Common use of Structured Outpatient Addiction Program Clause in Contracts

Structured Outpatient Addiction Program. (SOAP) - clinically intensive, structured day and/or evening substance use disorder services. These programs can be utilized as a transition service in the continuum of care for an Enrollee being discharged from Acute Substance Use Disorder Treatment, or can be utilized by individuals, who need Outpatient Services, but who also need more structured treatment for a substance use disorder. These programs may incorporate the evidence-based practice of Motivational Interviewing into clinical programming to promote individualized treatment planning. These programs may include specialized services and staffing for targeted populations including pregnant women, adolescents and adults requiring 24-hour monitoring and must be licensed by the Department of Public Health. Transitional Support Services (TSS) for Substance Use Disorders (ASAM Level 3.1) – Beginning no sooner than January 1, 2019 as directed by EOHHS, 24-hour short term intensive case management and psycho-educational residential programming with nursing available for Enrollees requiring short-term placements. Enrollees with co- occurring disorders receive coordination of transportation and referrals to mental health providers to ensure treatment for their co-occurring psychiatric conditions. TSS programs must be licensed by the Department of Public Health. APPENDIX B – COVERED SERVICES DEFINTIONS Exhibit 3: Expansions of Services Durable Medical Equipment (DME) - Environmental Aids and Assistive/Adaptive Technology Durable Medical Equipment – Training in Usage, Repairs, and Modifications Personal Assistance Services – Cueing and Monitoring APPENDIX B – COVERED SERVICES DEFINTIONS Exhibit 4: New Community-based Services Day Services that provide for on-site structured day activity typically for Enrollees with pervasive and extensive support needs who are not ready to join the general workforce. Such day services are individually designed around Consumer choice and preferences with a focus on improvement or maintenance of the person’s skills and their ability to live as independently as possible in the community; Such services often include assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive, and other strategies; interpersonal skills; prevocational skills; and recreational/socialization skills. Home Care Services provided within the Enrollee’s home or in the community. Such services include several types of home supports, including: Providing a worker or support person to perform general household tasks such as preparing meals, doing laundry and routine housekeeping, and/or to provide companionship to the member; Providing a range of personal support and assistance to enable an Enrollee to accomplish tasks that they would normally do for themselves if they could, including such things as help with bathing, dressing, personal hygiene and other activities of daily living. Such assistance may take the form of hands-on assistance or cueing and supervision to prompt the Enrollee to perform a task; Providing a variety of activities to help the Enrollee acquire, retain, or improve his/her skills related to personal finance, health, shopping, use of community resources, community safety, and other social and adaptive skills to live in the community. This may include skills training and education in self-determination and self-advocacy to enable the Enrollee to acquire skills to exercise control and responsibility over the services and supports they receive, and to become more independent, integrated, and productive in their communities; and Requires all such home care services/supports to be appropriate when the Enrollee needs them and/or when the person who is regularly responsible for the activities, such as a family caregiver, is absent or unable to manage the tasks. Respite Care services provided within the Enrollee’s home or in locations such as hospitals, rest homes, nursing facilities, assisted living residences, adult day health or adult xxxxxx care. Such services include services provided to an Enrollee to support his/her caregiver (family member, friend); and Such services may be provided to relieve informal caregivers from the daily stresses and demands of caring for an Enrollee in order to strengthen or support the informal support system. Peer Support/Counseling/Navigation services within an Enrollee’s home or community. The Enrollee must be an active participant in the Comprehensive Assessment process. Such services may be provided in small groups or may involve one peer providing support to another peer to promote and support the Enrollee’s ability to participate in self-advocacy. The one-to-one peer support is instructional; it is not counseling; Such services enhance the skills of the Enrollee to function in the community and/or family home. Care Transitions Assistance provided across facility and community settings. Such services facilitate safe and coordinated transitions across care settings, which may be particularly appropriate for Enrollees who have experienced or are expecting an inpatient stay, such as: Ensuring appropriate two-way exchange of information about the Enrollee, including: Primary diagnoses and major health problems; Care plan that includes Enrollee goals and preferences, diagnosis and treatment plan, and community care/service plan (if applicable); Enrollee’s goals of care, Advance Directives, and power of attorney; Emergency plan and contact number and person; Reconciled medication list; Identification of, and contact information for, transferring clinician/institution; Patient’s cognitive and Functional Status; Follow-up appointment schedule with contact information; Formal and informal caregiver status and contact information; Designated community-based care provider, long-term services, and social services as appropriate. Telephonic or other follow-up with Enrollees within 48 hours of an inpatient encounter; Culturally and linguistically competent post-discharge education regarding symptoms that may indicate additional health problems or a deteriorating condition; Patient-centered self-management support and relevant information specific to the Enrollee’s condition and any ongoing risks; and Referral to and care coordination with post-acute and outpatient providers as needed, including community-based support services providers. Home Modifications that are physical adaptations to an Enrollee’s private residence that are necessary to ensure the health, welfare and safety of an Enrollee or that enable the Enrollee to function with greater independence in the home. Such modifications include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or the installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies required for the Enrollee. Excluded from covered home modifications are those modifications or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the Enrollee, or which would normally be considered the responsibility of the landlord. Home modifications that add to the total square footage of the home are excluded except when necessary to complete an adaptation (e.g., in order to improve entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair). Community Health Workers are trained health workers who apply their unique understanding of the experience, language, and/or culture of the populations they serve in order to carry out one or more of the following roles: Providing culturally appropriate health education, information, and outreach in community-based settings, such as homes, schools, clinics, shelters, local businesses, and community centers; Bridging and/or culturally mediating between individuals, communities, and health and human services, including actively building individual and community capacity; Assuring that people access the services they need; Providing direct services, such as informal counseling on access to services, social support, care coordination, and health screenings; Advocating for individual and community needs pertaining to access to services; Actively assisting Enrollees with access to community resources; Assisting Enrollees to engage in wellness activities as well as chronic disease self-management; and Conducting home visits to assess health risk and mitigation opportunities in the home setting; Community Health Workers are distinguished from other health professionals because they are hired primarily for their understanding of the populations and communities they serve; conduct outreach a significant portion of the time on one or more of the categories above; and have experience providing services in community settings. Medication Management provided in the Enrollee’s home to support the Enrollee capable of self-administration of prescription and over-the-counter medications, including the following activities provided by the support worker: Reminding the Enrollee to take the medication; Checking the package to ensure that the name on the package is that of the Enrollee; Observing the Enrollee taking the medication; and Documenting in writing the observation of the Enrollee’s actions regarding the medication (e.g., whether the Enrollee took or refused the medication, date and time); and If requested by the Enrollee, opening the prepackaged medication or open containers, read the name of the medication and the directions on the label to the Enrollee, and responds to any questions the Enrollee may have regarding those directions. Non-Medical Transportation services within the community to enable the Enrollee to access community services, activities and resources in order to xxxxxx the Enrollee’s independence and support integration and full participation in his/her community.

Structured Outpatient Addiction Program. (SOAP) - ‑ clinically intensive, structured day and/or evening substance use disorder services. These programs can be utilized as a transition service in the continuum of care for an Enrollee being discharged from Acute Substance Use Disorder Treatment, or can be utilized by individuals, who need Outpatient Services, but who also need more structured treatment for a substance use disorder. These programs may incorporate the evidence-based evidence‑based practice of Motivational Interviewing into clinical programming to promote individualized treatment planning. These programs may include specialized services and staffing for targeted populations including pregnant women, adolescents and adults requiring 24-hour 24‑hour monitoring and must be licensed by the Department of Public Health. Transitional Support Services (TSS) for Substance Use Disorders (ASAM Level 3.1) – Beginning no sooner than January 1, 2019 as directed by EOHHS, 24-hour 24‑hour short term intensive case management and psycho-educational psycho‑educational residential programming with nursing available for Enrollees requiring short-term short‑term placements. Enrollees with co- occurring co‑occurring disorders receive coordination of transportation and referrals to mental health providers to ensure treatment for their co-occurring co‑occurring psychiatric conditions. TSS programs must be licensed by the Department of Public Health. APPENDIX Appendix B – COVERED SERVICES DEFINTIONS Covered Services Defintions Exhibit 3: Expansions of Services Durable Medical Equipment (DME) - ‑ Environmental Aids and Assistive/Adaptive Technology Durable Medical Equipment – Training in Usage, Repairs, and Modifications Personal Assistance Services – Cueing and Monitoring APPENDIX Appendix B – COVERED SERVICES DEFINTIONS Covered Services Defintions Exhibit 4: New Community-based Community‑based Services Day Services that provide for on-site on‑site structured day activity typically for Enrollees with pervasive and extensive support needs who are not ready to join the general workforce. Such day services are individually designed around Consumer choice and preferences with a focus on improvement or maintenance of the person’s skills and their ability to live as independently as possible in the community; Such services often include assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive, and other strategies; interpersonal skills; prevocational skills; and recreational/socialization skills. Home Care Services provided within the Enrollee’s home or in the community. Such services include several types of home supports, including: Providing a worker or support person to perform general household tasks such as preparing meals, doing laundry and routine housekeeping, and/or to provide companionship to the member; Providing a range of personal support and assistance to enable an Enrollee to accomplish tasks that they would normally do for themselves if they could, including such things as help with bathing, dressing, personal hygiene and other activities of daily living. Such assistance may take the form of hands-on hands‑on assistance or cueing and supervision to prompt the Enrollee to perform a task; Providing a variety of activities to help the Enrollee acquire, retain, or improve his/her skills related to personal finance, health, shopping, use of community resources, community safety, and other social and adaptive skills to live in the community. This may include skills training and education in self-determination self‑determination and self-advocacy self‑advocacy to enable the Enrollee to acquire skills to exercise control and responsibility over the services and supports they receive, and to become more independent, integrated, and productive in their communities; and Requires all such home care services/supports to be appropriate when the Enrollee needs them and/or when the person who is regularly responsible for the activities, such as a family caregiver, is absent or unable to manage the tasks. Respite Care services provided within the Enrollee’s home or in locations such as hospitals, rest homes, nursing facilities, assisted living residences, adult day health or adult xxxxxx care. Such services include services provided to an Enrollee to support his/her caregiver (family member, friend); and Such services may be provided to relieve informal caregivers from the daily stresses and demands of caring for an Enrollee in order to strengthen or support the informal support system. Peer Support/Counseling/Navigation services within an Enrollee’s home or community. The Enrollee must be an active participant in the Comprehensive Assessment process. Such services may be provided in small groups or may involve one peer providing support to another peer to promote and support the Enrollee’s ability to participate in self-advocacyself‑advocacy. The one-to-one one‑to‑one peer support is instructional; it is not counseling; Such services enhance the skills of the Enrollee to function in the community and/or family home. Care Transitions Assistance provided across facility and community settings. Such services facilitate safe and coordinated transitions across care settings, which may be particularly appropriate for Enrollees who have experienced or are expecting an inpatient stay, such as: Ensuring appropriate two-way two‑way exchange of information about the Enrollee, including: Primary diagnoses and major health problems; Care plan that includes Enrollee goals and preferences, diagnosis and treatment plan, and community care/service plan (if applicable); Enrollee’s goals of care, Advance Directives, and power of attorney; Emergency plan and contact number and person; Reconciled medication list; Identification of, and contact information for, transferring clinician/institution; Patient’s cognitive and Functional Status; Follow-up Follow‑up appointment schedule with contact information; Formal and informal caregiver status and contact information; Designated community-based community‑based care provider, long-term long‑term services, and social services as appropriate. Telephonic or other follow-up follow‑up with Enrollees within 48 hours of an inpatient encounter; Culturally and linguistically competent post-discharge post‑discharge education regarding symptoms that may indicate additional health problems or a deteriorating condition; Patient-centered self-management Patient‑centered self‑management support and relevant information specific to the Enrollee’s condition and any ongoing risks; and Referral to and care coordination with post-acute post‑acute and outpatient providers as needed, including community-based community‑based support services providers. Home Modifications that are physical adaptations to an Enrollee’s private residence that are necessary to ensure the health, welfare and safety of an Enrollee or that enable the Enrollee to function with greater independence in the home. Such modifications include the installation of ramps and grab-barsgrab‑bars, widening of doorways, modification of bathroom facilities, or the installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies required for the Enrollee. Excluded from covered home modifications are those modifications or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the Enrollee, or which would normally be considered the responsibility of the landlord. Home modifications that add to the total square footage of the home are excluded except when necessary to complete an adaptation (e.g., in order to improve entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair). Community Health Workers are trained health workers who apply their unique understanding of the experience, language, and/or culture of the populations they serve in order to carry out one or more of the following roles: Providing culturally appropriate health education, information, and outreach in community-based community‑based settings, such as homes, schools, clinics, shelters, local businesses, and community centers; Bridging and/or culturally mediating between individuals, communities, and health and human services, including actively building individual and community capacity; Assuring that people access the services they need; Providing direct services, such as informal counseling on access to services, social support, care coordination, and health screenings; Advocating for individual and community needs pertaining to access to services; Actively assisting Enrollees with access to community resources; Assisting Enrollees to engage in wellness activities as well as chronic disease self-managementself‑management; and Conducting home visits to assess health risk and mitigation opportunities in the home setting; Community Health Workers are distinguished from other health professionals because they are hired primarily for their understanding of the populations and communities they serve; conduct outreach a significant portion of the time on one or more of the categories above; and have experience providing services in community settings. Medication Management provided in the Enrollee’s home to support the Enrollee capable of self-administration self‑administration of prescription and over-the-counter over‑the‑counter medications, including the following activities provided by the support worker: Reminding the Enrollee to take the medication; Checking the package to ensure that the name on the package is that of the Enrollee; Observing the Enrollee taking the medication; and Documenting in writing the observation of the Enrollee’s actions regarding the medication (e.g., whether the Enrollee took or refused the medication, date and time); and If requested by the Enrollee, opening the prepackaged medication or open containers, read the name of the medication and the directions on the label to the Enrollee, and responds to any questions the Enrollee may have regarding those directions. Non-Medical Non‑Medical Transportation services within the community to enable the Enrollee to access community services, activities and resources in order to xxxxxx the Enrollee’s independence and support integration and full participation in his/her community.

Structured Outpatient Addiction Program. (SOAP) - clinically intensive, structured day and/or evening substance use disorder services. These programs can be utilized as a transition service in the continuum of care for an Enrollee being discharged from Acute Substance Use Disorder Treatment, or can be utilized by individuals, who need Outpatient Services, but who also need more structured treatment for a substance use disorder. These programs may incorporate the evidence-based practice of Motivational Interviewing into clinical programming to promote individualized treatment planning. These programs may include specialized services and staffing for targeted populations including pregnant women, adolescents and adults requiring 24-hour monitoring and must be licensed by the Department of Public Health. Transitional Support Services (TSS) for Substance Use Disorders (ASAM Level 3.1) – Beginning no sooner than January 1, 2019 as directed by EOHHS, 24-hour short term intensive case management and psycho-educational residential programming with nursing available for Enrollees requiring short-term placements. Enrollees with co- co-occurring disorders receive coordination of transportation and referrals to mental health providers to ensure treatment for their co-occurring psychiatric conditions. TSS programs must be licensed by the Department of Public Health. APPENDIX B – COVERED SERVICES DEFINTIONS Exhibit 3: Expansions of Services Durable Medical Equipment (DME) - Environmental Aids and Assistive/Adaptive Technology Durable Medical Equipment – Training in Usage, Repairs, and Modifications Personal Assistance Services – Cueing and Monitoring APPENDIX B – COVERED SERVICES DEFINTIONS Exhibit 4: New Community-based Services Day Services that provide for on-site structured day activity typically for Enrollees with pervasive and extensive support needs who are not ready to join the general workforce. Such day services are individually designed around Consumer choice and preferences with a focus on improvement or maintenance of the person’s skills and their ability to live as independently as possible in the community; Such services often include assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive, and other strategies; interpersonal skills; prevocational skills; and recreational/socialization skills. Home Care Services provided within the Enrollee’s home or in the community. Such services include several types of home supports, including: Providing a worker or support person to perform general household tasks such as preparing meals, doing laundry and routine housekeeping, and/or to provide companionship to the member; Providing a range of personal support and assistance to enable an Enrollee to accomplish tasks that they would normally do for themselves if they could, including such things as help with bathing, dressing, personal hygiene and other activities of daily living. Such assistance may take the form of hands-on assistance or cueing and supervision to prompt the Enrollee to perform a task; Providing a variety of activities to help the Enrollee acquire, retain, or improve his/her skills related to personal finance, health, shopping, use of community resources, community safety, and other social and adaptive skills to live in the community. This may include skills training and education in self-determination and self-advocacy to enable the Enrollee to acquire skills to exercise control and responsibility over the services and supports they receive, and to become more independent, integrated, and productive in their communities; and Requires all such home care services/supports to be appropriate when the Enrollee needs them and/or when the person who is regularly responsible for the activities, such as a family caregiver, is absent or unable to manage the tasks. Respite Care services provided within the Enrollee’s home or in locations such as hospitals, rest homes, nursing facilities, assisted living residences, adult day health or adult xxxxxx care. Such services include services provided to an Enrollee to support his/her caregiver (family member, friend); and Such services may be provided to relieve informal caregivers from the daily stresses and demands of caring for an Enrollee in order to strengthen or support the informal support system. Peer Support/Counseling/Navigation services within an Enrollee’s home or community. The Enrollee must be an active participant in the Comprehensive Assessment process. Such services may be provided in small groups or may involve one peer providing support to another peer to promote and support the Enrollee’s ability to participate in self-advocacy. The one-to-one peer support is instructional; it is not counseling; Such services enhance the skills of the Enrollee to function in the community and/or family home. Care Transitions Assistance provided across facility and community settings. Such services facilitate safe and coordinated transitions across care settings, which may be particularly appropriate for Enrollees who have experienced or are expecting an inpatient stay, such as: Ensuring appropriate two-way exchange of information about the Enrollee, including: Primary diagnoses and major health problems; Care plan that includes Enrollee goals and preferences, diagnosis and treatment plan, and community care/service plan (if applicable); Enrollee’s goals of care, Advance Directives, and power of attorney; Emergency plan and contact number and person; Reconciled medication list; Identification of, and contact information for, transferring clinician/institution; Patient’s cognitive and Functional Status; Follow-up appointment schedule with contact information; Formal and informal caregiver status and contact information; Designated community-based care provider, long-term services, and social services as appropriate. Telephonic or other follow-up with Enrollees within 48 hours of an inpatient encounter; Culturally and linguistically competent post-discharge education regarding symptoms that may indicate additional health problems or a deteriorating condition; Patient-centered self-management support and relevant information specific to the Enrollee’s condition and any ongoing risks; and Referral to and care coordination with post-acute and outpatient providers as needed, including community-based support services providers. Home Modifications that are physical adaptations to an Enrollee’s private residence that are necessary to ensure the health, welfare and safety of an Enrollee or that enable the Enrollee to function with greater independence in the home. Such modifications include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or the installation of specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies required for the Enrollee. Excluded from covered home modifications are those modifications or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the Enrollee, or which would normally be considered the responsibility of the landlord. Home modifications that add to the total square footage of the home are excluded except when necessary to complete an adaptation (e.g., in order to improve entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair). Community Health Workers are trained health workers who apply their unique understanding of the experience, language, and/or culture of the populations they serve in order to carry out one or more of the following roles: Providing culturally appropriate health education, information, and outreach in community-based settings, such as homes, schools, clinics, shelters, local businesses, and community centers; Bridging and/or culturally mediating between individuals, communities, and health and human services, including actively building individual and community capacity; Assuring that people access the services they need; Providing direct services, such as informal counseling on access to services, social support, care coordination, and health screenings; Advocating for individual and community needs pertaining to access to services; Actively assisting Enrollees with access to community resources; Assisting Enrollees to engage in wellness activities as well as chronic disease self-management; and Conducting home visits to assess health risk and mitigation opportunities in the home setting; Community Health Workers are distinguished from other health professionals because they are hired primarily for their understanding of the populations and communities they serve; conduct outreach a significant portion of the time on one or more of the categories above; and have experience providing services in community settings. Medication Management provided in the Enrollee’s home to support the Enrollee capable of self-administration of prescription and over-the-counter medications, including the following activities provided by the support worker: Reminding the Enrollee to take the medication; Checking the package to ensure that the name on the package is that of the Enrollee; Observing the Enrollee taking the medication; and Documenting in writing the observation of the Enrollee’s actions regarding the medication (e.g., whether the Enrollee took or refused the medication, date and time); and If requested by the Enrollee, opening the prepackaged medication or open containers, read the name of the medication and the directions on the label to the Enrollee, and responds to any questions the Enrollee may have regarding those directions. Non-Medical Transportation services within the community to enable the Enrollee to access community services, activities and resources in order to xxxxxx the Enrollee’s independence and support integration and full participation in his/her community.