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 12VAC30-130-5050 - Covered services: clinic services - opioid treatment program services

Current through Register Vol. 40, No. 24, July 15, 2024
A. Settings for
				  opioid treatment program (OTP) services. The agency-based OTP provider shall be
				  licensed by DBHDS and contracted by DMAS or its contractor or an MCO. The
				  staffing requirements for OTP providers shall follow the DBHDS licensing
				  requirements set forth in
				  12VAC35-105-925
				  and in the DBHDS guidance document entitled "Opioid Medication Assisted
				  Treatment License and Oversight" (March, 2017). The interdisciplinary team
				  shall include CATPs acting within the scope of practice in accordance to their
				  professional regulatory board and state and federal requirements, including an
				  addiction-credentialed physician as defined in
				  12VAC30-130-5020. OTP
				  services are allowed simultaneously for members in other ASAM Levels, including
				  1.0 through 3.7 (excluding inpatient services). OTPs shall meet the service
				  components, staff requirements, and risk management requirements.
B. OTP service components.
1. Linking the individual to psychological,
				  medical, and psychiatric consultation as necessary to meet the individual's
				  needs.
2. Access to emergency
				  medical and psychiatric care through connections with more intensive levels of
				  care.
3. Access to evaluation and
				  ongoing primary care.
4. Ability to
				  conduct or arrange for appropriate laboratory and toxicology tests including
				  drug screenings, using either urine or blood serums.
5. Physicians who are available to evaluate
				  and monitor (i) use of methadone, buprenorphine products, or naltrexone
				  products and (ii) pharmacists and nurses to dispense and administer these
				  medications and who follow the Board of Medicine guidance for treatment of
				  individuals with buprenorphine for addiction.
6. Individualized, patient-centered
				  assessment and treatment.
7.
				  Ability to assess, order, administer, reassess, and regulate medication and
				  dose levels appropriate to the individual; supervise withdrawal management from
				  opioid analgesics, including methadone, buprenorphine products, or naltrexone
				  products; and oversee and facilitate access to appropriate treatment for opioid
				  use disorder.
8. Medication for
				  other physical and mental health illness is provided as needed either onsite or
				  through collaboration with other providers.
9. Cognitive, behavioral, and other substance
				  use disorder-focused psychotherapies and substance use disorder counseling by a
				  CATP reflecting a variety of treatment approaches, provided to the individual
				  on an individual, group, or family basis. CSACs and CSAC-supervisees are
				  recognized to provide substance use disorder counseling in these settings as
				  allowed within scopes of practice as defined in §
											54.1-3507.1
				  of the Code of Virginia.
10.
				  Optional substance use care coordination that includes integrating behavioral
				  health into primary care and specialty medical settings through
				  interdisciplinary care planning and monitoring individual progress and tracking
				  individual outcomes; supporting conversations between buprenorphine-waivered
				  practitioners and behavioral health professionals to develop and monitor
				  individualized treatment plans; linking individuals with community resources to
				  facilitate referrals and respond to social service needs; and tracking and
				  supporting individuals when they obtain medical, behavioral health, or social
				  services outside the practice.
11.
				  Provision of onsite screening or the ability to refer for screening for
				  infectious diseases such as human immunodeficiency virus, hepatitis B and C,
				  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.
12. Onsite medication administration
				  treatment during the induction phase, which must be provided by a physician,
				  nurse practitioner, physician assistant, or registered nurse. Medication
				  administration during the maintenance phase may be provided either by a
				  registered nurse or licensed practical nurse.
13. Prescription of naloxone for each member
				  receiving methadone, buprenorphine products, or naltrexone products.
14. Ability to provide pregnancy testing for
				  women of childbearing age.
15. For
				  individuals of childbearing age, the ability to provide family planning
				  services or to refer the individual for family planning services.