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 12VAC30-130-5140 - Covered services: medically monitored intensive inpatient services (adult) and medically monitored high intensity inpatient services (adolescent) (ASAM Level 3.7)

Current through Register Vol. 40, No. 24, July 15, 2024
A. Medically
				  monitored intensive inpatient services (adult) and medically monitored high
				  intensity inpatient services (adolescent) (ASAM Level 3.7) settings for
				  services. The facility-based provider of ASAM Level 3.7 services shall be
				  licensed by DBHDS as (i) a freestanding psychiatric hospital or inpatient
				  psychiatric unit with a DBHDS medical detoxification license or managed
				  withdrawal license; (ii) a residential crisis stabilization unit with a DBHDS
				  medical detoxification license or managed withdrawal license; (iii) a substance
				  abuse residential treatment service for women with children with a DBHDS
				  managed withdrawal license; (iv) a Level C (psychiatric residential treatment
				  facility) provider; (v) a "mental health residential-children" provider with a
				  substance abuse residential license and a DBHDS managed withdrawal license;
				  (vi) a "managed withdrawal-medical detox adult residential treatment" provider;
				  or (vii) a "medical detox-chemical dependency unit" for adults and shall be
				  contracted by DMAS or its contractor or the MCO. ASAM Level 3.7 providers shall
				  meet the service components and staff requirements in this section.
B. Medically monitored intensive inpatient
				  services (adult) and medically monitored high intensity inpatient services
				  (adolescent) (ASAM Level 3.7) service components. The following therapies shall
				  be provided as directed by the ISP for reimbursement:
1. Daily clinical services provided by an
				  interdisciplinary team to involve appropriate medical and nursing services, as
				  well as individual, group, and family activity services. Activities may include
				  pharmacological, including medication assisted treatment that is provided
				  onsite or through referral; withdrawal management; cognitive-behavioral; and
				  other psychotherapies and substance use disorder counseling administered on an
				  individual or group basis and modified to meet the individual's level of
				  understanding and assist in the individual's recovery.
2. Counseling and clinical monitoring to
				  facilitate re-involvement in regular productive daily activities and successful
				  re-integration into family living if applicable.
3. Psychoeducational activities.
4. Random drug screens to monitor use and
				  strengthen recovery and treatment gains.
5. Regular medication monitoring.
6. Planned clinical activities to enhance
				  understanding of substance use disorders.
7. Health education associated with the
				  course of addiction and other potential health related risk factors, including
				  tuberculosis, human immunodeficiency virus, hepatitis B and C, and other
				  sexually transmitted infections.
8.
				  Evidence based practices, such as motivational interviewing to address an
				  individual's readiness to change, designed to facilitate understanding of the
				  relationship of the substance use disorder and life impacts.
9. Daily treatments to manage acute symptoms
				  of biomedical substance use or mental illness.
10. Services to family and significant others
				  as appropriate to advance the individual's treatment goals and objectives
				  identified in the ISP.
11.
				  Physician monitoring, nursing care, and observation shall be available. A
				  physician shall be available to assess the individual in person or via
				  telemedicine within 24 hours of admission and thereafter as medically
				  necessary.
12. A licensed and
				  registered nurse who shall conduct an alcohol or other drug-focused nursing
				  assessment upon admission. A licensed registered nurse or licensed practical
				  nurse shall be responsible for monitoring the individual's progress and for
				  medication administration duties.
13. Additional medical specialty
				  consultation; psychological, laboratory, and toxicology services shall be
				  available onsite, either through consultation or referral.
14. Coordination of necessary services shall
				  be available onsite or through referral to a closely coordinated offsite
				  provider to transition the individual to lower levels of care.
15. Psychiatric services shall be available
				  onsite or through consultation or referral to a closely coordinated offsite
				  provider when a presenting problem could be attended to at a later time. Such
				  services shall be available within eight hours of requested service by
				  telephone or within 24 hours of requested service in person or via
				  telemedicine.