Substance Abuse Services. Inpatient, intermediate and outpatient substance abuse services are covered when Medically Necessary and may be covered when a Member is admitted to a Hospital or Other Health Care Facility.
a. For those disorders that cannot be effectively treated in an outpatient (including Partial Hospitalization) environment, intermediate substance abuse services in a Residential Treatment facility may be covered under a 24-hour intensive and structured supervised treatment program providing an inpatient level of care but in a non-Hospital environment. Treatment must be received in a facility specifically licensed as a Residential Treatment facility or Residential Treatment center by the State of Florida (or if outside Florida, applicable state law), to provide Residential Treatment programs for substance use disorders. The facility must require admission by a Physician, must have a behavioral health provider or an appropriately state certified professional actively on duty during the day and evening therapeutic programming, and the facility’s medical director must be a Physician. For Detoxification programs in a Residential Treatment setting there must be a registered nurse onsite 24 hours per day, 7 days per week, and care must be provided under direct supervision of a Physician. Prior Authorization is required.
b. As an alternative to inpatient hospitalization, Partial Hospitalization may be covered under a structured program of active psychiatric treatment, provided in a Hospital outpatient setting or by a community mental health center, that is more intense than the care received in a Physician’s or therapist’s office. Prior Authorization is required.
c. Outpatient and Intensive Outpatient Treatment for substance use disorders may be covered when provided by a state-licensed psychiatrist or other Physician, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, Physician assistant, or other qualified mental health professional as allowed under applicable state law. Prior Authorization is required for Intensive Outpatient Treatment.
Substance Abuse Services. Inpatient, intermediate and outpatient substance abuse services are covered when Medically Necessary and may be covered when a Member is admitted to a Hospital or Other Health Care Facility.
a. For those disorders that cannot be effectively treated in an outpatient (including Partial Hospitalization) environment, intermediate substance abuse services in a Residential Treatment facility may be covered under a 24-hour intensive and structured supervised treatment program providing an inpatient level of care but in a non-Hospital environment. Prior Authorization is required.
b. As an alternative to inpatient hospitalization, Partial Hospitalization may be covered under a structured program of active psychiatric treatment provided in a Hospital outpatient setting or by a community mental health center, that is more intense than the care received in a Physician’s or therapist’s office. Prior Authorization is required.
c. Outpatient and intensive outpatient treatment for substance use disorders may be covered when provided by a state-licensed psychiatrist or other Physician, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, physician assistant, or other qualified mental health professional as allowed under applicable state law. Prior Authorization is required for intensive outpatient treatment.
Substance Abuse Services. Substance abuse is the use of alcohol or other drugs at dosages that place a Member’s social, economic, psychological, and physical welfare in potential hazard, or endanger public health, safety, or welfare. Benefits for the treatment of substance abuse includes detoxification and rehabilitation.
1. Detoxification - Inpatient Benefits for inpatient detoxification include services to assist an alcohol and/or drug intoxicated or dependent member in the elimination of the intoxicating alcohol or drug as well as alcohol or drug dependency factors while minimizing the physiological risk to the member. Services must be performed under the supervision of a licensed physician and in a facility licensed by the state in which it is located.
Substance Abuse Services. Benefits are provided for individual and group counseling and psychotherapy, psychological testing, and Family Counseling for the treatment of Substance Abuse when rendered to a Member by a Facility Provider or Professional Provider and include the following:
1. Inpatient Hospital or Substance Abuse Treatment Facility Services for detoxification;
2. Substance Abuse Treatment Facility Services for non-Hospital Inpatient residential treatment and rehabilitation Services; and
3. Outpatient Hospital or Substance Abuse Treatment Facility or Outpatient Substance Abuse Treatment Facility Services for rehabilitation therapy. For purposes of this benefit, a Substance Abuse Service provided on a Partial Hospitalization basis shall be deemed an Outpatient care Visit subject to Outpatient care cost-sharing amounts. Benefits are subject to provisions set forth in Subsection D. HEALTH CARE MANAGEMENT SERVICES of SECTION HC - HEALTH CARE MANAGEMENT
Substance Abuse Services. In accordance with the Disaster Services section of these General Provisions, Contractor may be required to assist in mitigating the psychological trauma experienced by victims, survivors, and responders to a disaster. Contractor may assist the individual or family in returning to a normal (pre-disaster) level of functioning and assist in decreasing the psychological and physical effects of acute and/or prolonged stress. In the event clients already receiving substance abuse services are affected, Contractor may work with the affected individuals in conjunction with the individual’s current support system. Contractor shall develop policies and procedures to address response and recovery for substance abuse programs. Contractor’s responsibilities include, but are not limited to the following: for treatment and OSAR Contractors, enter, and update as necessary, into CBMHS, the names and twenty-four (24)-hour contact information of Contractor’s Risk Manager or Safety Officer and at least two professional staff trained in mental health, substance abuse, or crisis counseling, one of whom may be the Contractor’s Risk Manager or Safety Officer, as disaster contacts; for treatment and OSAR Contractors, submit disaster substance abuse services policies and procedures if requested by DSHS; collaborate with DSHS and local preparedness, response and recovery efforts. OSAR staff shall assist in coordinating the disaster/incident response among substance abuse treatment providers, community mental health and emergency disaster service organizations, such as, emergency shelters and food banks. OSAR staff shall facilitate outreach to substance abuse clients and their families and ensure they are provided access to individual and group counseling, education, assessment, referral and community support; assign employees to assist DSHS to meet staffing needs for shelters, morgues, schools, hospitals, Disaster Recovery Centers, community support centers, death notifications, mass inoculations sites, and other necessary services during local, state or federal emergencies; contract with DSHS to provide FEMA-funded Crisis Counseling, Assistance and Training Program(s) (CCATP) after federal declarations as appropriate. CCATP services include housing, hiring and co-managing CCATP Team(s), as appropriate, and are described at xxxx://xxx.xxxx.xxx/public-assistance-local-state-tribal-and-non-profit/recovery-directorate/crisis-counselingand participate in disaster substance abuse educat...
Substance Abuse Services. Benefits are provided for individual and group counseling and psychotherapy, psychological testing, and Family Counseling for the treatment of Substance Abuse when rendered to a Member by a Facility Provider or Professional Provider and include the following:
1. Inpatient Hospital or Substance Abuse Treatment Facility Services for detoxification;
Substance Abuse Services. Has the same meaning as “substance abuse programs and services” pursuant to s. 397.331(1)(b), F.S. A Substance Abuse and Mental Health Services Administration (SAMHSA) technical assistance initiative designed to help individuals increase earlier access to SSI and SSDI through improved approval rates on initial Social Security applications by providing training, technical assistance, and strategic planning to Network Service Providers. A1-27 Temporary Assistance to Needy Families (TANF) As defined by 42 U.S.C. ss. 601, et seq., and Chapter 414, F.S. A1-28 Wait List A master list for the Network, maintained by a Managing Entity that shows:
Substance Abuse Services. All services must be provided directly INPATIENT: NONE by PHP or upon approved referral. Includes coverage for inpatient and outpatient care for drug and alcohol Inpatient services are limited to not abuse including counseling and placement more than seven inpatient days per assistance. contract year for medical detoxification only and thirty days residential Outpatient services include evaluation, services. diagnosis and treatment by a licensed practitioner. Outpatient visits are limited to a OUTPATIENT: $3 per visit maximum of forty visits per contract year. Enrollee Benefit Schedule Page 27 of 44
Substance Abuse Services. Health Plan enrollees will receive Medicaid-funded substance abuse services through the fee-for-service system. The Health Plan shall develop methods of coordinating and integrating mental health and substance abuse services for enrollees. The Health Plan shall be required to use the Florida Supplement to the American Society of Addictions Medicine Patient Placement Criteria for the coordination of mental health treatment with substance abuse providers as part of the integration effort (Second Edition ASAM PPC- 2R). The coordination shall be reflected in their individualized treatment plans for enrollees with co-occurring disorder.
Substance Abuse Services. Health plan Enrollees will receive Medicaid funded substance abuse services through the fee-for- service system. The health plan shall develop methods of coordinating and integrating mental health and substance abuse services for plan enrollees. The plan shall be required to use the Florida Supplement to the American Society of Addictions Medicine Patient Placement Criteria for the coordination of mental health treatment with substance abuse providers as part of the integration effort (Second Edition ASAM PPC-2, July 1998.) the coordination shall be reflected in their individualized Treatment Plan for enrollees with co-occurring disorder. The protocol for integrating mental health services with substance abuse services shall be monitored through the Quality of Care monitoring activities completed by the Agency’s EQRO contractor and the Quality Improvement requirements in Section D.34
