and Non-Substance-Related Disorders, prior to being incarcerated or during incarceration, determined by substance use history. 3.8.2. ii. Beneficiaries under the age of 21, qualify for DMC-ODS medically necessary services after the initial assessment, in the following circumstances: 3.8.2.1. 1) All services that are Medi-Cal-coverable, appropriate, and medically necessary, needed to correct and ameliorate health conditions shall be provided, as per federal Early & Periodic Screening, Diagnostic and Treatment (EPSDT) statutes and regulations. 3.8.2.2. 2) Services need not be curative or completely restorative to ameliorate a health condition, including substance misuse and SUDs, consistent with federal guidance. 3.8.2.3. 3) Services that sustain, support, improve, or make more tolerable substance misuse or an SUD are considered to ameliorate the condition and are thus covered as EPSDT services.

Access to Substance Use Disorder Services. 3.1. In collaboration with the COUNTY, CONTRACTOR will work to ensure that individuals to whom the CONTRACTOR provides SUD services meet access criteria and medical necessity requirements, as per DHCS guidance specified in BHIN 23-001. Specifically, the CONTRACTOR will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time of time-of-service provision as specified below. 3.2. CONTRACTOR shall have written admission criteria for determining the client’s eligibility and suitability for treatment and services. All clients admitted shall meet the admission criteria and this shall be documented in the client’s record. 3.3. Programs shall ensure that their policies, procedures, practices, and rules and regulations do not discriminate against the above special populations. Whenever the needs of the client cannot be reasonably accommodated, efforts shall be made to make referral(s) to appropriate programs. 3.4. CONTRACTOR should recognize and educate staff and collaborative partners that Parole and Probation status is not a barrier to SUD services. 3.5. CONTRACTOR will ensure that the clinical record for each client includes information as a whole indicating that client’s presentation and needs are aligned with the criteria applicable to their age at the time-of-service provision as outlined in this Agreement. 3.6. The initial assessment shall be performed face-to-face, by telehealth or by telephone by an Licensed Practitioner of the Healing Arts (LPHA) or registered or certified counselor and may be done in the community or the home, except for residential treatment services and narcotic treatment programs (NTPs). If the assessment of the client is completed by a registered or certified counselor, then an LPHA shall evaluate that assessment with the counselor and the LPHA shall make the final diagnosis. The consultation between the LPHA and the registered or certified counselor can be conducted in person, by video conferencing, or by telephone. 3.7. CONTRACTOR shall comply with beneficiaries’ access criteria and services provided during the initial assessment process requirements: 3.7.1. For beneficiaries 21 years of age and older, a full assessment using the ASAM Criteria shall be completed within 30 days of the beneficiary’s first visit with an LPHA or registered or certified counselor, or Peer Support Specialist (except for residential treatment services) 3.7.2. For beneficiaries under the age of 21, a full assessment using the ASAM Criteria shall be completed within 60 days of the beneficiary’s first visit with an LPHA or registered or certified counselor (except for residential treatment services). 3.7.3. For beneficiaries experiencing homelessness and where the provider documents that due to homelessness additional time is required to complete the assessment, a full assessment using the ASAM Criteria shall be completed within 60 days of the beneficiary’s first visit with an LPHA or registered or certified counselor (except for residential treatment services). 3.7.4. If a client withdraws from treatment prior to completion of the assessment or prior to establishing a DSM diagnosis for Substance-Related and Addictive Disorder, and later returns, the 30-day or 60-day time period starts over. 3.8. CONTRACTOR shall comply with beneficiaries’ access criteria after initial assessment requirements: 3.8.1. Beneficiaries 21 years of age and older, to qualify for DMC-ODS services after the initial assessment, must meet one of the following criteria: 3.8.1.1. Have at least one diagnosis from the most current edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders for Substance-Related and Addictive Disorders, except for Tobacco-Related Disorders and Non- Substance-Related Disorders, OR 3.8.1.2. Have had at least one diagnosis from the most current edition of the DSM for Substance-Related and Addictive Disorders, except for Tobacco-Related Disorders and Non-Substance-Related Disorders, prior to being incarcerated or during incarceration, determined by substance use history. 3.8.2. Beneficiaries under the age of 21, qualify for DMC-ODS medically necessary services after the initial assessment, in the following circumstances: 3.8.2.1. All services that are Medi-Cal-coverable, appropriate, and medically necessary, needed to correct and ameliorate health conditions shall be provided, as per federal Early & Periodic Screening, Diagnostic and Treatment (EPSDT) statutes and regulations. 3.8.2.2. Services need not be curative or completely restorative to ameliorate a health condition, including substance misuse and SUDs, consistent with federal guidance. 3.8.2.3. Services that sustain, support, improve, or make more tolerable substance misuse or an SUD are considered to ameliorate the condition and are thus covered as EPSDT services.