Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 130 - AMOUNT, DURATION AND SCOPE OF SELECTED SERVICES › Part XX - Addiction and Recovery Treatment Services › Section 12VAC30-130-5060 - Covered services: clinic services - preferred office-based addiction treatment

Current through Register Vol. 40, No. 24, July 15, 2024
A. Preferred
				  office-based addiction treatment (OBAT) shall be provided by a
				  buprenorphine-waivered practitioner and may be provided in a variety of
				  practice settings, including primary care clinics, outpatient health system
				  clinics, psychiatry clinics, FQHCs, CSBs, BHAs, local health department
				  clinics, and physician offices. The practitioner shall be contracted by DMAS or
				  its contractor or an MCO to perform OBAT services. OBAT services shall meet the
				  criteria established in this section.
B. OBAT service components.
1. Access to emergency medical and
				  psychiatric care.
2. Affiliations
				  with more intensive levels of care such as intensive outpatient programs and
				  partial hospitalization programs to which individuals can be referred when
				  clinically indicated.
3.
				  Individualized, patient-centered multidimensional assessment and
				  treatment.
4. Assessing, ordering,
				  administering, reassessing, and regulating medication and dose levels
				  appropriate to the individual; supervising withdrawal management from opioid
				  analgesics and other substances; and overseeing and facilitating access to
				  appropriate treatment for substance use disorder.
5. Medication for other physical and mental
				  health disorders shall be provided as needed either onsite or through
				  collaboration with other providers.
6. Assurance that medications for opioid use
				  disorder and alcohol use disorder are only dispensed onsite during the
				  induction phase. After the induction phase, medications shall be prescribed to
				  the member.
7. Assurance that
				  buprenorphine monoproduct is only prescribed in accordance with Board of
				  Medicine rules related to the prescribing of buprenorphine for
				  addiction.
8. Cognitive,
				  behavioral, and other substance use disorder-focused counseling and
				  psychotherapies, reflecting a variety of treatment approaches, shall be
				  provided to the individual on an individual, group, or family basis and shall
				  be provided by CATPs working in collaboration with the buprenorphine-waivered
				  practitioner. These therapies can be provided via telemedicine as long as they
				  meet DMAS requirements for an OBAT and for the use of telemedicine. Preferred
				  OBATs may utilize CSACs and CSAC-supervisees to provide substance use disorder
				  counseling and psychoeducational services within their scope of practice as
				  defined in § 54.1-3507.1 of the Code of Virginia.
9. Substance use care coordination provided,
				  including interdisciplinary care planning between the buprenorphine-waivered
				  practitioner and the treatment team to develop and monitor individualized and
				  personalized treatment plans focused on the best outcomes for the individual.
				  This care coordination includes monitoring individual progress, tracking
				  individual outcomes, linking the individual with community resources to
				  facilitate referrals and respond to social service needs, and tracking and
				  supporting the individual's medical, behavioral health, or social services
				  received outside the practice.
10.
				  Provision of onsite screening or referral for screening for clinically
				  indicated infectious disease testing for diseases such as HIV; hepatitis A, B,
				  and C; syphilis; and tuberculosis at treatment initiation and then at least
				  annually or more often based on risk factors and the ability to provide or
				  refer for treatment of infectious diseases as necessary.
11. Onsite medication administration
				  treatment during the induction phase, which shall be provided by a physician,
				  nurse practitioner, physician assistant, registered nurse, or licensed
				  practical nurse.
12. Ability to
				  provide pregnancy testing for women of childbearing age.
13. For individuals of childbearing age, the
				  ability to provide family planning services or to refer the individual for
				  family planning services.