Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-4 - Covered behavioral health services

Current through July 10, 2024
The following behavioral health services shall be covered
				behavioral health services within the GABHP:
(1) Acute psychiatric hospitalization: A
			 medically necessary, inpatient behavioral health service delivered in a private
			 freestanding psychiatric hospital, general hospital or state-operated facility
			 that meets and maintains all applicable licensing and certification
			 requirements of federal and state statutes or regulations pertaining to
			 treatment of a psychiatric disability or co-occurring disorder, where an
			 individual's admission is the result of a serious or dangerous condition that
			 requires rapid stabilization of psychiatric symptoms. Acute psychiatric
			 hospitalization is used when 24-hour medical and nursing supervision are
			 required to deliver intensive evaluation, medication titration, symptom
			 stabilization and intensive, brief treatment. Acute psychiatric hospitalization
			 may be delivered to individuals committed under a Physician's Emergency
			 Certificate (PEC), pursuant to section
			 17a-502
			 of the Connecticut General Statutes, and may occur on a locked psychiatric
			 unit;
(2) Ambulatory
			 detoxification: A medically necessary, non-residential behavioral health
			 service delivered in a private freestanding psychiatric hospital, general
			 hospital, state-operated facility or other facility that meets and maintains
			 all applicable licensing and certification requirements of federal and state
			 statutes or regulations pertaining to ambulatory chemical detoxification.
			 Ambulatory detoxification uses prescribed medication to alleviate physical or
			 psychological effects experienced by an individual as a result of withdrawal
			 from a specific psychoactive substance and shall be delivered only after an
			 evaluation has been conducted and a determination has been made that the
			 individual is medically able to tolerate an outpatient detoxification.
			 Ambulatory detoxification shall involve an assessment of needs, including those
			 related to recovery supports and motivation of the individual regarding his or
			 her continuing participation in the treatment process. Individuals shall
			 receive a minimum of one (1) hour per week of substance use disorders
			 services;
(3) Ambulatory
			 detoxification with on-site monitoring: A medically necessary, non-residential
			 behavioral health service delivered in a private freestanding psychiatric
			 hospital, general hospital, state-operated facility or other facility that
			 meets and maintains all applicable licensing and certification requirements of
			 federal and state statutes or regulations pertaining to ambulatory chemical
			 detoxification. Ambulatory detoxification with on-site monitoring shall deliver
			 psychiatric and other behavioral health services that address the individual's
			 problems as identified through a comprehensive biopsychosocial assessment.
			 Ambulatory detoxification with on-site monitoring uses prescribed medication to
			 alleviate physical or psychological effects experienced by an individual as a
			 result of withdrawal from a specific psychoactive substance and shall be
			 delivered only after an evaluation has been conducted and a determination has
			 been made that the individual is medically able to tolerate an outpatient
			 detoxification. Ambulatory detoxification with on-site monitoring shall involve
			 an assessment of individual needs, including those related to recovery supports
			 and motivation of the individual regarding his or her continuing participation
			 in the treatment process. Individuals shall receive a minimum of one (1) hour
			 of substance use disorders services per week;
(4) Chemical maintenance treatment: A
			 medically necessary, non-residential behavioral health service delivered in a
			 facility that meets and maintains all applicable licensing and certification
			 requirements of federal and state statutes or regulations pertaining to
			 chemical maintenance treatment. Chemical maintenance treatment involves
			 regularly scheduled administration of SAMHSA-approved medication, prescribed at
			 individual dosages and shall include a minimum of one (1) clinical contact per
			 month. More frequent clinical contacts shall be delivered if indicated in the
			 individual's recovery plan;
(5)
			 Initial intake evaluation: The first evaluation of an individual to determine
			 whether it is medically necessary for the individual to be admitted to a
			 covered behavioral health service;
(6) Intensive outpatient-mental health: A
			 medically necessary, non-residential behavioral health service delivered in a
			 private freestanding psychiatric hospital, general hospital, a state-operated
			 facility or other facility that meets and maintains all applicable licensing
			 and certification requirements of federal and state statutes or regulations
			 pertaining to psychiatric outpatient services for adults. Each individual shall
			 receive three (3) to four (4) hours per day, three (3) to five (5) days per
			 week (i.e., a minimum of nine (9) hours per week) of individualized treatment
			 that includes at least one (1) individual or group therapy session per day.
			 Treatment shall focus on reducing symptoms, improving functioning, maintaining
			 the individual in the community, preventing relapse and reducing the likelihood
			 that care may be required in a more restrictive setting;
(7) Intensive outpatient-substance use: A
			 medically necessary, non-residential behavioral health service delivered in a
			 private freestanding psychiatric hospital, general hospital, state-operated
			 facility or other facility that meets and maintains all applicable licensing
			 and certification requirements of federal and state statutes or regulations
			 pertaining to intensive outpatient-substance use services. Each individual
			 shall receive three (3) to four (4) hours per day, three (3) to five (5) days
			 per week (i.e., a minimum of nine (9) hours per week) of individualized
			 treatment that includes at least one (1) individual or group therapy session
			 per day. Treatment shall focus on relapse prevention and the individual's
			 ability to manage his or her recovery;
(8) Intensive residential treatment: A
			 medically necessary, residential behavioral health service delivered in a
			 private freestanding psychiatric hospital, general hospital, state-operated
			 facility or other facility that meets and maintains all applicable licensing
			 and certification requirements of federal and state statutes or regulations.
			 Intensive residential treatment shall be delivered in a 24-hour setting to
			 treat individuals with substance use disorders who require an intensive
			 rehabilitation program. Intensive residential treatment is delivered within a
			 fifteen (15) to thirty (30) day period and includes a minimum of thirty (30)
			 hours of substance use disorder services per week;
(9) Intermediate or long-term treatment or
			 care: A medically necessary, residential behavioral health service delivered in
			 a facility that meets and maintains all applicable licensing and certification
			 requirements of federal and state statutes or regulations pertaining to
			 intermediate or long-term treatment or care and rehabilitation. Each individual
			 shall receive substance use disorder services to address significant problems
			 with his or her behavior and functioning in major life areas due to a substance
			 use disorder and to reintegrate such individual into the community.
			 Intermediate or long-term treatment or care shall be delivered in a structured
			 recovery environment and shall comply with the following applicable
			 requirements:
(A) If the facility is licensed
			 for and delivers intermediate or long-term residential treatment, a minimum of
			 twenty (20) hours per week of substance use disorder services shall be
			 delivered to each individual;
(B)
			 If the facility is licensed for care and rehabilitation and delivers long-term
			 care, a minimum of twenty (20) hours of substance use disorder services shall
			 be delivered to each individual per week; and
(C) If the facility is licensed for
			 intermediate or long-term residential treatment and delivers transitional or
			 halfway-house services, a minimum of four (4) hours per week of substance use
			 disorder services shall be delivered to each individual;