SUBSTANCE USE DISORDER TREATMENT SERVICES …

1 SUBSTANCE USE DISORDER TREATMENT SERVICES PROVIDER MANUAL Version Last Updated: July 2020 Page 1 of 241 SUBSTANCE USE DISORDER TREATMENT SERVICES PROVIDER MANUAL Version Last Updated: July 2020 Page 2 of 241 TABLE OF CONTENTS Section 1. MODERNIZING SUBSTANCE USE DISORDER TREATMENT .. 7 Transforming the TREATMENT System of Care .. 8 SUBSTANCE Use disorders as a Chronic Disease .. 8 Defining Patient-Centered Care .. 12 Ensuring a Standard Quality of Service .. 13 Integration and Coordination of Care .. 13 Section 2. PATIENT SERVICE STANDARDS .. 15 The SUBSTANCE Use DISORDER Benefit 16 Eligibility Determination and Establishing Benefits .. 16 Access to 21 Service Connection Portals .. 23 Client Engagement and Navigation SERVICES Information .. 27 Direct-to-Provider .. 32 Service and Bed Availability Tool and Provider 34 Timeliness and Access Standards.

2 34 Network Adequacy Certification Tool .. 37 Definition of At-Risk for Youth (ages 12 17) and Young Adults (ages 18 20): .. 40 Process for Determining Medical Necessity .. 41 Assessment .. 42 Service Benefit and Levels of Care .. 43 Case Management .. 47 Outpatient for At-Risk Youth and Young Adults (ASAM AR) .. 56 Outpatient TREATMENT (ASAM ) .. 57 Intensive Outpatient TREATMENT (ASAM ) .. 57 Residential SERVICES .. 58 Withdrawal Management .. 61 Ambulatory Withdrawal Management .. 64 Opioid TREATMENT Programs (1-OTP) .. 70 Recovery Support SERVICES .. 71 Recovery Bridge Housing .. 74 SUBSTANCE USE DISORDER TREATMENT SERVICES PROVIDER MANUAL Version Last Updated: July 2020 Page 3 of 241 Physician Consultation 80 Service Delivery Options .. 81 Field-Based SERVICES .. 81 Telehealth and Telephone .. 86 Intake and Enrollment .. 88 Required Forms.

3 88 Required Processes .. 91 TREATMENT Service Components .. 93 Group 93 Patient Education .. 94 Individual Counseling .. 94 Crisis Intervention .. 95 Family Therapy .. 95 Collateral SERVICES .. 96 Alcohol and Drug Testing .. 96 Medications for Addiction TREATMENT Within All Levels of Care .. 97 Medication SERVICES and Safeguarding Medications .. 98 Discharge Planning .. 100 Culturally, Linguistically, and Population-Appropriate SERVICES .. 100 Special Populations .. 101 Co-Occurring DISORDER Population .. 101 Pregnant and Parenting Women Population .. 103 Adolescent Patients .. 104 Young Adults .. 106 Older Adults .. 108 Criminal Justice Involved Patients .. 109 Homeless Population .. 111 Lesbian, Gay, Bisexual, Transgender, Questioning Population .. 112 Veterans .. 114 Population-Based SERVICES by Funding Source Adult .. 115 Special Programs Defined .. 115 Los Angeles County Superior Court Referrals.

4 116 SUBSTANCE USE DISORDER TREATMENT SERVICES PROVIDER MANUAL Version Last Updated: July 2020 Page 4 of 241 TREATMENT Program Procedures for Probation Referrals .. 119 Los Angeles County Sheriff s - Referrals SUBSTANCE TREATMENT and Re-entry Transition - Community (START-Community) Referrals .. 122 In-Custody to Community Referral Program .. 126 Department of Public Social SERVICES (DPSS) California Work Opportunity and Responsibility to Kids (CalWORKs) Referrals .. 127 Intake .. 127 Department of Public Social SERVICES General Relief Referrals .. 128 Department of Children and Family SERVICES (DCFS) Promoting Safe and Stable Families Time Limited Family Reunification (PSSF-TLFR) Referrals .. 129 Department of Children and Family SERVICES Family Dependency Drug Court (FDDC) Referrals .. 131 Pregnant and Parenting Women (PPW) .. 132 Homeless SERVICES .

5 136 Population-Based SERVICES by Funding Source Youth .. 138 Juvenile Justice Crime Prevention Act Program .. 138 Crossover ( ) 139 Title IV-E Youth Project .. 141 Juvenile Delinquency Drug Court .. 142 Section 3. CLINICAL PROCESS STANDARDS .. 144 Quality Improvement & Utilization Management Program .. 145 SAPC Committee Structure .. 145 Quality Improvement Components .. 146 Accessibility of SERVICES .. 148 Utilization Management Components .. 148 Eligibility Verification .. 149 Pre-authorized SERVICES .. 156 Authorized SERVICES .. 161 Providers Quality Improvement Expectations .. 166 Peer Reviews .. 166 Quality Improvement Projects .. 167 Performance and Outcome Measures .. 168 Workforce .. 170 Quality Assurance Regulations .. 175 SUBSTANCE USE DISORDER TREATMENT SERVICES PROVIDER MANUAL Version Last Updated: July 2020 Page 5 of 241 Confidentiality.

6 176 42 CFR Part 438 Managed Care .. 177 CCR Title 22 Drug Medi-Cal and the DMC-ODS Special Terms and Conditions .. 177 California Code of Regulations (CCR) Title 9 Counselor Certification .. 177 Evidence-Based Practices .. 177 Documentation .. 179 TREATMENT Plan .. 180 Progress Notes .. 183 Miscellaneous Notes .. 185 Discharge Summary and Transfer .. 186 Complaints/Grievances and Appeals Processes .. 186 Complaint/Grievance Process .. 187 Notice of Adverse Benefit Determinations .. 189 Appeals Process .. 190 Risk Management and Reportable Incidents .. 194 Risk Management Committee at the Provider Level .. 194 Section 4. BUSINESS PROCESS STANDARDS .. 196 Contract Management .. 197 How to Join SAPC s Provider Network or Add 197 Updating Service Provider s Contract .. 198 Ongoing Compliance Monitoring .. 200 Contracted Provider and Staff Credentialing .. 200 Contractual and Regulatory Technical Assistance.

7 201 Finance Management .. 202 Rates and Standards .. 202 Cost Reconciliation Not Cost Reimbursement .. 204 Projecting Utilization and Managing Expenditures .. 205 Capacity Building to Support a Modern SUD System .. 205 Budget Development Process .. 207 Claims Submission and Reimbursement 209 Cost Reporting .. 211 Information Technology Management .. 214 SUBSTANCE USE DISORDER TREATMENT SERVICES PROVIDER MANUAL Version Last Updated: July 2020 Page 6 of 241 Sage and Electronic Health Record Requirements .. 214 Section 5. APPENDICES .. 218 Definitions .. 219 Acronyms .. 228 Case Management References .. 231 CENS: Procedure for Additional Co-Location 233 SUD Screening Referral Form .. 234 SUBSTANCE Use DISORDER (SUD) Screening Results and TREATMENT Referral Report .. 235 SUD TREATMENT Referral Tracking Form .. 237 Program Incident 239 Telehealth SERVICES Attestation Form.

8 240 NOTE: Given the continual evolution of the field of addiction TREATMENT , the Provider Manual is a living document and evolves with the availability of new information and research, changes in policy, regulatory mandates, and/or contractual agreements. As a result, this document is subject to ongoing review and revision at the discretion of the County. SUBSTANCE USE DISORDER TREATMENT SERVICES PROVIDER MANUAL Version Last Updated: July 2020 Page 7 of 241 Section 1. MODERNIZING SUBSTANCE USE DISORDER TREATMENT SUBSTANCE USE DISORDER TREATMENT SERVICES PROVIDER MANUAL Version Last Updated: July 2020 Page 8 of 241 Transforming the TREATMENT System of Care The System Transformation to Advance Recovery and TREATMENT , Los Angeles County s SUBSTANCE Use DISORDER Organized Delivery System (START-ODS) provides increased access to SUBSTANCE use DISORDER (SUD) TREATMENT SERVICES for youth and adults enrolled or eligible for Medi-Cal, My Health LA and/or participating in select County funded programs.

9 It also presents an opportunity for the County to achieve the following: Integrating physical and mental health service needs with SUD SERVICES ; Raising quality standards to improve health outcomes; Providing the right SERVICES , at the right time, in the right setting, for the right duration; Establishing a single benefit package for publicly funded SUD SERVICES regardless of referral source or insurance plan; and Solidifying SUD s status as a chronic health condition rather than as an acute condition. These enhancements enable SUD patients to receive quality SERVICES that match their individualized needs and preferences, and to improve health and social outcomes. This document, along with other federal, state and local regulations* govern delivery of SUD TREATMENT SERVICES in Los Angeles County. The Provider Manual is specifically designed for use by all administrative and direct service staff to ensure understanding of core values for the SUD system of care.

10 It also provides clinical and business expectations meant to ensure delivery of quality and outcome-based SERVICES . *42 Code of Federal Regulations ( ) Part 2 Confidentiality of SUBSTANCE Use DISORDER Patient Records; 42 Part 438 Managed Care; Health Insurance Portability and Accountability Act (HIPAA); California Code of Regulations (CCR) Title 9 Chapter 8 Certification of Alcohol and Other Drug counselors; CCR Title 22, Section Drug Medi-Cal SUBSTANCE Use DISORDER ; Drug Medi-Cal Organized Delivery System Special Terms and Conditions; State-County Intergovernmental Agreement; Department of Health Care SERVICES Perinatal Practice Guidelines and Youth TREATMENT Guidelines; START-ODS Implementation Plan and Finance and Rates Plan; and the Department of Public Health, SUBSTANCE Abuse Prevention and Control (SAPC) Contract including but not limited to the Specific SERVICES to be Provided and Bulletins.