Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 346.00 - Rates for Certain Substance-related and Addictive Disorders Programs › Section 346.02 - Definitions

Current through Register 1525, July 5, 2024
As used in 101 CMR 346.00, unless the context requires
				otherwise, terms have the meanings in
				101
				CMR 346.02.
Acute Treatment Provider (ATP)
. An
				eligible provider of acute treatment services.
Acute Treatment Services (Inpatient)
.
				Those medically managed and/or monitored acute intervention and stabilization
				services that provide supervised detoxification to individuals in acute
				withdrawal from alcohol or other drugs and address the biopsychosocial problems
				associated with alcoholism and other drug addictions requiring a 24-hour
				supervised inpatient stay.
Approved Program Rate
. The rate per
				service unit approved by EOHHS and filed with the Secretary of the
				Commonwealth.
Case Consultation
. A meeting with a
				professional of another agency to resolve treatment issues or to exchange other
				relevant client information. Case consultation may be billed only for
				face-to-face meetings that are necessary as a result of the inability or
				inappropriateness of other forms of communication, such as telephone and
				letter. Such circumstances and services must be documented in the client's
				record and be available as part of any record audit that the purchasing agency
				may perform.
Case Management
. Services, as
				specified by the MassHealth program, that coordinate the substance-related and
				addictive disorders treatment of pregnant women with other medical and
				community services that are critical to the needs of the woman and her
				pregnancy. Case management is billable only for women enrolled in the Day
				Treatment Program. Service is limited to one hour per week per enrollee,
				provided in no less than 15-minute increments.
Child Enhancement for Residential Rehabilitation
				Services
. A supplemental rate to reflect the costs of young
				children who may be accompanying their parents in the program.
Client
. An individual that receives
				substance-related and addictive disorders services purchased by a governmental
				unit.
Client Resources
. Revenue received in
				cash or in kind from publicly assisted clients to defray all or a portion of
				the cost of program services. Client resources may include payments made by
				publicly assisted clients to defray the room and board expense of residential
				services, clients' food stamps, or payments made by clients according to their
				ability to pay or a sliding fee scale.
Clinical Case Management Master's
				Level
. Individualized case management provided as part of a
				clinical outpatient service that facilitates ongoing engagement in
				community-based treatment and recovery services; links to community resources
				such as housing, employment, education, and health care; and facilitates access
				to mainstream benefits and includes evidence-based models that integrate
				clinical treatment and case management services.
Clinical Case Management Non-master's
				Level
. Individualized case management provided as part of a
				clinical outpatient service that facilitates ongoing engagement in
				community-based treatment and recovery services; links to community resources
				such as housing, employment, education, and health care; and facilitates access
				to mainstream benefits.
Clinically Managed Detoxification
				Services
. Medical assessment, intensive counseling, and case
				management services to clients who are not intoxicated or have been safely
				withdrawn from alcohol or other drugs or are addicted to a drug that does not
				require medical withdrawal. These clients require a 24-hour supervised
				inpatient stay to address the acute emotional, behavioral, or biomedical
				distress resulting from an individual's use of alcohol or other drugs. This
				level of service includes four hours of nursing services seven days a week.
				These services are governed by the Massachusetts Department of Public Health at
				105
				CMR 164.133(A)(1)(c):
Clinically Managed Detoxification
.
Cost Report
. The document used to
				report costs and other financial and statistical data. The Uniform Financial
				Statements and Independent Auditor's Report (UFR) is used when required.
Couple Counseling
. Therapeutic
				counseling provided to a couple whose primary complaint or concern is
				disruption of their relationship or family due to substance-related and
				addictive disorders.
Day Treatment
. A highly structured day
				treatment program for substance-related and addictive disorders that meets the
				service criteria set forth by the Massachusetts Department of Public Health
				pursuant to
				105
				CMR 164.231,
				105
				CMR 164.232(A) through (C),
				and MassHealth. A Day Treatment Program operates at least 3 1/2 hours per day,
				five days per week.
Driver Alcohol Education
. The program
				of services, provided through licensed outpatient substance-related and
				addictive disorders counseling programs, legislated by M.G.L. c. 90, § 24D
				to first offender drunk drivers adjudicated in Massachusetts courts.
Educational/Motivational Session
. A
				meeting between staff of a Driver Alcohol Education Program and not more than
				15 clients. Clients are required to participate in 32 hours of this interactive
				group programming through 16 two-hour groups.
Enhanced Acute Treatment Services
. A
				program that is medically managed and/or monitored acute intervention and
				stabilization services, provides supervised detoxification to dually diagnosed
				individuals in acute withdrawal from alcohol or other drugs, and addresses the
				mental health needs and biopsychosocial problems associated with alcoholism and
				other drug addictions requiring a 24-hour supervised inpatient stay.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Established Charge
. The lowest fee
				that is charged or accepted as payment by the provider to the general public or
				any third-party payer, other than a governmental unit, for the provision of
				services. Fees based upon the client's ability to pay, as in the case of a
				sliding fee scale, and fees subject to EOHHS review and approval are not
				established charges.
Extraordinary Circumstances/Flex
				Funding
. A method whereby a purchasing governmental unit may
				provide resource allocations to a client and/or provider for specific support
				services in order to address extraordinary circumstances.
Family Counseling
. The therapeutic
				counseling of more than one member of a family at the same time in the same
				session, where the primary complaint or concern is disruption of the family due
				to substance-related and addictive disorders.
Family Residential Treatment Service
.
				A structured and comprehensive rehabilitative environment in programs ranging
				in size from 11 to 16 family units. Such services support a resident's recovery
				from alcohol and/or other drug problems, support the family's recovery from the
				effects of substance-related and addictive disorders, and encourage movement
				toward independence.
Family Supportive Housing Program
. A
				transitional sober living environment for families recovering from
				substance-related and addictive disorders that assists and supports families in
				their recovery to achieve self-sufficiency and independent living. This is
				achieved through
(a) case management
			 services within an alcohol- and drug-free living environment that supports the
			 active search for permanent housing and employment and reinforces recovery;
			 and
(b) establishing community-based
			 supports to maintain ongoing goals in the recovery process.
Federally Qualified Health Centers (FQHCs) Office
				Based Opioid Treatment (OBOT)
. Community-based programs offering
				medication-assisted treatment (MAT) options in Federally Qualified Health
				Centers (FQHCs), community health centers (CHCs), or entities fully licensed
				under
				105 CMR
				164.000:
Licensure of Substance Abuse
				Treatment Programs
,
				105 CMR
				130.000:
Hospital Licensure
, or
				105 CMR
				140.000:
Licensure of Clinics
who are
				in good standing.
Governmental Unit
. The Commonwealth,
				any board, commission, department, division, or agency of the Commonwealth and
				any political subdivision of the Commonwealth.
Group Counseling
. Therapeutic
				counseling to an unrelated group of people having a common problem or concern
				that is associated with substance-related and addictive disorders.
Individual Consideration (I.C)
.
				Payment rates for certain services are designated as individual consideration
				(I.C.). Where I.C. rates are designated, the purchasing governmental unit will
				determine the appropriate payment as the actual cost of the item or service as
				evidenced by invoice, published tuition amount, or other price reasonably
				obtained by a competitive market for the product or service.
Individual Counseling
. A therapeutic
				meeting between the staff of an eligible provider and an individual whose
				primary complaint or concern is his or her substance-related and addictive
				disorder or that of a significant other.
Individual Assessment Session
. A
				meeting between a clinician and a client to explore the client's current and
				past substance-related and addictive disorders, psychosocial history, and
				motivation for change and to make recommendations for an appropriate level of
				care for treatment. Full assessment documentation is required.
In-home Therapy
. A therapeutic
				counseling service for substance-related and addictive disorders provided in
				the home by a clinician. In-home therapy is allowed when specific barriers to
				accessing services at a clinic site are identified for the client. The need for
				in-home therapy is reassessed at least every 90 days.
Jail Diversion
. A continuum of
				services prescribed by the courts as an alternative to jail. The first phase
				consists of approximately three months in a 24-hour, structured, therapeutic,
				semi-secure residential setting. Evidence-based treatment services are provided
				to address resistance to care, co-occurring disorders, and criminogenic issues,
				and prepare individuals to engage in ongoing substance-related and addictive
				disorders treatment. In the second phase, a case manager is assigned to each
				client for approximately nine months to assist the client's transition to
				community treatment and ancillary services.
Medically Monitored Inpatient Detoxification
				Services
. Acute detoxification and related treatment services
				provided to individuals whose current or potential withdrawal symptoms
				constitute a risk to the patient's health and well-being and require medical
				monitoring. These services are governed by the Massachusetts Department of
				Public Health at
				105
				CMR 164.133(A)(1)(b):
Medically Monitored Inpatient Detoxification Services
.
Medical Services Visit
. A medical
				services visit to an opioid treatment program includes medical assessment,
				medical case management, and dispensing of medication to opiate-addicted
				individuals who require support of opioid substitution therapy, as noted in the
				Department of Public Health's standard RFR program description of Opioid
				Treatment Programs and pursuant to
				105
				CMR 164.302:
Provision of Services -
				All Opioid Treatment
and
				105
				CMR 164.303:
Additional Service
				Requirements for Opioid Detoxification
.
Office-based Opioid Treatment (OBOT)
.
				These programs provide medically monitored treatment services for clients who
				are addicted to opiate drugs such as heroin or pain medications in a primary
				care setting. Services combine medical and pharmacological interventions with
				case management and supportive services. Services are offered on both a short-
				and long-term basis.
Office-based Opioid Treatment (OBOT) Wraparound
				Services
. Services that provide administrative support to OBOT
				programs and case management services to individuals who are participating in
				an OBOT program utilizing medication-assisted treatment (MAT).
Operating Agency
. An individual,
				group, partnership, corporation, trust, or other legal entity that operates a
				program.
Opioid Treatment
. Medically monitored
				treatment services for opiate-addicted clients that combine medical and
				pharmacological interventions with professional counseling, education, and
				vocational services. Services are offered on both a short-term (detoxification)
				and long-term (treatment) basis. Any individuals who are addicted to opiate
				drugs and are medically screened as appropriate are eligible.
P4P Eligible Provider (P4PEP)
. A
				provider that provides a P4P eligible service.
P4P Eligible Service
. A
				substance-related and addictive disorders treatment class of services, such as
				transitional support services or acute treatment services, that has been
				identified by the purchasing governmental unit as eligible for participation in
				a P4P program.
Pay for Performance (P4P)
. A
				value-based purchasing program implemented by a purchasing governmental unit to
				pay providers to perform activities related to improving the quality of care
				delivered to clients.
Postpartum Enhancement for Residential
				Rehabilitation Services
. A supplemental rate to cover the
				additional staffing and other costs necessary to meet the needs of postpartum
				women and their infants in the program.
Pregnant Enhancement for Residential Rehabilitation
				Services
. A supplemental rate to cover the additional staffing and
				other costs necessary to meet the needs of pregnant women in the
				program.
Provider
. Any individual, group,
				partnership, trust, corporation, or other legal entity that offers services for
				purchase by a governmental unit and that meets the conditions of purchase or
				licensure that have been adopted by a purchasing governmental unit.
Psycho-educational Group
. An
				educational group that provides intervention and motivation for individuals who
				may need substance-related and addictive disorders treatment/intervention
				services or who are family members of those in need of addiction treatment
				services.
Publicly Assisted Client
. A person who
				receives program services for which a governmental unit is liable, in whole or
				in part, under a statutory program of financial assistance.
Purchasing Governmental Unit
. A
				governmental unit that has purchased or is purchasing service units from an
				eligible provider.
Recovery Coaching
. A non-clinical
				service provided by a trained recovery advocate who provides guidance and
				coaching for individuals to meet their recovery goals.
Recovery Support Centers (RSC)
. A
				service that provides a broad range of supports that can help individuals build
				a stable life in recovery. The RSCs provide peer-to-peer recovery support to
				individuals in recovery from substance use disorder, as well as serving
				families and loved ones affected by addiction. RSCs support multiple pathways,
				provide hope, promote wellness, and assist members in building capital and
				developing their own unique individual, social, and community support, to help
				prevent relapse and promote long-term recovery from alcohol, opioids, and other
				addictions.
Related Party
. A person or
				organization that is associated or affiliated with, has control of, or is
				controlled by the operating agency or any director, stockholder, partner, or
				administrator of the operating agency by common ownership or control or in a
				manner specified in §§ 267(b) and (c) of the Internal Revenue Code of
				1954; provided, however, that 10% is the operative factor as set out in
				§§ 267(b)(2) and (3) and provided further that the definition of
				"family members" found in § 267(c)(4) of said code includes the following
				for the purpose of
				101 CMR
				346.00:
(a)
			 husband and wife;
(b) natural
			 parent, child, and sibling;
(c)
			 adopted child and adoptive parent;
(d) stepparent and stepchild;
(e) father-in-law, mother-in-law,
			 sister-in-law, brother-in-law, son-in-law, and daughter-in-law; and
(f) grandparent and grandchild.
Reporting Year
. The operating agency's
				fiscal year for which costs incurred are reported to the Operational Services
				Division on the Uniform Financial Statements and Independent Auditor's Report
				(UFR), normally July 1st to June
				30th.
Residential Rehabilitation
. The
				program of services defined as organized substance-related and addictive
				disorders treatment and education services featuring a planned program of care
				in a 24-hour residential setting. These services are provided to clients who
				require safe and stable living environments in order to develop their recovery
				skills. Types of residential rehabilitation services are those designed for
				adult individuals, adults with their families, adolescents, and
				driving-under-the-influence second offenders pursuant to the Massachusetts
				Department of Public Health at
				105 CMR
				164.000:
Licensure of Substance Abuse
				Treatment Programs
.
Residential Rehabilitation Co-occurring
				Enhanced
. The program of services defined as organized
				substance-related and addictive disorders treatment and education services
				featuring a planned program of care in a 24-hour residential setting for
				individuals with a moderate-to-severe substance use and mental health disorder.
				These services are provided to clients in a safe, structured, and
				developmentally appropriate environment. This specialized program offers
				appropriate psychiatric and substance use treatment services, including
				medication evaluation and laboratory services. These services are provided
				on-site and as appropriate to the severity and urgency of the patient's mental
				condition.
School-based Targeted Prevention
.
				Developmentally focused, competency-enhancement programs targeting 6- through
				12-year-old elementary/middle school students who are at risk for early
				development of conduct problems, emotional dysregulation, or substance use.
				Program components may include needs assessment, case management, case
				consultation, individual counseling, psychoeducation groups, parent education
				and skills training, after-school and summer activities, education services,
				mentoring, and contingency management.
Second Offender Driver Alcohol Education
				Residential Rehabilitation
. The program of services described in
				M.G.L. c. 90, § 24 and provided through licensed residential counseling
				programs to driving-under-the-influence second offenders.
Substance-related and Addictive Disorders
				Outpatient Counseling
. The services defined by the Massachusetts
				Department of Public Health at
				105
				CMR 164.200:
Outpatient
				Services
.
Supportive Case Management
. A program
				for individuals and families residing in recovery-focused transitional and
				permanent housing settings that includes care coordination, recovery support,
				housing stabilization, and facilitated access to mainstream benefits,
				especially primary health care. There are seven services for supportive case
				management: Permanent Adult, Permanent Families, Permanent Young Adults,
				Transitional Adults, Transitional Families, Transitional Young Adults, and Low
				Threshold.
Telephone Recovery Support
. A
				telephone support service provided by a counselor who is trained in an
				evidence-based model of telephone recovery support.
Transitional Support Services
.
				Residential case management services provided to bridge the gap between
				detoxification and residential rehabilitation and/or community ambulatory
				aftercare services. This level of service includes four hours of nursing
				services seven days a week.
Transitional Support Services with Special
				Programming for Women
. Residential case management services
				provided to bridge the gap between detoxification and residential
				rehabilitation and/or community ambulatory aftercare services, and that focus
				on the unique needs of women; are structured in a smaller residential setting
				(16 versus 36 beds); and offer more intensive services (more counseling and
				smaller staff/client ratio).
Treatment for Civilly Committed Persons
				Add-on
. An enhanced level of care that includes transportation,
				extra medical, psychiatric, recovery specialist care, family counseling, and
				additional administrative staff for the intake for all civilly committed
				persons in the Commonwealth. May be purchased in addition to medically
				monitored detoxification services, clinically managed detoxification services,
				and transitional support services for individuals who have been civilly
				committed by a district court of the Commonwealth, under M.G.L. c. 123, §
				35.
Triage, Engagement, and Assessment
				Program
. The Triage, Engagement, and Assessment (TEA) Program
				(formerly known as Substance Abuse Shelters for Individuals, or SASI) has as
				its focused populations homeless and chronically homeless adults active in
				their addiction who are under the influence at the point of contact with the
				program. Individuals are assessed, engaged, and stabilized with the intention
				of moving them into the substance use disorder continuum of care to provide
				treatment and to access permanent housing. The TEA Program provides a
				specialized setting for these individuals who often present as behaviorally
				difficult to manage due to active substance use and are often inappropriate
				(and frequently ineligible) for non-specialized shelter settings. Individuals
				in the TEA Program setting are treated with respect in a caring, judgment-free
				environment.
Workforce Initiatives
. Funds directed
				to a provider for workforce development.