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 12VAC30-130-5200 - Peer support services and family support partners: documentation of required activities

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				  recommendation for services shall include the dated signature and credentials
				  of the practitioner described in 12VAC30-130-5190 B who made the
				  recommendation. The recommendation shall be included as part of the recovery,
				  resiliency, and wellness plan and medical record. The recommendation shall
				  verify that the individual meets the medical necessity criteria and shall be
				  valid for no longer than 30 calendar days.
B. Under the clinical oversight of the
				  practitioner making the recommendation described in 12VAC50-130-5190 B for ARTS
				  peer support services or ARTS family support partners, the peer recovery
				  specialist in consultation with his direct supervisor shall develop a recovery,
				  resiliency, and wellness plan based on the recommendation for service, the
				  individual's, and, as applicable the caregiver's, perceived recovery needs and
				  multidisciplinary assessment as defined in this section within 30 calendar days
				  of the initiation of service. Development of the recovery, resiliency, and
				  wellness plan shall include collaboration with the individual and, as
				  applicable, the identified family member or caregiver involved in the
				  individual's recovery. Individualized goals and strategies shall be focused on
				  the individual's identified needs for self-advocacy and recovery. The recovery,
				  resiliency, and wellness plan shall also include documentation of how many days
				  per week and how many hours per week are required to carry out the services in
				  order to meet the goals of the plan. The recovery, resiliency, and wellness
				  plan shall be completed, signed, and dated by the practitioner making the
				  recommendation, the PRS, the direct supervisor, the individual, and, as
				  applicable, the identified family member or caregiver involved in the
				  individual's recovery within 30 calendar days of the initiation of service. The
				  PRS shall act as an advocate for the individual, encouraging the individual,
				  and as applicable the caregiver, to take a proactive role in developing and
				  updating goals and objectives in the individualized recovery
				  planning.
C. Services shall be
				  delivered in accordance with the individual's goals and objectives as
				  identified in the recovery, resiliency, and wellness plan and consistent with
				  the recommendation of the referring practitioner who recommended services. As
				  determined by the goals identified in the recovery, resiliency, and wellness
				  plan, services may be rendered in the provider's office or in the community, or
				  both. The level of services provided and total time billed by the enrolled
				  provider for the week shall not exceed the frequency established in the
				  recovery, resiliency, and wellness plan.
D. Under the clinical oversight of the
				  practitioner described in 12VAC30-130-5190 B making the recommendation, the
				  peer recovery specialist in consultation with his direct supervisor shall
				  conduct and document a review of the recovery, resiliency, and wellness plan
				  every 90 calendar days with the individual and the caregiver, as applicable.
				  The review shall be signed by the PRS and the individual and, as applicable,
				  the identified family member or caregiver. Review of the recovery, resiliency,
				  and wellness plan means the PRS evaluates and updates the individual's progress
				  every 90 days toward meeting the plan's goals and documents the outcome of this
				  review in the individual's medical record. For DMAS to determine that these
				  reviews are complete, the reviews shall (i) update the goals and objectives as
				  needed to reflect any change in the individual's recovery as well as any newly
				  identified needs, (ii) be conducted in a manner that enables the individual to
				  actively participate in the process, and (iii) be documented by the PRS in the
				  individual's medical record no later than 15 calendar days from the date of the
				  review.
E. Progress notes as
				  defined in
				  12VAC30-50-130 shall be required
				  and shall record the date, time, place of service, participants, face-to-face
				  or telephone contact, and circumstance of contact, regardless of whether or not
				  a billable service was provided, and shall summarize the purpose and content of
				  the session along with the specific strategies and activities utilized as
				  related to the goals in the recovery, resiliency, and wellness plan.
				  Documentation of specific strategies and activities shall fully disclose the
				  details of services rendered and align with the recovery, resiliency, and
				  wellness plan. Strategies and activities shall include at a minimum:
1. Person centered, strength-based planning
				  to promote the development of self-advocacy skills;
2. Empowering the individual to take a
				  proactive role in the development and updating of his recovery, resiliency, and
				  wellness plan;
3. Crisis support;
				  and
4. Assisting in the use of
				  positive self-management techniques, problem-solving skills, coping mechanisms,
				  symptom management, and communication strategies identified in the recovery,
				  resiliency, and wellness plan so that the individual:
a. Remains in the least restrictive
				  setting;
b. Achieves his goals and
				  objectives identified in the recovery resiliency and wellness plan;
c. Self-advocates for quality physical and
				  behavioral health services; and
d.
				  Has access to strength-based behavioral health services, social services,
				  educational services, and other supports and resources.