CLINICAL STABILIZATION SERVICES FOR SUBSTANCE ABUSE LEVEL III.5 Providers contracted for this level of care or service will be expected to comply with all requirements of these service-specific performance specifications. Additionally, providers of this service and all contracted services will be held accountable to the General performance specifications, located at the beginning of this section of the Provider Manual. Clinical Stabilization Services for Substance Abuse (CSS), Level III.5 shall mean 24-hour treatment, usually following Acute Treatment Services (ATS) for Substance Abuse. This service includes intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others, and aftercare planning for individuals beginning to engage in recovery from addiction. These programs provide multidisciplinary treatment interventions and emphasize individual, group, family, and other forms of therapy. Linkage to aftercare, relapse prevention services, and self-help groups, such as AA and NA, are integrated into treatment and discharge planning. Unless contraindicated, the family, guardian, and/or natural supports are actively involved in the treatment as required by the treatment plan, or there are active efforts being made, and documented, to involve them. This service is not intended as a step-down service from a psychiatric hospitalization level of care or psychiatric stabilization service. It is intended for Members with a primary substance use disorder. Components of Service 1. The program admits Members seven days per week, 24 hours per day, 365 days per year. 2. The program agrees, subject to bed availability and age appropriateness, to admit persons who require 24-hour, substance use, short-term residential treatment who have met the MBHP medical necessity criteria as defined for CSS III.5, and who are referred to the program by one or more of the following programs or providers, an Emergency Services Program (ESP); Acute Treatment Services (ATS) for Substance Abuse; Level IV medically managed detoxification; Enhanced ATS (E-ATS); 84
outpatient treaters; community agencies; or Members who self-refer. 3. Full therapeutic programming is supplied with sufficient professional staff to manage a therapeutic milieu of services seven days a week, including holidays. The following are required programmatic elements: Psychosocial evaluation, monitoring, and treatment Psychiatric consultation Psychopharmacological consultation Medical evaluation Individual, group, and family counseling Behavioral/health/medication education and planning Psycho-educational groups Relapse prevention High-risk/HIV education On-site, peer-led self-help groups Case management Discharge planning Aftercare planning and coordination with primary care providers The program admits, and has the capacity to treat, Members who are currently receiving opioid replacement treatments, such as methadone or suboxone. The program has active affiliation agreements with such programs. Such agreements, at a minimum, should include the referral and intake process as well as the discharge process including, care coordination and the transition into planned aftercare. 4. The program admits pregnant Members and has appropriate policies and procedures and collaborative agreements for coordinating prenatal care with ob/gyn providers, in order to ensure the health and safety of the Member. 5. Members admitted as a transfer, after having received at least one full day at a higher level of care including Level IV Detox, E-ATS, or ATS will be assumed to have had a physical assessment at the higher level and will be provided a thorough evaluation by a qualified healthcare professional within 24 hours of admission. Members being admitted directly from the community will be given an admission appointment at a time when a qualified health professional is present and a through 85
Staffing Requirements medical evaluation should be provided within 30 minutes to assess medical needs. 6. The program provides at least three hours of individual counseling per week utilizing motivational interviewing, cognitive behavioral therapy, or other evidence-based practice to support the Member s engagement in treatment. Individual counseling will be used to address the current impact of Member concerns about trauma, parenting, custody issues, sexual assault, legal/criminal justice issues, and co-occurring disorders. 7. The program provides at least three 30-minute per week, face-to-face individual care coordination/case management reviews of the current treatment, care coordination, and aftercare plan with each Member. 8. The program provides at least one therapeutic group per day that totals at least 10 hours of therapeutic group per week. 9. The program provides specialized therapeutic group to address genderspecific treatment issues, poly-substance use, co-occurring disorders, trauma, medications, life skills, housing, and other relevant topics. 10. The program also provides at least four psycho-educational groups per day that totals at least 28 hours of psycho-educational group per week. Psycho-educational groups will contain distinct modules that address substance use education, relapse prevention, self-help programs, HIV and other STIs awareness, viral hepatitis counseling and testing, treatment planning, medication management/protocols, co-occurring disorders, and life-skills issues. 11. The program provides at least one self-help, 12-step group, per day, on the premises. 12. The program has policies and procedures in place to allow for the safe, appropriate, and self-administration of medication(s) by Members. 13. A patient handbook is available for Members which describes, at minimum, the program requirements/expectations, daily treatment schedule, treatment philosophy, components of treatment, staff resources available, Member rights, grievance procedures, termination criteria, and self-help information. 1. The program meets the staffing requirements for DPH/BSAS licensure for ASAM Service Level 3.5. 2. The program utilizes a multidisciplinary staff including nursing staff, credentialed counseling staff, physician coverage, psychiatric consultation, care coordination staff, and recovery specialist staff with training and expertise in established treating protocols for individuals with substance use disorders. 86
Program Director- 1FTE: who oversees the program, staff, and operations Clinical Director -1FTE: senior clinician with master s degree and licensure who has a minimum of three years experience providing clinical supervision to an interdisciplinary team in a similar substance use treatment environment Nursing: at least four hours per day/seven days per week of RN, nurse practitioner, or physician assistant level staff. LPNs may be used in combination with an RN, to supplement nursing/client coverage, if requested, reviewed and approved for programs serving a larger than average number of clients. Counseling: 1:8 counselor-to-member ratio, or better, seven days per week for 12 hours per day (excludes overnight). Counselors will have a CAC, CADAC, LADC I, or LADC II credential or the equivalent as defined by BSAS, OR shall provide evidence of receiving a waiver from DPH Bureau of Substance Abuse Services to perform at this level. The waiver process is described in the DPH/BSAS Licensing Regulation 164.023. Recovery Specialist: 1:15 specialist-to-member ratio, or better, at all times (24/7). Recovery specialists will have a LADC II or LADC III credential or the equivalent as defined by BSAS OR shall provide evidence of receiving a waiver from DPH Bureau of Substance Abuse Services to perform at this level. The waiver process is described in the DPH/BSAS Licensing Regulation 164.023. Care Coordinator: 1:15 coordinator-to-member ratio, or better, Monday-Friday, at least eight hours per day. Care coordinators will have an associate s or bachelor s degree along with knowledge of the addiction treatment continuum and related community resources OR shall provide evidence of receiving a waiver from DPH Bureau of Substance Abuse Services to perform at this level. The waiver process is described in the DPH/BSAS Licensing Regulation 164.023. Physician Coverage: The program will have policies and procedures that require contacting the Member s PCC in the event of non-emergency illness and for calling emergency services when deemed appropriate for primary care coordination. 3. Psychiatric and pharmacological consultation and direct services are provided as needed by a psychiatrist or a Psychiatric Nurse Mental Health Clinical Specialist who is appropriately credentialed and licensed in Massachusetts. These services will be billed and reimbursed as additional outpatient services and are not contained within the per diem definition nor the rate established for the CSS 87
services. 4. The program ensures the Member has access to therapeutic staff support, in-house and on the premises, 24 hours a day, seven days a week. 5. The program ensures that all staff are provided with regularly scheduled supervision appropriate to their licensure levels and MBHP credentialing criteria, including the supervision of all clinical work by a senior-level, licensed clinician. All members of the interdisciplinary treatment team must receive at least one hour per week of individual supervision from a qualified, credentialed, and experienced supervisor. Team members will have training in evidence-based practices and will be provided with opportunities to engage in continuing education to refine their skills and knowledge in emerging treatment protocols. Service, Community, and Collateral Linkages 1. The program maintains formal, active affiliation agreements for service linkages and care coordination with all of the following levels of care, and must be able and willing to accept referrals from and refer to these levels of care when clinically indicated: Level IV medically managed detoxification Acute Treatment Services (ATS) for Substance Abuse Enhanced Acute Treatment Services (E-ATS) for Substance Abuse Structured Outpatient Addictions Programs (SOAP) Substance use halfway house and long-term residential programs Opioid replacement services Transitional housing TSS Such agreements, at a minimum, include the agreed upon policies and procedures for a referral, transition to care, aftercare, and discharge process. 2. The program provides or arranges for transportation as needed by the client to attend aftercare interviews and transitional appointments, residential placements, community-based self-help meetings, medical and psychiatric visits. 3. With Member consent, the program refers all pregnant, substance-using women to MBHP s care management program for Pregnancy- Enhanced Services and documents such referral in the Member s record. 88
Quality Management 1. The facility will submit to DPH/BSAS the data DPH requires for entry and tracking in ESM DPH s Substance Abuse Management Information System. 2. The program will administer pre- and post-clinical measurement/assessment. Process Specifications Treatment Planning and Documentation Discharge Planning and Documentation 1. The program admits Members seven days per week, 24 hours per day, 365 days per year. 2. The program makes and documents a decision, in most cases, within 15-30 minutes of a request for admission to the program following a face-to-face evaluation by an identified MBHP-contracted provider who has determined medical and clinical appropriateness for this level of care. 3. The program determines and documents at the time of admission the medical and psychiatric appropriateness of all self-referred Members, based on MBHP medical necessity criteria for Level III.5 service. 4. The administration of an assessment tool, such as the CIWA, CAGE, DAST, etc., is done at the time of admission. Results are documented in the Member s record. 5. An individualized treatment and discharge plan is completed and documented with the client within 48 hours by nursing or counseling staff that includes goals, measurable objectives, and activities to meet those objectives. 6. With consent, a pregnancy test is administered and documented to all women of child-bearing age prior to the administration of any medication(s). 7. The program makes arrangements to obtain and document appropriate toxic screens, urinalysis, and laboratory work documented in the Member s treatment plan as medically necessary. 8. The program continually monitors, and documents in the medical record, any changes in the Member s mental status throughout the Member s treatment episode. 1. The program conducts and documents a discharge interview with every Member. 89
2. At least one initial aftercare appointment for outpatient services is scheduled to occur no more than seven business days from the Member s discharge from the facility, and this appointment is understood by the Member and clearly documented in the Member s record and discharge plan. 3. For those Members discharged on medications, at least one initial psychiatric medication monitoring appointment is scheduled to occur no more than 14 calendar days from the Member s discharge from the facility, and this appointment is understood by the Member and clearly documented in the Member s record and discharge plan. 4. The program makes all reasonable efforts to discharge the Member to living situations other than emergency shelters. The efforts are intended to decrease immediate risk of relapse. However, any such dispositions to shelters must be clearly documented in the Member s record. 5. The program will complete and forward to DMH a DMH-eligibility packet for homeless Members who appear to meet DMH-eligibility criteria and who have not already been assessed for eligibility for DMH Continuing Care Service. The application process must be clearly documented in the Member s record. 90