Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 23 - Behavioral Health Services
Rule 016.23.10-002 - Supplemental Manual for Substance Abuse Treatment Services (SATS) Rules of Practice and Procedures
Current through Register Vol. 49, No. 9, September, 2024
100.00 Introduction
This supplemental manual describes standards and requirements that community-based behavioral health care providers must follow to receive Substance Abuse Treatment Services (SATS) Programs certification. Areas addressed in this supplemental manual are:
The following Arkansas Department of Human Services Division of Behavioral Health Services publications apply and will be helpful in interpreting the requirements set forth in this supplement. See http://www.arkansas.gov/dhs/dmhs/
Refer to the Arkansas Department of Human Services Division of Medicaid Services SATS Provider Manual for general and specific guidance on Medicaid provider enrollment, application process, official notices, and billing and remittance advice message.
See
200.00 Guiding Principles for Substance Abuse Treatment Services
300.00 Eligible Beneficiaries
400.00 Eligible Provider Organizations
The following requirements must be met for DBHS/OADAP certification:
DBHS for specific populations and services provided.
NOTE:SATS certification does not guarantee enrollment in the Arkansas
Medicaid Program.
500.00 Covered Services and Service Definitions
The SATS program will cover the following services:
"The following service definitions were developed by a work group composed of members from DBHS, DMS, as well as advocates, providers, and policymakers. The service definitions also contain sections that address the target population, program requirements, treatment planning, staffing requirements, and service requirements."
SERVICES: |_______________ADDICTION ASSESSMENT_______________
DEFINITION:
The Substance Abuse Assessment Service identifies and evaluates the nature and extent of an individual's use/abuse/addiction to alcohol and/or other drugs and identifies any existing co-morbid conditions. A standardized assessment instrument, approved by DBHS and DMS must be used to complete the assessment process. The assessment process results in the assignment of a diagnostic impression, patient placement recommendation for treatment regimen appropriate to the condition and situation presented by the beneficiary, and referral into a service or level of care appropriate to effectively treat the condition(s) identified. A 9 panel test is part of the assessment to assist in the beneficiary's self-report of the alcohol and drug use and to develop an accurate diagnosis, referral and treatment plan. The 9 Panel Test is a screening test for marijuana, cocaine, benzoylecgonine, PCP, Morphine and its related metabolites derived from opium (opiates), methamphetamines (including Ecstasy), methadone, amphetamines, barbiturates, and benzodiazepines.
TARGET POPULATION:
For Beneficiaries:
Pregnant women through the last day of the month in which the 60th post-partum day falls who have a suspected substance abuse or dependency diagnosis and as clinically appropriate. Children and adolescents age 9 up to 21 years old who have a substance abuse or dependency diagnosis and as clinically appropriate.
PROGRAM REQUIREMENTS:
ASSESSMENT:
For outpatient services an assessment must be completed within 14 calendar days of the initial contact.
The Treatment Plan must be reviewed at least every ninety calendar days.
The assessment process results in the assignment of a diagnostic impression,
patient placement recommendation for treatment regimen appropriate to the condition and situation presented by the beneficiary, interim treatment plan recommendations and referral to a service appropriate to effectively treat the condition(s) identified.
If indicated, the assessment process must refer the beneficiary for a psychiatric consultation.
Alcohol and/or Other Drug Addiction Screening analysis is part of the assessment to assist in the beneficiary's self-report of the alcohol and drug use and to develop an accurate diagnosis, referral and treatment plan.
For adults the Addiction Severity Index must be used for the assessment. In addition, the Assessment must include the components set forth in the
Division of Behavioral Health Services Licensure Standards for Alcohol and/or
Other Drug Abuse Treatment Programs. Pg. 28, SA3.
For children and adolescents a nationally recognized addiction assessment tool, approved by DBHS and DMS, in addition to a thorough behavioral health assessment based on national accreditation standards, must be used.
Every Assessment and Treatment Plan must include the signature of the
Licensed Master's level professional that issued the diagnostic impression or assigned the diagnosis to confirm that the information was reviewed by the treating clinician in a face to face contact with the beneficiary.
An assessment must be completed for each new beneficiary. A new assessment should only be completed upon admission, updated annually,
when there's been a significant change in status and when there's been a change in provider (client moves to a new provider).
STAFFING REQUIREMENTS: (All staff must have a contractual or salaried employee relationship with the certified SATS Provider.)
. Board certified or board eligible Psychiatrist
. Other licensed physician in state of Arkansas
. Advanced Practice Nurse (APN) and Physicians Assistant who have a collaborative agreement with a physician licensed in state of Arkansas
. Licensed Alcoholism and Drug Abuse Counselor (LADAC)
. Advanced Certified Alcoholism and Drug Abuse Counselor (ACADC)
. Certified Co-Occurring Disorder Professional - Diplomate Level (CCDP-D)
With the addition of substance abuse credentials (LADAC, ACADC, CCDP-D), the following persons may provide substance abuse clinical services:
. Licensed Certified Social Worker (LCSW) and Licensed Master Social Worker (LMSW). (LMSW must be under approved supervision)
. Licensed Professional Counselor (LPC) and Licensed Marriage and Family Therapist (LMFT) are independent practice and don't require supervision, and Licensed Associate Counselor (LAC) - must have approved supervision
. Psychologist
. Psychological Examiner (LPE-I) licensed to practice independently
. Psychological Examiner (LPE) under the supervision of a Psychologist
SERVICES: |_________________TREATMENT PLANNING_________________
DEFINITION:
A developed plan in cooperation with the individual (parent or guardian if the individual is under 18) to deliver specific addiction services to the individual to restore, improve or stabilize the individual's condition. The plan must be based on individualized service needs identified in the completed Addiction Assessment. The plan must include goals for the medically necessary treatment of identified problems, symptoms and addiction issues. The plan must identify individuals or treatment teams responsible for treatment, specific treatment modalities prescribed for the individual, and time limitations for services.
TARGET POPULATION:
For Beneficiaries:
Pregnant women through the last day of the month in which the 60th postpartum day falls who have a substance abuse and or dependency diagnosis and as clinically appropriate.
Children and adolescents age 9 up to 21 years old who have a substance abuse or dependency diagnosis and as clinically appropriate.
PROGRAM REQUIREMENTS: TREATMENT PLANNING:
The comprehensive treatment plan shall minimally include a clear and objective statement of the client's needs to be addressed. The comprehensive treatment plan will also be completed within 14 days of admission and a new treatment plan will be completed annually.
The plan contains clearly stated and objective goals the client is capable of understanding.
The means of achieving each goal is documented.
The method and frequency of treatment per goal are documented.
The projected date of completion, per goal, is documented.
The staff person responsible for carrying out the treatment plan is specified.
Aftercare plan which addresses relapse prevention.
The treatment plan must include the components set forth in the Division of
Behavioral Health Services Licensure Standards for Alcohol and/or Other Drug
Abuse Treatment Programs. Pg. 29: CTP1.
The Treatment Plan must be reviewed at least every ninety calendar days.
STAFFING REQUIREMENTS: (All staff must have a contractual or salaried employee relationship with the certified SATS Provider.)
. Board certified or board eligible Psychiatrist
. Other licensed physician in state of Arkansas
. Advanced Practice Nurse (APN) and Physicians Assistant who have a collaborative agreement with a Physician licensed in state of Arkansas
. Licensed Alcoholism and Drug Abuse Counselor (LADAC)
. Advanced Certified Alcoholism and Drug Abuse Counselor (ACADC)
. Certified Co-Occurring Disorder Professional - Diplomate Level (CCDP-D)
With the addition of substance abuse credentials (LADAC, ACADC, CCDP-D) the following persons may provide substance abuse clinical services:
. Licensed Certified Social Worker (LCSW) and Licensed Master Social Worker (LMSW). (LMSW must be under approved supervision)
. Licensed Professional Counselor (LPC) and Licensed Marriage and Family Therapist (LMFT) are independent practice and don't require supervision, and Licensed Associate Counselor (LAC) - must have approved supervision
. Psychologist
. Psychological Examiner (LPE-I) licensed to practice independently
. Psychological Examiner (LPE) under the supervision of a Psychologist
SERVICES: | CARE COORDINATION
DEFINITION:
Care Coordination services are services that will assist the client and family in gaining access to needed medical, social, educational, and other services. Care Coordination will be provided using a wrap-around or recovery model and will include the following activities: input into the treatment planning process, coordination of the treatment planning team, referral to services and resources identified in the treatment plan, facilitating linkages between levels of care, and monitoring and follow up activities that are necessary to ensure the goals identified in the treatment plan are met or need to be revised. Care Coordination services ensure communication and collaboration between agencies, providers and other individuals necessary to implement the goals identified in the treatment plan.
TARGET POPULATION:
For Beneficiaries:
. Pregnant women through the last day of the month in which the 60th post-partum day falls who have a substance abuse or dependency diagnosis and as clinically appropriate. . Children and adolescents age 9 up to 21 years old who have a substance abuse or dependency diagnosis and as clinically appropriate. . DBHS and DMS will be responsible for identifying and updating the range of these diagnoses.
PROGRAM REQUIREMENTS:
CARE COORDINATION :
* The care coordinator is responsible for a variety of necessary functions to ensure the client's goals and needs are identified and the appropriate services are rendered. Using the information from the client's treatment plan, the care coordinator is responsible for arranging and facilitating for the provision of all services identified in the plan. The care coordinator will be responsible for coordinating regular, and as needed, meetings with the client and family to monitor and reevaluate the treatment plan as well as holding regular, and as- needed-, meetings with the program staff and others involved in the delivery of services to the client to monitor and evaluate progress. The care coordinator is responsible for participating in aftercare planning for the client in inpatient, residential or intensive outpatient services prior to discharge.
. The Care Coordinator may assist the clinician in the assessment process. They may assist the clinician in organizing and guiding the development of an individualized treatment plan. The Care Coordinator will work with the individual and family to identify a Case Planning Team and a Wrap Around Planning Team. The Case Planning Team will be the
source for information needed to form a complete assessment of the individual. The Case Planning Team includes, as appropriate, providers, care coordinators from state agencies that provide services to the individual, family members, and natural supports such as neighbors, friends and clergy. Care Coordinator activities include:
* Using the information collected through an assessment, the Care Coordinator and the clinician convenes and facilitates the Case Planning Team. The Case Planning Team with the client and family develops a person and family-centered, individualized Treatment Plan that specifies the goals and actions to address the medical, social, educational and other services needed by the eligible individual, and works directly with the client, the family (or the individual's authorized health care decision maker) and others to identify the strengths, needs and goals of the client and the strengths, needs and goals of the family in meeting the client's needs (when applicable). At a minimum, the Case Planning Team must meet monthly or more frequently if so indicated.
REFERRAL AND RELATED ACTIVITIES:
This will include:
MONITORING AND FOLLOW-UP:
These activities include reviewing the progress towards the goals in the treatment plan periodically and working with the primary care provider to update it to reflect the changing needs of the client. The Care Coordinator in conjunction with the Case Planning Team perform such reviews and include (1) whether services are being provided in accordance with the treatment plan (2) whether the services in the treatment plan are adequate and (3) whether there are changes in the needs or status of the individual and if so, adjusting the treatment plan as necessary.
Beneficiary receiving case coordination services may only have one case coordinator for all Medicaid services.________________________________
STAFFING REQUIREMENTS: (All staff must have a contractual or salaried employee relationship with the certified SATS Provider.)
A care coordinator must have the following credentials:
The following persons may provide substance abuse Care Coordinator Services while under the supervision of a Certified Clinical Supervisor (CCS) recognized by the Arkansas Substance Abuse Certification Board or Registered Clinical Supervisor recognized by the Arkansas Board of Examiners of Alcoholism and Drug Abuse Counselors (BEADAC):
Certified Alcohol and Drug Counselor (CADC)
Certified Co-occurring Disorder Professional - Bachelors Level (CCDP-B) Certified Co-Occurring Disorder Professional - Associate Level (CCDP-A) Licensed Associate Alcoholism and Drug Abuse Counselor (LAADAC) Counselor in Training (CIT) as defined by ADAP licensing standards
The staff ratios shall not exceed 30 clients to 1 care coordinator.
The Case Planning Team must include a credential practitioner and a care coordinator. The Credential Practitioner must also hold one or more of the following Credentials: CCDP-D, LADAC, or ACADC.
SERVICES: | MULTI-PERSON (FAMILY) GROUP COUNSELING DEFINITION:
Multi-Person (Family) Counseling Services is a group therapeutic intervention using face to face verbal interaction between 2 to a maximum of 9 beneficiaries and their family members or significant others. The Multi-Person (Family) Group Counseling Service provided to a group composed of family members of more than one beneficiary that is designed to enhance members' insight into family interactions, facilitate inter-family emotional or practical support and to develop alternative strategies to address familial issues, problems and needs. The goal being to support the rehabilitation and recovery effort. Multi-Family Group Counseling must be prescribed on the Treatment Plan to address familial problems or needs and to achieve goals or objectives specified on the Treatment Plan.
TARGET POPULATION:
For Beneficiaries:
Pregnant women through the last day of the month in which the 60th postpartum day falls with a substance abuse and or dependency diagnosis and as clinically appropriate.
Up to 2 family members or significant others of each beneficiary may attend. Children and adolescents age 9 up to 21 years old who have a substance abuse or dependency diagnosis and as clinically appropriate. Up to 2 family members or significant others of the beneficiary including those who have been granted custody of the adolescent beneficiary.
PROGRAM REQUIREMENTS:
MULTI-PERSON (FAMILY) GROUP COUNSELING:
Multi-Person (Family) Group Counseling is a face to face intervention delivered in a manner consistent with the goals outlined in the primary beneficiary's treatment plan. It has an identifiable approach and is used to encourage the engagement or retention of the beneficiary and significant other/family in the recovery process.
Services must be scheduled at times convenient for the significant others.
Multi-Person (Family) Group Counseling shall include those approaches that are identified by the Division of Behavioral Health Services to be evidence-based.
Multi-Person (Family) Group Counseling service must be provided in a licensed provider location. These services must be rendered by the appropriately credentialed staff of a program licensed by ADAP. HIPAA compliant release of information, completed, signed and dated.
STAFFING REQUIREMENTS: (All staff must have a contractual or salaried employee relationship with the certified SATS Provider.)
Board certified or board eligible Psychiatrist
Other licensed physician in state of Arkansas
Advanced Practice Nurse (APN) and Physicians Assistant who have a collaborative agreement with a physician licensed in state of Arkansas
Licensed Alcoholism and Drug Abuse Counselor (LADAC)
Advanced Certified Alcoholism and Drug Abuse Counselor (ACADC)
Certified Co-Occurring Disorder Professional - Diplomate Level (CCDP-D)
With the addition of substance abuse credentials (LADAC, ACADC, CCDP-D) the following persons may provide substance abuse clinical services:
Licensed Certified Social Worker (LCSW) and Licensed Master Social Worker
(LCSW) . (LMSW must be under approved supervision)
Licensed Professional Counselor (LPC) and Licensed Marriage and Family
Therapist (LMFT) are independent practice and don't require supervision,
and Licensed Associate Counselor (LAC) - must have approved supervision
Psychologist
Psychological Examiner (LPE-I) licensed to practice independently
Psychological Examiner (LPE) under the supervision of a Psychologist
SERVICES: \ INDIVIDUAL COUNSELING
DEFINITION:
Individual Counseling services includes the face to face counseling services necessary to initiate and support the rehabilitation effort, orient the beneficiary to the treatment process, develop the ongoing treatment plan, augment the treatment process, intervene in a problem area, contingency management, prevent a relapse situation, continuing care or provide ongoing psychotherapy as dictated by the beneficiary's needs.
TARGET POPULATION:
For Beneficiaries:
Pregnant women through the last day of the month in which the 60th
post-partum day falls who have a substance abuse and or dependency diagnosis and as clinically appropriate.
Children and adolescents age 9 up to 21 years old who have a substance abuse or dependency diagnosis and as clinically appropriate.
PROGRAM REQUIREMENTS:
Individual Counseling is a direct service which provides intervention for a specified problem in the treatment plan and has an identifiable approach.
Individual Counseling shall include those approaches that are identified by the Division of Behavioral Health Services to be evidence-based. Annually, the Division will publish a list of these evidence-based clinical approaches to be used by programs for this service.
STAFFING REQUIREMENTS: (All staff must have a contractual or salaried employee relationship with the certified SATS Provider.)
. Board certified or board eligible Psychiatrist
* Other licensed physician in state of Arkansas
* Advanced Practice Nurse (APN) and Physicians Assistant who have a collaborative agreement with a Physician licensed in state of Arkansas
* Licensed Alcoholism and Drug Abuse Counselor (LADAC)
* Advanced Certified Alcoholism and Drug Abuse Counselor (ACADC)
. Certified Co-Occurring Disorder Professional - Diplomate Level (CCDP-D)
With the addition of substance abuse credentials (LADAC, ACADC, CCDP-D) the following persons may provide substance abuse clinical services:
* Licensed Certified Social Worker (LCSW) and Licensed Master Social Worker (LMSW). (LMSW must be under approved supervision)
* Licensed Professional Counselor (LPC) and Licensed Marriage and Family Therapist (LMFT) are independent practice and don't require supervision, and Licensed Associate Counselor (LAC) - must have approved supervision
. Psychologist
* Psychological Examiner (LPE-I) licensed to practice independently
* Psychological Examiner (LPE) under the supervision of a Psychologist
SERVICES: |__________________GROUP COUNSELING__________________
DEFINITION:
Face-to-face interventions provided to a group of beneficiaries on a regularly scheduled basis to improve one's capacity to deal with problems that are a result of and/or contribute to substance abuse. The professional uses the emotional interactions of the group's members to assist them in implementing each beneficiary's master treatment plan, orient the beneficiary to the treatment process, support the rehabilitation effort, and to minimize relapse. Services are to be congruent with the age, strengths, needed accommodation for any disability, and cultural framework of the beneficiary and his/her family.
TARGET POPULATION:
For Beneficiaries:
Pregnant women through the last day of the month in which the
60th post-partum day falls who have a substance abuse and or dependency diagnosis and as clinically appropriate.
Children and adolescents age 9 up to 21 years old who have a substance abuse or dependency diagnosis and as clinically appropriate.
PROGRAM REQUIREMENTS: GROUP COUNSELING:
Group Counseling is a direct service which provides
intervention for a specified problem in the treatment plan and has an
identifiable approach. Group Counseling shall include those approaches that are
identified by the Division of Behavioral Health Services to be evidence-based.
Annually, the Division will publish a list of these evidence-based clinical
approaches to be used by programs for this service. See (
STAFFING REQUIREMENTS: (All staff must have a contractual or salaried employee relationship with the certified SATS Provider.)
. Board certified or board eligible Psychiatrist . Other licensed physician in state of Arkansas
* Advanced Practice Nurse (APN) and Physicians Assistant who have a collaborative agreement with a Physician licensed in state of Arkansas
. Licensed Alcoholism and Drug Abuse Counselor (LADAC)
. Advanced Certified Alcoholism and Drug Abuse Counselor (ACADC)
* Certified Co-Occurring Disorder Professional - Diplomate Level (CCDP-D)
With the addition of substance abuse credentials (LADAC, ACADC, CCDP-D) the following persons may provide substance abuse clinical services:
. Licensed Certified Social Worker (LCSW) and Licensed Master Social Worker (LMSW). (LMSW must be under approved supervision)
. Licensed Professional Counselor (LPC) and Licensed Marriage and Family Therapist (LMFT) are independent practice and don't require supervision, and Licensed Associate Counselor (LAC) - must have approved supervision
. Psychologist
. Psychological Examiner (LPE-I) licensed to practice independently
. Psychological Examiner (LPE) under the supervision of a Psychologist
SERVICES: |_____________MARITAL/FAMILY COUNSELING_____________
DEFINITION:
Face-to-face treatment provided to more than one member of a family simultaneously in the same session or treatment with an individual family member (i.e. Spouse or Single Parent) that is specifically related to achieving goals identified on the beneficiary's master treatment plan. The identified beneficiary must be present for this service. Services are to be congruent with the age, strengths, needed accommodations for disability, and cultural framework of the beneficiary and his/her family. These services are to be utilized to identify and address marital/family dynamics and improve/strengthen marital/family interactions and functioning in relationship to the beneficiary, the beneficiary's condition and the condition's impact on the marital/family relationship.
TARGET POPULATION:
For Beneficiaries:
Pregnant women through the last day of the month in which the 60th postpartum day falls who have a substance abuse and or dependency diagnosis and as clinically appropriate.
Children and adolescents age 9 up to 21 years old who have a substance ______________abuse or dependency diagnosis and as clinically appropriate.________________
PROGRAM REQUIREMENTS:
MARITAL/FAMILY COUNSELING:
Marital/Family Counseling is a direct service which provides intervention for a specified problem in the treatment plan and has an identifiable approach.
Marital/Family Counseling must target the impact the beneficiary's condition has on the spouse/family and/or improve marital/family interactions between the beneficiary and the spouse/family.
Marital/Family Counseling shall include those approaches that are identified by the Division of Behavioral Health Services to be evidence-based. Annually,
the Division will publish a list of these evidence-based clinical approaches to be used by programs for this service.
Documented plan for next session, including any homework assignments and/or crisis plans.
HIPAA compliant release of information, completed, signed and dated.
STAFFING REQUIREMENTS: (All staff must have a contractual or salaried employee relationship with the certified SATS Provider.)
. Board certified or board eligible Psychiatrist . Other licensed physician in state of Arkansas
* Advanced Practice Nurse (APN) and Physicians Assistant who have a collaborative agreement with a Physician licensed in state of Arkansas
*Licensed Alcoholism and Drug Abuse Counselor (LADAC)
* Advanced Certified Alcoholism and Drug Abuse Counselor (ACADC)
* Certified Co-Occurring Disorder Professional - Diplomate Level (CCDP-D)
With the addition of substance abuse credentials (LADAC, ACADC, CCDP-D) the following persons may provide substance abuse clinical services:
*Licensed Certified Social Worker (LCSW) and Licensed Master Social Worker (LMSW). (LMSW must be under approved supervision)
*Licensed Professional Counselor (LPC) and Licensed Marriage and Family Therapist (LMFT) are independent practice and don't require supervision, and Licensed Associate Counselor (LAC) - must have approved supervision
* Psychologist
*Psychological Examiner (LPE-I) licensed to practice independently . Psychological Examiner (LPE) under the supervision of a Psychologist
SERVICES:\MEDICATION MANAGEMENT
DEFINITION:
This service is a direct service including pharmacologic management, medication assessment, prescription, use and review of medication. This service is limited to the prescribing of psychotropic medications and those medications necessary to treat addiction related medical conditions and medication assisted addiction treatment.
TARGET POPULATION:
For Beneficiaries:
Pregnant women through the last day of the month in which the 60th post-partum day falls who have a substance abuse and or dependency diagnosis and as clinically appropriate. Children and adolescents age 9 up to 21 years old who have a substance abuse or dependency diagnosis and as clinically ____________________appropriate.____________________________________________________
PROGRAM REQUIREMENTS:
MEDICATION MANAGEMENT:
Medication Management Services are limited to psychotropic medications and those medications necessary to treat addiction related medical conditions:
* All Medication Management activities must be provided face to face.
*At a minimum, Medication Management must be available to beneficiaries during normal business hours. . This service cannot be provided in a group setting.
* Telemedicine services are available for Medication Management for beneficiaries age 21 and older for prescriptions related to addiction related medical conditions and psychotropic prescriptions only.
Methadone and Buprenorphine medication assisted addiction treatment must be delivered in a direct face to face service.
STAFFING REQUIREMENTS: (All staff must have a contractual or salaried employee relationship with the certified SATS Provider.)
. Board certified or board eligible Psychiatrist . Other licensed physician in state of Arkansas
. Advanced Practice Nurse (APN) and Physicians Assistant who have collaborative agreement with a Physician licensed in state of Arkansas
600.00 Application for DBHS Certification as SATS
Substance Abuse Treatment Program