substance abuse intensive outpatient – sa iop

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www.dmas.virginia.gov 1

Department of Medical Assistance Services

Substance Abuse Intensive Outpatient – SA IOP

2013

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DisclaimerThese slides contain only highlights of the Virginia Medicaid Community Mental Health Rehabilitative Services Manual (CHMRS) and are not meant to substitute for the comprehensive information available in the manual or state and federal regulations.

*Please refer to the manual, available on the DMAS website portal, for in-depth information on Community Mental Health Rehabilitative Services criteria. Providers are responsible for adhering to related state and federal regulations.

www.vita.virginia.govwww.dmas.virginia.gov 2


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Substance Abuse Intensive Outpatient

Objectives of this Training Are:

• To define the criteria of Substance Abuse Intensive Outpatient (SA IOP)

• To identify staff qualifications;• To clarify eligibility criteria;• To identify required activities;• To review limitations of the service; • To outline service units and reimbursement; and• To review service authorization requirements.



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SA IOPService Definition

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SA Intensive Outpatient is provided to individuals who do not require the intensive level of care of inpatient, residential, or day treatment services, but do require more intensive services than outpatient services.

SA Intensive Outpatient is provided in a concentrated manner, and generally involve multiple outpatient visits per week over a period of time for individuals requiring stabilization

These services include monitoring and multiple group therapy sessions during the week, and individual and family therapy which are focused on the Medicaid eligible individual.



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SA IOPLicensing

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SA Intensive Outpatient providers must have a Department of Behavioral Health and Developmental Services (DBHDS) license to provide Outpatient Substance Abuse Services.



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SA IOPStaff Qualifications

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SA Intensive Outpatient may be provided by the following: Qualified Substance Abuse Professional* (QSAP) Paraprofessional (peer support specialist)

Qualification requirements may be found in Chapter II of the Community Mental Health Rehabilitative Services (CMHRS) Manual

* Please see Chapter II of the CMHRS manual for supervision requirements for certain QSAPs.



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Individual and group counseling, family therapy, and occupational and recreational therapy must be provided by at least a QSAP.

A QSAP or a paraprofessional, under the supervision of a QSAP, may provide education about the effects of alcohol and other drugs on the physical, emotional, and social functioning of the individual; relapse prevention; and occupational and recreational activities.

A QSAP must be onsite when a paraprofessional is providing services.



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SA IOPEligibility Criteria

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In order for individuals to receive Medicaid-reimbursed SA IOP Services, individuals must demonstrate a clinical necessity for the service by meeting the Diagnostic Statistical Manual diagnostic criteria for an Axis I Substance Use Disorder, with the exception of nicotine or caffeine abuse or dependence.

A diagnosis of nicotine or caffeine abuse or dependence, which includes Tobacco Use, shall not be sufficient for approval for these services.

American Society of Addiction Medicine (ASAM) criteria will be used to determine the appropriate level of treatment.



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If an individual has co-occurring mental health and substance use disorder, integrated treatment for both disorders is allowed within Substance Abuse Intensive Outpatient Treatment.



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SA IOPRequired Activities

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SA IOP shall provide major substance abuse treatment and psychiatric, psychological and psycho-educational modalities to include:

Individual, group, and family therapy; Education about the effects of alcohol and other drugs on the

physical, emotional, and social functioning of the individual; Relapse prevention; Occupational and recreational therapy; Or other therapies



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Psycho-education refers to education on mental health and substance abuse topics to improve the individual’s behavioral, mental or emotional condition and may include communication, problem solving, anger management, and interpersonal communication skills.

A QSAP must perform a face-to-face evaluation/diagnostic service-specific provider assessment and authorize the services prior to initiation of services.

An Individual Service Plan (ISP) must be completed by a QSAP within 30 days of the initiation of services and cosigned by the individual receiving services.



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Services must be provided in accordance with the ISP. The service provider must notify or document the attempts

to notify the primary care provider of the individual’s receipt of community mental health rehabilitative services.

Progress notes for SA IOP Treatment Services must be completed when services are delivered.

Documentation must include the date of the service, the service or activity provided, the units provided, the provider rendering the service, and a dated staff signature with credentials.



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A QSAP must perform a face-to-face evaluation and re-authorize services that are provided longer than 90 continuous days.

If case management is being provided there must be coordination with the case management agency.

The program must operate a minimum of two continuous hours in a 24-hour period.



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SA IOPLimitations and Supervision

Requirements

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A QSAP must be onsite when a paraprofessional is providing services.

The QSAP must supervise the paraprofessional at least twice a month.

Supervision shall include documented face-to-face meetings between the supervisor and the paraprofessional providing the services. Supervision may occur individually or in a group.

Documentation of supervision shall be in the individual’s clinical record and signed by the QSAP.



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A QSAP that has a bachelor’s degree and is certified as

A Substance Abuse Counselor by the Board of Counseling; or An Addictions Counselor by the Substance Abuse Certification

Alliance of Virginia; or A Level II Addiction counselor by the National Association of

Alcoholism and Drug Abuse Counselors or from the International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse, Inc

must also be supervised by a QSAP listed in Chapter II of the CMHRS manual under provider qualifications for Medicaid reimbursed Substance Abuse Day Treatment 1(a)-1(e).



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Paraprofessional who do not meet the experience requirements listed in Chapter II of the CMHRS manual may provide services for Medicaid reimbursement if they are working directly with a qualified paraprofessional on-site and supervised by a QSAP.

Monthly supervision of a paraprofessional who does not meet the requirements in Ch. II must be documented and include: On site observation of services; Face-to-face consultation with the paraprofessional; A review of progress notes; Review of the individual’s progress towards achieving ISP goals

and objectives; and Recommendations for ISP change based on the individual’s

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No more than 19 hours per week of service may be provided.

Individuals shall be discharged from this service when less intensive services may achieve stabilization.

Staff travel time is excluded.

SA IOP may not be provided at the same time as SA Day Treatment Services or Opioid Treatment.



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SA IOPUnits and Reimbursement

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There is a maximum of 600 hours allowed per fiscal year. A claim edit is in place that will cut back payment or deny claims for services beyond the maximum number of units allowed.

One unit = 15 minutes

Reimbursement is based on the level of professional providing the service.

A fiscal year is July 1 to June 30. All units will reset to zero on July 1 of each year.



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SA IOPService Authorization

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Service authorization is not currently required.



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Helpful Resources:

• 12VAC30-50-228 & 12VAC30-60-180 – Community substance abuse treatment services

• Virginia Medicaid Web Portal link www.virginiamedicaid.dmas.virginia.gov

• DMAS Office of Behavioral Health:– Email Address [email protected]

• DMAS Helpline: 804-786-6273 Richmond Area1-800-552-8627 All other



http://www.virginiamedicaid.dmas.virginia.gov/

mailto:[email protected]

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Thank you for attending this training and helping to serve Virginia’s Medicaid Recipients.



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