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 12VAC30-130-5080 - Covered services: outpatient services - physician services (ASAM Level 10)

Current through Register Vol. 40, No. 24, July 15, 2024
A. Outpatient
				  services (ASAM Level 1.0) shall be provided by a CATP contracted by DMAS or its
				  contractor or an MCO to perform the services in the following community based
				  settings: primary care clinics, outpatient health system clinics, psychiatry
				  clinics, FQHCs, RHCs, CSBs, BHAs, local health departments, and physician and
				  provider offices. Reimbursement for substance use outpatient services shall be
				  made for medically necessary services provided in accordance with an ISP or the
				  treatment plan and include withdrawal management as necessary. Services can be
				  provided in person or by telemedicine. Outpatient services shall meet the ASAM
				  Level 1.0 service components and staff requirements as follows:
1. Outpatient services (ASAM Level 1.0)
				  service components.
a. Substance use
				  outpatient services shall be provided fewer than nine hours per week and may be
				  delivered in the following health care settings: local health departments,
				  FQHCs, rural health clinics, CSBs, BHAs, health systems, emergency departments,
				  physician and provider offices, and outpatient clinics. Provision of services
				  in a setting other than the office or a clinic, as defined in this subsection
				  shall be documented. Services shall include professionally directed screening,
				  evaluation, treatment, and ongoing recovery and disease management
				  services.
b. A multidimensional
				  assessment shall (i) be used, (ii) be documented to determine that an
				  individual meets the medical necessity criteria, and (iii) include the
				  evaluation or analysis of substance use disorders, the diagnosis of substance
				  use disorder, and the assessment of treatment needs to provide medically
				  necessary services. The multidimensional assessment shall include a physical
				  examination and laboratory testing necessary for substance use disorder
				  treatment as necessary.
c.
				  Individual psychotherapy or substance use disorder counseling shall be provided
				  by a CATP. Services shall be provided in person or by telemedicine.
d. Group psychotherapy or substance use
				  disorder counseling shall be provided by a CATP with a maximum of 10
				  individuals in the group and shall focus on the needs of the individuals
				  served.
e. Family psychotherapy or
				  substance use disorder counseling shall be provided by a CATP to facilitate the
				  individual's recovery and support for the family's recovery.
f. Evidenced-based patient education on
				  addiction, treatment, recovery, and associated health risks shall be
				  provided.
g. Medication services
				  shall be provided, including the prescription of or administration of
				  medication related to substance use treatment or the assessment of the side
				  effects or results of that medication. Medication services shall be provided by
				  staff lawfully authorized to provide such services who shall order laboratory
				  testing within their scope of practice or licensure.
h. Collateral services shall be
				  provided.