Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1223 - OUTPATIENT DRUG AND ALCOHOL CLINIC SERVICES
GENERAL PROVISIONS
Section 1223.2 - Definitions
Current through Register Vol. 54, No. 44, November 2, 2024
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Chemotherapy clinic visit-A minimum 15-minute visit only for administration of a drug for purposes other than methadone maintenance or opiate detoxification, and evaluation of a patient's physical and mental condition during the course of prescribed medication. This visit is provided to an eligible recipient by a licensed physician or by drug/alcohol medical personnel under the supervision of a physician in an approved drug/alcohol outpatient clinic.
Comprehensive medical examination-An initial examination and evaluation by a licensed physician. The term includes a complete physical examination, comprehensive medical and drug/alcohol history, evaluation of pertinent diagnostic information necessary to formulate a diagnosis and treatment plan and recommendations for treatment or further diagnostic studies or consultation.
DAAP-Drug and alcohol addictions professional-One of the following:
(i) An individual who is certified as an addictions counselor by a Statewide certification body and who is a member of a National certification body.
(ii) An individual who is certified by another state government's substance abuse counseling certification board.
(iii) An individual possessing a minimum of a bachelor's degree in social science and 2 years experience in treatment/case management services for persons with substance abuse/addiction disorders.
(iv) An individual meeting the qualifications of one of the following:
DAC-Drug and alcohol counselor-An individual who provides a wide variety of treatment services which may include performing diagnostic assessments for chemical dependency, developing treatment plans, and providing individual and group counseling. This individual shall meet the education and experience requirements in 28 Pa. Code §704.7 (relating to qualifications for the position of counselor).
DACA-Drug and alcohol counselor assistant-An individual in an entry level position who provides treatment services under the direct supervision of a trained counselor or clinical supervisor. This individual shall meet the education, experience, supervision and training requirements in 28 Pa. Code §§704.8 and 704.11 (relating to qualifications for the position of counselor assistant; and staff development program).
DACMSP-Drug and alcohol case management specialist-An individual who meets the minimum experience and training requirements established by the State Civil Service Commission for DACMSP.
DACMST-Drug and alcohol case management specialist trainee-An individual who meets the minimum experience and training requirements established by the Civil Service Commission for DACMST.
DACMSU-Drug and alcohol case management supervisor-An individual who meets the minimum experience and training requirements established by the Civil Service Commission for DACMSU.
Department-The Department of Public Welfare of the Commonwealth.
Drug/alcohol outpatient clinic medical personnel-Licensed physicians, that is, medical doctors or osteopaths, registered nurses, licensed practical nurses, certified registered nurse practitioners and certified physician assistants.
Drug/alcohol outpatient clinic provider-A facility approved by the Department to participate in the Medical Assistance Program and which is fully or provisionally licensed by the Department of Health to provide regular psychotherapy, client management, medical and psychological outpatient services for the diagnosis and treatment of drug and alcohol abuse and dependence to eligible Medical Assistance outpatient recipients who are not residents of a treatment institution or receiving similar treatment elsewhere. A drug/alcohol clinic may provide methadone maintenance if approved to do so by the Department of Health.
Drug/alcohol outpatient clinic psychotherapy personnel-Licensed physicians, clinical social workers who have been graduated from a graduate school of social work accredited or approved by the Council on Social Work Education, licensed psychologists with psychotherapy training, and other individuals permitted by the Department of Health.
Drug/alcohol outpatient clinic services-Outpatient medical services listed in the Medical Assistance program fee schedule furnished to an outpatient while the patient is not a resident of a treatment institution, provided by or under the supervision of a physician in a facility organized and operated to provide medical care to outpatients.
Drug-free clinic visit-A minimum 15-minute clinic visit for the purpose of evaluating a patient's physical and mental condition during a course of treatment which is free of prescribed medication. This visit is provided to an eligible recipient by a licensed physician or by drug/alcohol clinic personnel under the supervision of a physician in an approved drug/alcohol outpatient clinic.
Family-A person living alone or the following persons living together: spouses; parents and their unemancipated minor children and another unemancipated minor children who are related by blood or marriage; or other adults or emancipated minor children living in the household who are dependent upon the head of the household.
Family psychotherapy-Psychotherapy provided to members of a family who regularly live and interact together. At least one family member must have a diagnosed drug/alcohol abuse or dependence problem. Sessions shall be at least 1/2 hour in duration and shall be conducted by drug/alcohol clinic psychotherapy personnel under the supervision of a physician.
Group psychotherapy-Psychotherapy provided to no less than two and no more than ten persons with diagnosed drug/alcohol abuse or dependence problems for a minimum of 1 hour. These sessions shall be conducted by drug/alcohol clinic psychotherapy personnel under the supervision of a physician.
Home visit-A compensable drug/alcohol clinic service with the exception of group psychotherapy, delivered by appropriate drug/alcohol clinic personnel to a severely physically disabled, home-bound drug/alcohol patient in his personal residence.
Individual psychotherapy-Psychotherapy provided to one person with a diagnosed drug/alcohol abuse or dependence problem for a minimum of one half hour. These sessions must be conducted by drug/alcohol clinic psychotherapy personnel under the supervision of a physician.
Inpatient-A patient who has been admitted to a treatment institution or an acute care hospital on the recommendation of a physician or dentist and is receiving room, board and professional services in the facility on a continuous 24-hour basis.
Intake-The first clinic contact with a patient for initiation or renewal of services.
Level of care assessment-A face-to-face interview with an individual using the most current edition of the Pennsylvania Client Placement Criteria for adults and the most current edition of the American Society of Addiction Medicine Patient Placement Criteria for adolescents to ascertain the severity of alcohol or other drug use and degree of impairment by identifying the biomedical, emotional/behavioral and environmental effects of that use in order to determine proper placement and treatment for the individual.
Methadone maintenance-The provision of methadone to achieve stabilization or prevent withdrawal symptoms in persons dependent upon methadone or an opiate substance with an ultimate goal of permanent discontinued use of the methadone or opiate substance by the patient. Slow withdrawal or outpatient detoxification of the patient from the maintenance substance is considered as a part of maintenance.
Methadone maintenance clinic visit-A minimum 15-minute visit only for administration of methadone, and evaluation of a patient's physical and mental condition during the course of prescribed methadone maintenance provided to an eligible recipient by a licensed physician or by drug/alcohol clinic medical personnel under the supervision of a physician in an approved drug/alcohol clinic.
Opiate detoxification clinic visit-A minimum 15-minute visit only for administration of a drug for ambulatory opiate detoxification, and evaluation of a patient's physical and mental condition during the course of prescribed medication. This visit is provided to an eligible recipient by a licensed physician or by drug/alcohol clinic medical personnel under the supervision of a physician in an approved drug/alcohol outpatient clinic. Ambulatory opiate detoxification does not follow methadone maintenance or apply to detoxification from methadone.
Outpatient-A patient who is not a resident of a treatment institution and who is receiving covered medical services at an organized licensed medical facility, or distinct part of the facility, which is not providing him with room and board and professional services on a continuous 24-hour basis.
Psychiatric evaluation-An initial mental status examination and evaluation provided only by a psychiatrist. The term includes a comprehensive history and evaluation of pertinent diagnostic information necessary to arrive at a diagnosis and treatment plan, recommendations for treatment or further diagnostic studies or consultation. The history shall include individual, social, family, occupational, drug, medical and previous drug/alcohol and psychiatric diagnostic and treatment information.
Psychosocial evaluation-A composite picture of the individual in relationship to the collected historical information in order to identify possible relationships, conditions and causes leading to the individual's current situation.
Psychotherapy-The treatment, by psychological means, of the problems of an emotional nature in which a trained person deliberately establishes a professional relationship with the patient with the object of removing, modifying or retarding existing symptoms, mediating disturbed patterns of behavior and promoting positive personality growth and development.
Single County Authority or SCA-The government agency designated by the Board of County Commissioners in a county or joinder to plan, fund and evaluate drug and alcohol activities in that county or joinder. The SCA conducts the following activities:
(i) Administration. The provision of planning, organizing, funding and control of the SCA drug and alcohol program.
(ii) Evaluation. The systematic collection, analyses and interpretation of objective data pertaining to the measurement of success in achieving goals and objectives or to the development of a needs assessment.
(iii) Research. The empirical investigation aimed at testing existing theories and generating new theories.
(iv) Training. The provision of necessary education and experience used to prepare those who will work or are currently working in the drug or alcohol field.
Supervision by a physician-Where the physician personally provides or orders, guides and oversees all compensable medical clinic services provided to recipients by drug/alcohol clinic medical and psychotherapy personnel.
Treatment institution-A facility licensed, funded or controlled by the Department of Health or its agents that provides or makes provision for full or part-time treatment or rehabilitative services for drug and alcohol abuse and dependence of resident patients.
The provisions of this § 1223.1 amended under sections 403(a) and (b), 443.3(1) and 509 of the Public Welfare Code (62 P. S. §§ 403(a) and (b), 443.3(1) and 509).
