Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 418.000 - Substance Use Disorder Treatment Services › Section 418.402 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in
				130 CMR
				418.000 have the meanings given in
				130
				CMR 418.402 unless the context clearly
				requires a different meaning.
Acupuncture Withdrawal Management
-
				the insertion of metal needles through the skin at certain points on the body,
				with or without the use of herbs, with or without the application of an
				electric current, and with or without the application of heat to the needles,
				skin, or both, for members experiencing the dysfunctional effects of the use of
				alcohol and/or other drugs, whose primary need is management of withdrawal
				symptoms, and thereafter, support services for the establishment and
				maintenance of recovery.
Acute Treatment Services (ATS)
- ASAM
				Medically Monitored Intensive Inpatient Services, a 24-hour, seven days-a-week,
				medically monitored inpatient addiction treatment service that provides
				evaluation and medically supervised withdrawal management services and/or
				induction onto maintenance treatment. These services are delivered by nursing
				and counseling staff under a physician-approved protocol and
				physician-monitored procedures and under the direction of a licensed medical
				professional
(i.e.,
physician, advanced practice registered
				nurse, physician assistant). Services include biopsychosocial assessment,
				induction onto FDA-approved medications for substance use disorders as
				clinically indicated, treatment planning, individual and group counseling,
				psychoeducational groups, and discharge planning.
Advanced Practice Registered Nurse
-
				an individual licensed by the Massachusetts Board of Registration in Nursing
				pursuant to M.G.L. c. 112, § 80B and
				244 CMR
				4.00:
Advanced Practice Registered
				Nursing.
Adverse Incident
- an occurrence that
				represents actual or potential serious harm to the well-being of a member, or
				to others under the care of a provider. Adverse incidents may be the result of
				the actions of a member served, actions of a staff member providing services,
				incidents that compromise the health and safety of the member receiving
				treatment at the program, or the operations of the provider.
American Society of Addiction Medicine
				(ASAM)
- a professional society in the field of addiction medicine
				that sets diagnostic and dimensional criteria for the delivery of substance use
				disorder treatment which includes a continuum of five basic levels of care from
				Early Intervention to Medically Managed Intensive Inpatient Treatment.
Behavioral Health Disorder
- any
				disorder pertaining to mental health or substance use, as defined by the
				current edition of the
Diagnostic and Statistical Manual of Mental
				Disorders.
Case Consultation
- intervention,
				including scheduled audio-only telephonic, audio-video, or in-person meetings,
				for behavioral and medical management purposes on a member's behalf with
				agencies, employers, or institutions which may include the preparation of
				reports of the member's psychiatric status, history, treatment, or progress
				(other than for legal purposes) for other physicians, agencies, or insurance
				carriers.
Certified Addiction Counselor (CAC)
-
				an individual who has received "Certification of Alcohol and Drug Counselors"
				provided by the Massachusetts Board of Substance Abuse Counselor Certification
				(MBSACC). There are three levels of certification: CAC, CADC, CADC II.
Clinical Stabilization Services for Substance Use
				Disorders (CSS)
- ASAM Clinically Managed High-Intensity
				Residential Services, a 24-hour, seven-days-a-week, clinically managed
				high-intensity residential treatment service offered in community settings. The
				services are delivered by nursing, case management, clinical, and recovery
				support staff under the direction of a licensed medical provider
				(
i.e.
, physician, advanced practice registered nurse,
				physician assistant). The services include comprehensive biopsychosocial
				multidimensional assessments and treatment planning, therapeutic milieu,
				intensive psychoeducation, individual and group counseling, outreach to
				families and significant others, linkage to medications for addiction
				treatment, case management with connection to primary care, community supports
				and aftercare planning for members beginning to engage in recovery from
				substance use disorders, and recovery support services.
Clinician
- an individual with a
				minimum of a master's degree in one of the following disciplines or a closely
				related field: clinical psychology, education counseling, medicine, psychology,
				psychiatric nursing, rehabilitative counseling, or social work, and who has a
				minimum of one year of supervised substance use disorder counseling
				experience.
Community Support Program for Homeless Individuals
				(CSP-HI)
- a specialized form of CSP for members who are
				experiencing homelessness as described in
				130 CMR
				461.000. CSP-HI includes assistance from specialized
				professionals who, based on their unique skills, education, or lived
				experience, have the ability to engage and support individuals experiencing
				homelessness in searching for permanent supportive housing, preparing for and
				transitioning to an available housing unit, and, once housed, coordinating
				access to physical health, behavioral health, and other needed services geared
				toward helping them sustain tenancy and meet their health needs.
Co-occurring Disorder
- a diagnosis of
				both a substance use disorder and one or more behavioral health
				disorders.
Co-occurring Enhanced Residential Rehabilitation
				Services for Substance Use Disorder (COE-RRS)
- ASAM Clinically
				Managed Low-Intensity Residential Services, a 24-hour, seven-days-per-week,
				clinically enhanced residential service that provides a safe, structured
				environment in the community. This service supports a member's recovery from
				substance use disorders and moderate to severe mental health conditions while
				reintegrating them into the community and returning to social,
				vocation/employment, and/or educational roles. Scheduled, goal-oriented, and
				evidence-based clinical services are provided in conjunction with ongoing
				support and assistance in developing and implementing recover skills.
Counselor
- an individual who has a
				minimum of a high school diploma or equivalent and a minimum of one year of
				supervised counseling experience in substance use disorder treatment or a
				closely related field.
Couples Counseling
- rehabilitative
				counseling provided to a couple whose primary complaint is disruption of their
				marriage, family, or relationship due to substance use and/or co-occurring
				disorders.
Direct and Continuous Supervision
-
				ongoing supervision provided to unlicensed staff and not independently licensed
				staff at a frequency of no less than one hour of supervision per week for
				full-time employees. Supervision time may be pro-rated based on scheduled hours
				for employees employed less than full-time. Direct and continuous supervision
				must be delivered by an independently licensed staff member or certified peer
				supervisor who is employed by the agency.
Enhanced Structured Outpatient Addiction Program
				(E-SOAP)
- ASAM Intensive Outpatient Services, a program that
				provides short-term, clinically intensive, structured day and/or evening SUD
				services. E-SOAP specifically serves specialty populations such as members
				experiencing homelessness and members at risk of experiencing homelessness,
				members who are pregnant, and adolescents.
Family Counseling
- the
				psychotherapeutic treatment of more than one member of a family simultaneously
				in the same session where the primary complaint is disruption of the family due
				to substance use and/or co-occurring disorders.
Group Counseling
- the use of
				psychotherapeutic and evidence-based counseling techniques in the treatment of
				a group of individuals, most of whom are not related by blood, marriage,
				domestic partnership, or legal guardianship, having a primary complaint that is
				associated with substance use and/or co-occurring disorders.
Individual Counseling
-
				psychotherapeutic services provided to a member whose primary complaint is
				substance use and/or co-occurring disorders.
Individual Treatment Plan
- a
				treatment plan based on results of the multidimensional biopsychosocial
				assessment and created in collaboration with the member, as defined by
				105 CMR
				164.000:
Licensure of Substance Use Disorder
				Treatment Programs.
Individualized Treatment Stabilization Services
				(ITS) Tier 1
- a program that provides integrated ATS and CSS
				services in a single unit or location for stabilization and continuity of care.
				ITS Tier 1 programs must meet all expectations for both ATS and CSS services
				models, including licensure requirements. ITS Tier 1 serves members who are
				involuntarily committed to treatment due to the severity and level of
				impairment caused by their SUD.
Individualized Treatment Stabilization Services
				(ITS) Tier 2
- an integrated program that provides enhanced ATS
				and CSS services in a single unit or location for stabilization and continuity
				of care. ITS Tier 2 must meet all expectations for both ATS and CSS services
				models. ITS Tier 2 serves members who have co-occurring disorders and multiple
				unsuccessful treatment episodes at lower levels of care who would benefit from
				fewer transitions between levels of care and enhanced engagement
				interventions.
Licensed Alcohol and Drug Counselor
				(LADC)
- an individual who has applied for and has been deemed
				qualified under applicable sections of
				105 CMR
				168.000:
Licensure of Alcohol and Drug
				Counselors
and duly licensed by the Department of Public Health to
				provide treatment for individuals with a substance use disorder as a Licensed
				Alcohol Drug Counselor I (LADC I), Licensed Alcohol Drug Counselor II (LADC
				II), or Licensed Alcohol Drug Counselor (LADC) Assistant.
Licensed Practical Nurse
- an
				individual licensed by the Massachusetts Board of Registration in Nursing in
				accordance with M.G.L. c. 112, § 74 and in compliance with
				244 CMR
				3.00:
Registered Nurse and Licensed Practical
				Nurse.
Medical Director
- a physician
				licensed to practice medicine with specialized training in addiction medicine,
				who assumes responsibility for administering all medical services performed by
				the program, either by performing them directly or by delegating specific
				responsibility to authorized program physicians and qualified healthcare
				professionals functioning under the Medical Director's direct
				supervision.
Medically Managed Intensive Inpatient Level of
				Care
- an intensive inpatient service provided in a hospital
				setting. These programs treat members with acute medically complex withdrawal
				management needs, as well as co-occurring biomedical and/or psychiatric
				conditions. Medically managed intensive inpatient levels of care are licensed
				by the Massachusetts Department of Public Health under
				105 CMR
				130.000:
Hospital Licensure
and
				105 CMR
				164.000:
Licensure of Substance Use Disorder
				Treatment Programs.
Medication Management
- management of
				medication including resident self-administration oversight, storage, and
				coordination of all medication prescribed during treatment.
Medication Specialist
- a staff member
				in residential rehabilitation programs who is responsible for the oversight,
				storage, and coordination of self-administration of medication.
Medication Visit
- a member visit
				specifically for prescription review and monitoring of psychotropic medication
				by a psychiatrist, psychiatric clinical nurse specialist, physician, physician
				assistant, or advanced practice registered nurse or administration of
				prescribed intramuscular medication by a physician, nurse, or physician
				assistant.
Mental Health Disorder
- any disorder
				pertaining to mental health, as defined by the current edition of the
				Diagnostic and Statistical Manual of Mental Disorders.
Motivational and Supportive Services
-
				counseling as a component of acupuncture withdrawal management treatment
				services that:
(a) encourages members
			 to remain in acupuncture withdrawal management treatment;
(b) helps members obtain necessary additional
			 medical and social services;
(c)
			 includes HIV/AIDS and other risk assessments and education services;
			 and
(d) motivates members to
			 participate in ongoing outpatient substance use disorder treatment.
Opioid Treatment Program (OTP)
- a
				program that provides opioid treatment services. An OTP must be federally
				certified by the Substance Abuse Mental Health Services Administration (SAMHSA)
				and must be licensed as an opioid treatment program by the Department of Public
				Health under
				105 CMR
				164.000:
Licensure of Substance Use Disorder
				Treatment Programs.
OTPs must conform to the federal opioid treatment
				standards in 42 CFR
				8.12.
Opioid Treatment Services
- services
				rendered in Opioid Treatment Programs, which include a biopsychosocial
				assessment and treatment of a member, using FDA-approved medications (including
				methadone, buprenorphine, buprenorphine/naloxone, and naltrexone), along with a
				comprehensive range of medical and rehabilitative services, when clinically
				necessary, to alleviate the adverse medical, psychological or physical effects
				incident to opiod dependence. Opioid Treatment Services encompass withdrawal
				management services and maintenance treatment.
Peer Recovery Coach
- an individual
				currently in recovery who has lived experience with substance use or other
				addictive disorders and/or co-occurring mental health disorders and has been
				trained to help their peers with a similar experience to gain hope, explore
				recovery, and achieve life goals. Peer recovery coaches engage in an equitable,
				non-clinical relationship with the member focused on removing obstacles to
				recovery. Peer recovery coaches link members to the recovery community and
				engage in mentoring.
Pharmacotherapy
- a type of therapy
				providing therapeutic treatment with pharmaceutical drugs.
Physician Assistant
- an individual
				who is registered by the Board of Registration of Physician Assistants in
				accordance with M.G.L. c. 112, § 9I and 263 CMR:
Board of
				Registration of Physician Assistants.
Quality Management
- a systematic and
				ongoing process for monitoring, evaluating, and improving the quality and
				appropriateness of services provided to members, with focused attention on
				addressing cultural, ethnic, and language needs.
Recovery Support Navigator
- a
				paraprofessional who receives specialized training in the essentials of
				substance use disorder or other addictive disorders and evidence-based
				techniques such as motivational interviewing, and who supports members in
				accessing and navigating the SUD treatment system through activities that can
				include care coordination, case management, and motivational support.
Registered Nurse
- an individual
				licensed by the Massachusetts Board of Registration in Nursing in accordance
				with M.G.L. c. 112, § 74 and in compliance with
				244 CMR
				3.00:
Registered Nurse and Licensed Practical
				Nurse.
Release of Information (ROI)
- a
				document that allows a patient to authorize and revoke what information they
				want to release from their patient record, who it can be released to, how long
				it can be released for, and under what statutes and guidelines it is
				released.
Residential Rehabilitation Services
				(RRS)
- ASAM Clinically Managed Low-Intensity Residential
				Services, are clinically managed low-intensity residential services that
				provide a 24 hour, seven-days-a-week, supervised structured and comprehensive
				rehabilitative environment. These services support members' independence and
				resilience to help them fully stabilize in recovery. Scheduled, goal-oriented
				clinical services are provided in conjunction with ongoing support and
				assistance to help members develop and maintain interpersonal skills necessary
				for developing and implementing recovery skills. Specialized RRS services
				tailored for the needs of youth, transitional age youth, young adults,
				families, and pregnant and port-partum individuals are also available to
				eligible members.
Structured Outpatient Addiction Program
				(SOAP)
- ASAM Intensive Outpatient Services, a substance use
				disorder treatment service that provides short-term, multi-disciplinary,
				clinically intensive structured treatment to address the sub-acute needs of
				members with substance use disorders and/or co-occurring disorders. These
				services may be used as a transition service in the continuum of care toward
				lower intensity outpatient programs or accessed directly.
Substance Use Disorder (SUD)
- any
				disorder pertaining to substance use as defined by the current edition of the
				Diagnostic and Statistical Manual of Mental Disorders.
Substance Use Disorder Outpatient Counseling
				Service
- an outpatient counseling service that is a
				rehabilitative treatment service for members and their families experiencing
				the effects of substance use and/or co-occurring disorders.
Substance Use Disorder Treatment
				Program
- an entity that delivers a comprehensive group of
				medical, clinical, and psychosocial treatment services to members seeking
				treatment for substance use disorders, which may include co-occurring mental
				health disorders.
Telehealth
- the use of synchronous or
				asynchronous audio, video, electronic media or other telecommunications
				technology, including, but not limited to:
(a) interactive audio-video
			 technology;
(b) remote patient
			 monitoring devices;
(c) audio-only
			 telephone; and
(d) online adaptive
			 interviews, for the purpose of evaluating, diagnosing, consulting, prescribing,
			 treating or monitoring of a patient's physical health, oral health, mental
			 health or substance use disorder condition.
Transitional Support Services (TSS)
-
				ASAM Clinically Managed Low-Intensity Residential Services, are active
				treatment and reassessment services provided on a short-term basis in a 24-hour
				community-based setting to members with a substance use
				disorder.