Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 346.00 - Rates for Certain Substance-related and Addictive Disorders Programs
Section 346.02 - Definitions

Current through Register 1518, March 29, 2024

As used in 101 CMR 346.00, unless the context requires otherwise, terms have the meanings in 101 CMR 346.02.

Acute Treatment Provider (ATP). An eligible provider of acute treatment services.

Acute Treatment Services (Inpatient). Those medically managed and/or monitored acute intervention and stabilization services that provide supervised detoxification to individuals in acute withdrawal from alcohol or other drugs and address the biopsychosocial problems associated with alcoholism and other drug addictions requiring a 24-hour supervised inpatient stay.

Approved Program Rate. The rate per service unit approved by EOHHS and filed with the Secretary of the Commonwealth.

Case Consultation. A meeting with a professional of another agency to resolve treatment issues or to exchange other relevant client information. Case consultation may be billed only for face-to-face meetings that are necessary as a result of the inability or inappropriateness of other forms of communication, such as telephone and letter. Such circumstances and services must be documented in the client's record and be available as part of any record audit that the purchasing agency may perform.

Case Management. Services, as specified by the MassHealth program, that coordinate the substance-related and addictive disorders treatment of pregnant women with other medical and community services that are critical to the needs of the woman and her pregnancy. Case management is billable only for women enrolled in the Day Treatment Program. Service is limited to one hour per week per enrollee, provided in no less than 15-minute increments.

Child Enhancement for Residential Rehabilitation Services. A supplemental rate to reflect the costs of young children who may be accompanying their parents in the program.

Client. An individual that receives substance-related and addictive disorders services purchased by a governmental unit.

Client Resources. Revenue received in cash or in kind from publicly assisted clients to defray all or a portion of the cost of program services. Client resources may include payments made by publicly assisted clients to defray the room and board expense of residential services, clients' food stamps, or payments made by clients according to their ability to pay or a sliding fee scale.

Clinical Case Management Master's Level. Individualized case management provided as part of a clinical outpatient service that facilitates ongoing engagement in community-based treatment and recovery services; links to community resources such as housing, employment, education, and health care; and facilitates access to mainstream benefits and includes evidence-based models that integrate clinical treatment and case management services.

Clinical Case Management Non-master's Level. Individualized case management provided as part of a clinical outpatient service that facilitates ongoing engagement in community-based treatment and recovery services; links to community resources such as housing, employment, education, and health care; and facilitates access to mainstream benefits.

Clinically Managed Detoxification Services. Medical assessment, intensive counseling, and case management services to clients who are not intoxicated or have been safely withdrawn from alcohol or other drugs or are addicted to a drug that does not require medical withdrawal. These clients require a 24-hour supervised inpatient stay to address the acute emotional, behavioral, or biomedical distress resulting from an individual's use of alcohol or other drugs. This level of service includes four hours of nursing services seven days a week. These services are governed by the Massachusetts Department of Public Health at 105 CMR 164.133(A)(1)(c): Clinically Managed Detoxification.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Couple Counseling. Therapeutic counseling provided to a couple whose primary complaint or concern is disruption of their relationship or family due to substance-related and addictive disorders.

Day Treatment. A highly structured day treatment program for substance-related and addictive disorders that meets the service criteria set forth by the Massachusetts Department of Public Health pursuant to 105 CMR 164.231, 105 CMR 164.232(A) through (C), and MassHealth. A Day Treatment Program operates at least 3^ hours per day, five days per week.

Driver Alcohol Education. The program of services, provided through licensed outpatient substance-related and addictive disorders counseling programs, legislated by M.G.L. c. 90, § 24D to first offender drunk drivers adjudicated in Massachusetts courts.

Educational/Motivational Session. A meeting between staff of a Driver Alcohol Education Program and not more than 15 clients. Clients are required to participate in 32 hours of this interactive group programming through 16 two-hour groups.

Enhanced Acute Treatment Services. A program that is medically managed and/or monitored acute intervention and stabilization services, provides supervised detoxification to dually diagnosed individuals in acute withdrawal from alcohol or other drugs, and addresses the mental health needs and biopsychosocial problems associated with alcoholism and other drug addictions requiring a 24-hour supervised inpatient stay.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Established Charge. The lowest fee that is charged or accepted as payment by the provider to the general public or any third-party payer, other than a governmental unit, for the provision of services. Fees based upon the client's ability to pay, as in the case of a sliding fee scale, and fees subject to EOHHS review and approval are not established charges.

Extraordinary Circumstances/Flex Funding. A method whereby a purchasing governmental unit may provide resource allocations to a client and/or provider for specific support services in order to address extraordinary circumstances.

Family Counseling. The therapeutic counseling of more than one member of a family at the same time in the same session, where the primary complaint or concern is disruption of the family due to substance-related and addictive disorders.

Family Residential Treatment Service. A structured and comprehensive rehabilitative environment in programs ranging in size from 11 to 16 family units. Such services support a resident's recovery from alcohol and/or other drug problems, support the family's recovery from the effects of substance-related and addictive disorders, and encourage movement toward independence.

Family Supportive Housing Program. A transitional sober living environment for families recovering from substance-related and addictive disorders that assists and supports families in their recovery to achieve self-sufficiency and independent living. This is achieved through

Federally Qualified Health Centers (FQHCs) Office Based Opioid Treatment (OBOT). Community-based programs offering medication-assisted treatment (MAT) options in Federally Qualified Health Centers (FQHCs), community health centers (CHCs), or entities fully licensed under 105 CMR 164.000: Licensure of Substance Abuse Treatment Programs, 105 CMR 130.000: Hospital Licensure, or 105 CMR 140.000: Licensure of Clinics who are in good standing.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Group Counseling. Therapeutic counseling to an unrelated group of people having a common problem or concern that is associated with substance-related and addictive disorders.

Individual Consideration (I.C). Payment rates for certain services are designated as individual consideration (I.C.). Where I.C. rates are designated, the purchasing governmental unit will determine the appropriate payment as the actual cost of the item or service as evidenced by invoice, published tuition amount, or other price reasonably obtained by a competitive market for the product or service.

Individual Counseling. A therapeutic meeting between the staff of an eligible provider and an individual whose primary complaint or concern is his or her substance-related and addictive disorder or that of a significant other.

Individual Assessment Session. A meeting between a clinician and a client to explore the client's current and past substance-related and addictive disorders, psychosocial history, and motivation for change and to make recommendations for an appropriate level of care for treatment. Full assessment documentation is required.

In-home Therapy. A therapeutic counseling service for substance-related and addictive disorders provided in the home by a clinician. In-home therapy is allowed when specific barriers to accessing services at a clinic site are identified for the client. The need for in-home therapy is reassessed at least every 90 days.

Jail Diversion. A continuum of services prescribed by the courts as an alternative to jail. The first phase consists of approximately three months in a 24-hour, structured, therapeutic, semi-secure residential setting. Evidence-based treatment services are provided to address resistance to care, co-occurring disorders, and criminogenic issues, and prepare individuals to engage in ongoing substance-related and addictive disorders treatment. In the second phase, a case manager is assigned to each client for approximately nine months to assist the client's transition to community treatment and ancillary services.

Medically Monitored Inpatient Detoxification Services. Acute detoxification and related treatment services provided to individuals whose current or potential withdrawal symptoms constitute a risk to the patient's health and well-being and require medical monitoring. These services are governed by the Massachusetts Department of Public Health at 105 CMR 164.133(A)(1)(b): Medically Monitored Inpatient Detoxification Services.

Medical Services Visit. A medical services visit to an opioid treatment program includes medical assessment, medical case management, and dispensing of medication to opiate-addicted individuals who require support of opioid substitution therapy, as noted in the Department of Public Health's standard RFR program description of Opioid Treatment Programs and pursuant to 105 CMR 164.302: Provision of Services - All Opioid Treatment and 105 CMR 164.303: Additional Service Requirements for Opioid Detoxification.

Office-based Opioid Treatment (OBOT). These programs provide medically monitored treatment services for clients who are addicted to opiate drugs such as heroin or pain medications in a primary care setting. Services combine medical and pharmacological interventions with case management and supportive services. Services are offered on both a short- and long-term basis.

Office-based Opioid Treatment (OBOT) Wraparound Services. Services that provide administrative support to OBOT programs and case management services to individuals who are participating in an OBOT program utilizing medication-assisted treatment (MAT).

Operating Agency. An individual, group, partnership, corporation, trust, or other legal entity that operates a program.

Opioid Treatment. Medically monitored treatment services for opiate-addicted clients that combine medical and pharmacological interventions with professional counseling, education, and vocational services. Services are offered on both a short-term (detoxification) and long-term (treatment) basis. Any individuals who are addicted to opiate drugs and are medically screened as appropriate are eligible.

P4P Eligible Provider (P4PEP). A provider that provides a P4P eligible service.

P4P Eligible Service. A substance-related and addictive disorders treatment class of services, such as transitional support services or acute treatment services, that has been identified by the purchasing governmental unit as eligible for participation in a P4P program.

Pay for Performance (P4P). A value-based purchasing program implemented by a purchasing governmental unit to pay providers to perform activities related to improving the quality of care delivered to clients.

Postpartum Enhancement for Residential Rehabilitation Services. A supplemental rate to cover the additional staffing and other costs necessary to meet the needs of postpartum women and their infants in the program.

Pregnant Enhancement for Residential Rehabilitation Services. A supplemental rate to cover the additional staffing and other costs necessary to meet the needs of pregnant women in the program.

Provider. Any individual, group, partnership, trust, corporation, or other legal entity that offers services for purchase by a governmental unit and that meets the conditions of purchase or licensure that have been adopted by a purchasing governmental unit.

Psycho-educational Group. An educational group that provides intervention and motivation for individuals who may need substance-related and addictive disorders treatment/intervention services or who are family members of those in need of addiction treatment services.

Publicly Assisted Client. A person who receives program services for which a governmental unit is liable, in whole or in part, under a statutory program of financial assistance.

Purchasing Governmental Unit. A governmental unit that has purchased or is purchasing service units from an eligible provider.

Recovery Coaching. A non-clinical service provided by a trained recovery advocate who provides guidance and coaching for individuals to meet their recovery goals.

Recovery Support Centers (RSC). A service that provides a broad range of supports that can help individuals build a stable life in recovery. The RSCs provide peer-to-peer recovery support to individuals in recovery from substance use disorder, as well as serving families and loved ones affected by addiction. RSCs support multiple pathways, provide hope, promote wellness, and assist members in building capital and developing their own unique individual, social, and community support, to help prevent relapse and promote long-term recovery from alcohol, opioids, and other addictions.

Related Party. A person or organization that is associated or affiliated with, has control of, or is controlled by the operating agency or any director, stockholder, partner, or administrator of the operating agency by common ownership or control or in a manner specified in §§ 267(b) and (c) of the Internal Revenue Code of 1954; provided, however, that 10% is the operative factor as set out in §§ 267(b)(2) and (3) and provided further that the definition of "family members" found in § 267(c)(4) of said code includes the following for the purpose of 101 CMR 346.00:

Reporting Year. The operating agency's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR), normally July 1st to June 30th.

Residential Rehabilitation. The program of services defined as organized substance-related and addictive disorders treatment and education services featuring a planned program of care in a 24-hour residential setting. These services are provided to clients who require safe and stable living environments in order to develop their recovery skills. Types of residential rehabilitation services are those designed for adult individuals, adults with their families, adolescents, and driving-under-the-influence second offenders pursuant to the Massachusetts Department of Public Health at 105 CMR 164.000: Licensure of Substance Abuse Treatment Programs.

Residential Rehabilitation Co-occurring Enhanced. The program of services defined as organized substance-related and addictive disorders treatment and education services featuring a planned program of care in a 24-hour residential setting for individuals with a moderate-to-severe substance use and mental health disorder. These services are provided to clients in a safe, structured, and developmentally appropriate environment. This specialized program offers appropriate psychiatric and substance use treatment services, including medication evaluation and laboratory services. These services are provided on-site and as appropriate to the severity and urgency of the patient's mental condition.

School-based Targeted Prevention. Developmentally focused, competency-enhancement programs targeting 6- through 12-year-old elementary/middle school students who are at risk for early development of conduct problems, emotional dysregulation, or substance use. Program components may include needs assessment, case management, case consultation, individual counseling, psychoeducation groups, parent education and skills training, after-school and summer activities, education services, mentoring, and contingency management.

Second Offender Driver Alcohol Education Residential Rehabilitation. The program of services described in M.G.L. c. 90, § 24 and provided through licensed residential counseling programs to driving-under-the-influence second offenders.

Substance-related and Addictive Disorders Outpatient Counseling. The services defined by the Massachusetts Department of Public Health at 105 CMR 164.200: Outpatient Services.

Supportive Case Management. A program for individuals and families residing in recovery-focused transitional and permanent housing settings that includes care coordination, recovery support, housing stabilization, and facilitated access to mainstream benefits, especially primary health care. There are seven services for supportive case management: Permanent Adult, Permanent Families, Permanent Young Adults, Transitional Adults, Transitional Families, Transitional Young Adults, and Low Threshold.

Telephone Recovery Support. A telephone support service provided by a counselor who is trained in an evidence-based model of telephone recovery support.

Transitional Support Services. Residential case management services provided to bridge the gap between detoxification and residential rehabilitation and/or community ambulatory aftercare services. This level of service includes four hours of nursing services seven days a week.

Transitional Support Services with Special Programming for Women. Residential case management services provided to bridge the gap between detoxification and residential rehabilitation and/or community ambulatory aftercare services, and that focus on the unique needs of women; are structured in a smaller residential setting (16 versus 36 beds); and offer more intensive services (more counseling and smaller staff/client ratio).

Treatment for Civilly Committed Persons Add-on. An enhanced level of care that includes transportation, extra medical, psychiatric, recovery specialist care, family counseling, and additional administrative staff for the intake for all civilly committed persons in the Commonwealth. May be purchased in addition to medically monitored detoxification services, clinically managed detoxification services, and transitional support services for individuals who have been civilly committed by a district court of the Commonwealth, under M.G.L. c. 123, § 35.

Triage, Engagement, and Assessment Program. The Triage, Engagement, and Assessment (TEA) Program (formerly known as Substance Abuse Shelters for Individuals, or SASI) has as its focused populations homeless and chronically homeless adults active in their addiction who are under the influence at the point of contact with the program. Individuals are assessed, engaged, and stabilized with the intention of moving them into the substance use disorder continuum of care to provide treatment and to access permanent housing. The TEA Program provides a specialized setting for these individuals who often present as behaviorally difficult to manage due to active substance use and are often inappropriate (and frequently ineligible) for non-specialized shelter settings. Individuals in the TEA Program setting are treated with respect in a caring, judgment-free environment.

Workforce Initiatives. Funds directed to a provider for workforce development.