Deprtment of Public Helth, Substnce Abuse Prevention nd Control (SAPC) ASAM 1.0-AR H0049 Screening $00.00 15-Minute Increment COMBINED SERVICES: Outptient for At-Risk Youth nd Young Adults 12-20 Only H0001 Intke/Assessment $29.63 15-Minute Increment $29.63 15-Minute Increment $29.63 $1.98 minute (min 60, mx 90) 1 $29.63 $1.98 minute (min 60, mx 90) 1 $29.63 15-Minute Increment H0006 Cse Mngement $33.83 15-Minute Increment Age 12-20: Intke Services No more thn 8 units or 2 hours per 60-dys 2,3 COMBINED SERVICES: Age 12-20: Direct Services No more thn 16 units or 4 hours per 60-dys 2,3 including Intke Services ASAM 1.0 H0049 Screening $00.00 Screen Outptient $29.63 15-Minute Increment $29.63 15-Minute Increment $29.63 $1.98 minute (min 60, mx 90) 1 $29.63 $1.98 minute (min 60, mx 90) 1 $29.63 15-Minute Increment $29.63 15-Minute Increment $29.63 15-Minute Increment $29.63 15-Minute Increment H2010 Mediction Services $29.63 15-Minute Increment $29.63 15-Minute Increment $00.00 UA Test 1 Unit COMBINED SERVICES: Minimum 2 hours per month nd no less or more thn 0-24 units per week or 0-6 hours per week 2,3 Age 18 nd Over: Minimum 2 hours per month nd no less or more thn 0-36 units per week or 0-9 hours per week 2,3
Deprtment of Public Helth, Substnce Abuse Prevention nd Control (SAPC) ASAM 2.1 H0049 Screening $00.00 Screen $32.01 15-Minute Increment COMBINED SERVICES: $32.01 15-Minute Increment $32.01 $2.13 minute (min 60, mx 90) 1 $32.01 $2.13 minute (min 60, mx 90) 1 $32.01 15-Minute Increment $32.01 15-Minute Increment $32.01 15-Minute Increment $32.01 15-Minute Increment H2010 Mediction Services $32.01 15-Minute Increment $32.01 15-Minute Increment $00.00 Test 1 Unit Intensive Outptient No less or more thn* 24-76 units per week or 6-19 hours per week 2,3 Age 18 nd Over: No less or more thn* 36-76 units per week or 9-19 hours per week 2,3 *If the minimum hours of service re not met, reimbursement will be reduced to the ASAM 1.0 fee/rte. If minimum service units re not met for 4 or more weeks the ptient needs to step down to lower LOC nd further reimbursement will be disllowed. ASAM 3.1 H0049 Screening H2010 Sfegurding Medictions T2001 Non-Emergency Trnsport Low Intensity Residentil $109.28 Dy Rte * If less thn 10 hours or 40 units of service re provided per week, for more thn 2 (ge 12-20) or 3 (ge 21+) weeks the ptient needs to step down to lower LOC nd further reimbursement will be disllowed. When services provided re less thn the minimum, it must be cliniclly necessry (e.g., hospitlized, on pss) nd documented in the progress notes. Alerts will be sent vi Sge if service unit minimums re not met. Pre-Authoriztion by County Required 4 COMBINED SERVICES*: 80+ units per week or 20+ hours per week 2,3 Mximum 2 noncontiguous 30-dy stys with one 30-dy extension per yer for ny ASAM residentil LOC unless mediclly necessry/perintl. 5 Age 18-20: 80+ units per week or 20+ hours per week 2,3 Mximum 2 noncontiguous 90-dy stys with one 30-dy extension per yer for ny ASAM residentil LOC unless mediclly necessry/perintl. 5 Age 21 nd over: 80+ units per week or 20+ hours per week 2,3 Mximum 2 noncontiguous 90-dy stys with one 30-dy extension per yer for ny ASAM residentil LOC. Perintl clients 60-dys post-prtum under DMC; criminl justice trnsition to other pyers if mediclly necessry nd llowble for dys 91-180. 5 S9976 Room nd Bord $46.96 Dy Rte Sme s Above
Deprtment of Public Helth, Substnce Abuse Prevention nd Control (SAPC) ASAM 3.3 H0049 Screening H2010 Sfegurding Medictions T2001 Non-Emergency Trnsport High Intensity Residentil Popultion Specific $140.89 Dy Rte * If less thn 12 hours or 48 units of service re provided per week, for more 3 (ge 18+) weeks the ptient needs to step down to lower LOC nd further reimbursement will be disllowed. When services provided re less thn the minimum, it must be cliniclly necessry (e.g., hospitlized, on pss) nd documented in the progress notes. Alerts will be sent vi Sge if service unit minimums re not met. Pre-Authoriztion by County Required 4 COMBINED SERVICES*: Age 18-20: 96+ units per week or 24+ hours per week 2,3 Mximum 2 noncontiguous 90-dy stys with one 30-dy extension per yer for ny ASAM residentil LOC unless mediclly necessry/perintl. 5 Age 21 nd over: 96+ units per week or 24+ hours per week 2,3 Mximum 2 noncontiguous 90-dy stys with one 30-dy extension per yer for ny ASAM residentil LOC. Young dults 18-20 cn hve longer lengths of sty if mediclly necessry. Perintl clients cn remin 60-dys post-prtum under DMC; criminl justice trnsition to other pyers if mediclly necessry nd llowble for dys 91-180. 5 S9976 Room nd Bord $46.96 Dy Rte Sme s Above ASAM 3.5 H0049 Screening H2010 Sfegurding Medictions T2001 Non-Emergency Trnsport High Intensity Residentil Non-Popultion Specific $125.23 Dy Rte * If less thn 11 hours or 44 units of service re provided per week, for more thn 2 (ge 12-20) or 3 (ge 21+) weeks the ptient needs to step down to lower LOC nd further reimbursement will be disllowed. When services provided re less thn the minimum, it must be cliniclly necessry (e.g., hospitlized, on pss) nd documented in the progress notes. Alerts will be sent vi Sge if service unit minimums re not met. Pre-Authoriztion by County Required 4 COMBINED SERVICES*: 88+ units per week or 22+ hours per week 2,3 Mximum 2 noncontiguous 30-dy stys with one 30-dy extension per yer for ny ASAM residentil LOC unless mediclly necessry/perintl. 5 Age 18-20: 88+ units per week or 22+ hours per week 2,3 Mximum 2 noncontiguous 90-dy stys with one 30-dy extension per yer for ny ASAM residentil LOC unless mediclly necessry/perintl. 5 Age 21 nd over: 88+ units per week or 22+ hours per week 2,3 Mximum 2 noncontiguous 90-dy stys with one 30-dy extension per yer t for ny ASAM residentil LOC. Perintl clients cn remin 60-dys post-prtum under DMC; criminl justice trnsition to other pyers if mediclly necessry nd llowble for dys 91-180. 5 S9976 Room nd Bord $46.96 Dy Rte Sme s Above
Deprtment of Public Helth, Substnce Abuse Prevention nd Control (SAPC) ASAM 3.7 H0049 Screening H2010 Sfegurding Medictions T2001 Non-Emergency Trnsport Intensive Inptient Services Mediclly Monitored $324.15 Dy Rte One yer pilot project. Mximum five beds t BHS nd five beds t TTC t ny given time for combined ASAM 3.7, 3.7-WM, 4.0, 4.0- WM. 2,3 Mximum 14-dys of service per episode. 2,3 S9976 Room nd Bord $95.34 Dy Rte Sme s Above ASAM 4.0 H0049 Screening H2010 Sfegurding Medictions T2001 Non-Emergency Trnsport Intensive Inptient Services Mediclly Mnged $324.15 Dy Rte One yer pilot project. Mximum five beds t BHS nd five beds t TTC t ny given time for combined ASAM 3.7, 3.7-WM, 4.0, 4.0- WM. 2,3 Mximum 14-dys of service per episode. 2,3 S9976 Room nd Bord $95.34 Dy Rte Sme s Above
Deprtment of Public Helth, Substnce Abuse Prevention nd Control (SAPC) ASAM 1-WM H0014-1 Ambultory Detox H0049 Screening $210.46 Dy Rte Mximum 14-dys of service per episode. 2,3 H2010 Mediction Services Ambultory Withdrwl Mngement Without Extended On-Site Monitoring ASAM 3.2-WM H0012 Subcute Detox Residentil H0049 Screening H2010 Mediction Services Residentil Withdrwl Mngement Cliniclly Mnged $286.13 Dy Rte Mximum 14-dy sty per episode. 2,3 S9976 Room nd Bord $95.34 Dy Rte Sme s Above
Deprtment of Public Helth, Substnce Abuse Prevention nd Control (SAPC) ASAM 3.7-WM H0010 Subcute Detox Residentil H0049 Screening H2010 Mediction Services Inptient Withdrwl Mngement Mediclly Monitored $324.15 Dy Rte One yer pilot project. Mximum five beds t BHS nd five beds t TTC t ny given time for combined ASAM 3.7, 3.7-WM, 4.0, 4.0-WM. 2,3 Mximum 14-dy sty per episode. 2,3 S9976 Room nd Bord $95.34 Dy Rte Sme s Above ASAM 4.0-WM H0011 Acute Detox Residentil H0049 Screening H2010 Mediction Services Inptient Withdrwl Mngement Mediclly Mnged $324.15 Dy Rte One yer pilot project. Mximum five beds t BHS nd five beds t TTC t ny given time for combined ASAM 3.7, 3.7-WM, 4.0, 4.0-WM. 2,3 Mximum 14-dy sty per episode. 2,3 S9976 Room nd Bord $95.34 Dy Rte Sme s Above
Deprtment of Public Helth, Substnce Abuse Prevention nd Control (SAPC) ASAM 1-OTP Opioid Tretment Progrms If two rtes the higher rte is for perintl Authoriztion by County Required for Minors H0049 H0001 T1007 H0005 T1012 H0004 H2011 Screening Assessment/Intke Tretment Pln Group Counseling Ptient Eduction Individul Counseling Crisis Intervention 90846 Medicl Psychotherpy T1006 H2010 Collterl Services Mediction Services $00.00 $00.00 $3.43 $4.28 $3.43 $4.28 $00.00 per Test G9228 Syphilis Test $00.00 per Test G9359 Tuberculosis (TB) Test $00.00 per Test D0001 H0020 Dischrge Services Methdone $13.11 $14.11 COMBINED SERVICES: County uthoriztion, nd for methdone: prentl consent nd 2 unsuccessful detoxifiction ttempts or drug free tretment episodes within 12 month period. Age 18 nd over: No less thn 5 units or 50-minutes, nd no more thn 20 units or 200 minutes unless mediclly necessry, per month 2,3 Alerts will be sent vi Sge if service units minimums re not met. per Dy - S5000 Nltrexone - Generic $19.06 per Fce to Fce Visit - S5000 S5000 Buprenorphine - Generic Disulfirm - Generic $26.06 $28.50 $10.47 $10.84 per Dy - Per Dy - S5000 Nloxone $150.00 per 2 Units -
Deprtment of Public Helth, Substnce Abuse Prevention nd Control (SAPC) RBH Recovery Bridge Housing POST-DISCHARGE H2034 Recovery Bridge Housing $35.00 $38.00 perintl Dy Rte Pre-Authoriztion by County Required 0 dy - Not llowble for this ge popultion Age 18 nd over 90 dys per clendr yer noncontiguous ok 2,6 RSS $29.63 15-Minute Increment COMBINED SERVICES*: Recovery Support Services $29.63 $1.98 minute (min 60, mx 90) 1 H0038-R Recovery Monitoring $20.89 15-Minute Increment H0038-S Substnce Abuse Assistnce $20.89 15-Minute Increment H0006 Cse Mngement $33.83 15-Minute Increment 1-24 units per month 2,3 Age 18 nd Over: 1-28 Units per month 2,3 1 GROUP COUNSELING CALCULATION: Formul: Stndrd: Exmples: (# minutes in the group divided by # of prticipnts in the group) times (LOC group rte divided by 15 to get per minute rte) = mount climed per person Minimum group durtion is 60 minutes nd mximum 90 minutes. Minimum 2 persons nd mximum 12 persons per group. (60 minute group 10 prticipnts) x ($1.98 ASAM 1.0) = $11.88 per person or $118.80 per group (ech person climed seprtely) (60 minute group 5 prticipnts) x ($1.98 ASAM 1.0) = $23.76 per person or $118.80 per group (ech person climed seprtely) (90 minute group 12 prticipnts) x ($1.98 ASAM 1.0) = $14.85 per person or $178.20 per group (ech person climed seprtely) (90 minute group 6 prticipnts) x ($1.98 ASAM 1.0) = $29.70 per person or $178.20 per group (ech person climed seprtely) Documenttion time is llowble for group sessions but cnnot exceed the following stndrds nd must represent ctul time documenting notes tilored to ech prticipnt: () 2-4 prticipnts one 15-minute unit; (b) 5-8 prticipnts up to two 15-minute units; nd (c) 9-12 prticipnts up to three 15-minute units. The number of minutes would be dded to the totl time submitted for the group session but it must be cler wht mount of time reltes to the time spent conducting the group versus the time spent documenting individulized group session notes. ([90 minute group + 15 minutes documenttion] 4 prticipnts) x ($1.98 ASAM 1.0) = $51.98 per person or $207.90 per group (ech person climed seprtely) ([90 minute group + 30 minutes documenttion] 8 prticipnts) x ($1.98 ASAM 1.0) = $29.70 per person or $237.60 per group (ech person climed seprtely) ([90 minute group + 45 minutes documenttion] 12 prticipnts) x ($1.98 ASAM 1.0) = $22.28 per person or $267.30 per group (ech person climed seprtely) 2 If services re not provided for 30 dys n lert will be sent vi Sge to notify the contrctor to dischrge the individul. If fter 45 dys no services hve been provided, n dministrtive dischrge will be utomticlly be completed nd the County monitors will discuss the deficiency t the next site visit. 3 An individul cnnot be concurrently enrolled in two or more levels of cre (except OTP, RBH) or be enrolled by more thn one contrctor t time (except OTP, RBH). 4 If relpse risk is deemed to be significnt without immedite plcement in residentil cre, residentil tretment provider my dmit n individul prior to receiving residentil preuthoriztion, with the understnding tht preuthoriztion denils will result in finncil loss, wheres preuthoriztion pprovls will be retroctively reimbursed to the dte of dmission. For exmple, residentil tretment provider my choose to ccept the finncil risk of dmitting residentil cses during the weekend, with the understnding tht SAPC will render n uthoriztion decision on the first business dy nd within 24 hours of receiving the request. 5 The first residentil tretment (ASAM 3.1, 3.3, 3.5) dmission for dults 21 yers of ge nd older will lwys be pid by Drug Medi-Cl for eligible beneficiries even if less thn seven (7) clendr dys. For subsequent residentil stys where the ptient dischrges (whether voluntrily or involuntrily) within seven (7) clendr dys, the sty will be reimbursed with non-dmc funds. This will help preserve the two llowble DMC reimbursble residentil dmissions per yer. There will be no cp on the number of grce period used for residentil stys less thn seven (7) clendr dys. Residentil stys greter thn seven (7) clendr dys will be reimbursed with DMC up to the service limit. 6 Recovery Bridge Housing prticipnts must be concurrently enrolled in outptient (ASAM 1.0), intensive outptient (ASAM 2.1), opioid tretment progrms (ASAM 1-OTP) or mbultory withdrwl mngement (ASAM 1-WM) services.