Substance Use Disorder Services. As part of this demonstration Project, in addition to the Substance Use Disorder (SUD) services described in Charts B and C, above, FFP is available under the demonstration for the Substance Use Disorder (SUD) services described in Chart D, below. By providing improved access to treatment and ongoing recovery support, EOHHS believes individuals with SUD will have improved health and increased rates of long-term recovery. These SUD services will contribute to reduced use of the emergency department and unnecessary hospitalizations. As is currently the case, MassHealth anticipates that the Department of Public Health, Bureau of Substance Abuse Services (BSAS), which is the single state authority on SUD services, continue to fund primary prevention efforts, including education campaigns and community prevention coalitions. Intervention and initial treatment will be available to MassHealth members, as described below, in a number of different settings (as set forth herein) and allow for a bio-psycho-social clinical assessment, based on the ASAM principles, to gain an understanding of addiction severity, co- occurring mental health issues and trauma, physical health issues, family and social supports, housing stability and other issues.
Substance Use Disorder Services. 1. Beginning March 1, 2018or when otherwise directed by EOHHS, the Contractor shall provide Residential Rehabilitative Services, Recovery Support Navigator services, and Recovery Coach services to all Covered Individuals.
2. The Contractor shall provide Enhanced Residential Rehabilitative Services for Dually Diagnosed, Clinically Managed Population-Specific High Intensity Residential Services, and Transitional Support Services to all Covered Individuals when directed by EOHHS.”
Substance Use Disorder Services.
1. Inmates/youth booked into Tuolumne County facilities who are intoxicated shall be placed in housing designated for intoxicated individuals and monitored by health care services and custody staff in accordance with established written policies and procedures approved by the Medical Director and Facility Administrator. Inmates/youth will be evaluated on an individual basis by health care services staff to determine the need for medically supported detoxification during incarceration.
2. The clinical management of chemically dependent inmates/youth shall include diagnosis of chemical dependency by a physician or qualified health services staff. An individualized treatment plan will be developed and implemented, and a referral for community resources will be given upon release when appropriate.
3. Inmates/youth exhibiting signs of drug or alcohol withdrawal will be evaluated by health services staff. During the time health services staff are not on-site and correctional staff suspect an inmate/youth is experiencing withdrawal symptoms, they should transport the inmate/youth to Adventist Health Sonora for medical clearance.
i. Inmates/youth identified by self or deputies as substance abusers shall be evaluated by health care services staff to determine medical status.
ii. Evaluation, treatment, and referral shall be carried out in accordance with direct physician orders, or approved CONTRACTOR Protocols/Standardized Procedures.
Substance Use Disorder Services a. Prior authorization shall not be required for the following services:
1) Inpatient Substance Use Disorder Services (Level IV), as defined in Appendix A, Exhibit 1;
2) Acute Treatment Services (ATS) for Substance Use Disorders (Level III.7), as defined in Appendix A, Exhibit 1;
3) Clinical Support Services (CSS), as defined in Appendix A, Exhibit 1, for Substance Use Disorders (Level III.5). The Contractor may implement utilization review procedures on the seventh day of a patient’s stay for CSS, but shall not make any utilization review decisions that impose any restriction or deny any future medically necessary CSS unless a patient has received at least 14 consecutive days of CSS;
4) The following Outpatient Services: Counseling (including Couples/Family Treatment, Group Treatment, and Individual Treatment) and Ambulatory Detoxification, as defined in Appendix A, Exhibit 1;
5) The following Non-24-Hour Diversionary Services: Structured Outpatient Addiction Program (SOAP), as defined in Appendix A, Exhibit 1;
6) Intensive Outpatient Program (IOP), as defined in Appendix A, Exhibit 1;
7) Partial Hospitalization as defined in Appendix A, Exhibit 1, with short-term day or evening mental health programming available seven days per week; and
8) The initiation or re-initiation of a buprenorphine/naloxone prescription of 32 mg/day or less, for either brand formulations (e.g. Suboxone™, Zubsolv™, Bunavail™) or generic formulations, provided, however, that the Contractor may have a preferred formulation. Contractor may establish review protocols for continuing prescriptions. Notwithstanding the foregoing, the Contractor may implement prior authorization for buprenorphine (Subutex™) and limit coverage to pregnant or lactating women and individuals allergic to naloxone, provided such limitations are clinically appropriate.
b. Providers providing Clinical Support Services for Substance Use Disorders (Level III.5) and Acute Treatment Services (ATS) for Substance Use Disorders (Level III.7) shall provide the Contractor, within 48 hours of an Enrollee’s admission, with notification of admission of an Enrollee and an initial treatment plan for such Enrollee. The Contractor may establish the manner and method of such notification but may not require the provider to submit any information other than the name of the Enrollee, information regarding the Enrollee’s coverage with the Contractor, and the provider’s initial treatment plan. Contractor may not use failure to prov...
Substance Use Disorder Services. In response to the opioid epidemic in West Virginia, the Department is seeking to enhance available substance use disorder (SUD) prevention and treatment services available to Medicaid members. Builiding on legislative and health systems activities, the goal is to create a seamless continuum of care to support members. The MCO is expected to support the following goals: • Improve quality of care and population health outcomes for Medicaid enrollees with SUD issues; • Increase enrollee access to, and utilization of, appropriate SUD treatment services based on American Society of Addiction Medicine (ASAM) criteria; • Decrease utilization of high-cost emergency department and hospital services by enrollees with a SUD; and • Improve care coordination and care transitions for Medicaid enrollees with SUD issues The MCO shall follow evidence-based clinical best practices and coverage policies relating to SUD services, such as use of methadone, as adopted by the Department upon approval by CMS.
Substance Use Disorder Services a. Detoxification - Inpatient
