alabama department of mental health mental health … · 7/1/2020 · services, eligible staff...

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ALABAMADEPARTMENTOFMENTALHEALTHMENTALHEALTHANDSUBSTANCEABUSESERVICES

DIVISION

SUBSTANCEABUSECONTRACTBILLINGMANUAL

EFFECTIVEJuly1,2020

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TABLEOFCONTENTSINTRODUCTION

INTRODUCTION,LISTINGOFMODIFIERS.....................................................................................................5

ASSESSMENTS

DIAGNOSTICTESTINGADMINISTEREDBYCOMPUTER(96103)...................................................................7DIAGNOSTICTESTINGADMINISTEREDBYPHYSICIAN(96101)....................................................................8DIAGNOSTICTESTINGADMINISTEREDBYTECHNICIAN(96102).................................................................9INTAKEEVALUATION(BEHAVIORALHEALTHPLACEMENTASSESSMENT(90791).....................................10INTAKEEVALUATION(BEHAVIORALHEALTHPLACEMENTASSESSMENT-SORONLY(H001).....................11INTAKE/BEHAVIORALHEALTHPLACEMENTASSESSMENTININSTITUTIONS(90791)...............................12MENTALHEALTHANDSUBSTANCEUSEDISORDERSASSESSMENTUPDATE(H0031)...............................13MEDICALASSESSMENTANDTREATMENT(H0004)...................................................................................14

ACCOMMODATIONS

ACCOMMODATIONSFORCHILDRENINRESIDENTIALSPECIALWOMEN’SPROGRAM(S9976).................16BEHAVIORALHEALTHACCOMMODATION(1003).....................................................................................17RESIDENTIALBEDHOLDDAY.....................................................................................................................18

BUNDLEDSERVICES

HOSPITALDETOXIFICATION(H0009).........................................................................................................20LEVEL1-WMAMBULATORYWITHDRAWALMANAGEMENT(H0014)......................................................21LEVEL2.5PARTIALHOSPITALIZATIONSERVICES(H0035)..........................................................................22LEVEL2-WMAMBULATORYWITHDRAWALMANAGEMENT(H0013)......................................................23LEVEL3.01TRANSITIONALRESIDENTIALTREATMENT(T2408).................................................................24LEVEL3.1CLINICALLYMANAGEDLOWINTENSITYRESIDENTIALTREATMENT(H2034)............................25LEVEL3.3CLINICALLYMANAGEDHIGH-INTENSITYRESIDENTIALTREATMENT(H0019)...........................26LEVEL3.5:CLINICALLYMANAGEDHIGHINTENSITYRESIDENTIALTREATMENT(H2036).........................27LEVEL3.5CLINICALLYMANAGEDMEDIUMINTENSITYRESIDENTIALTREATMENT(H2036).....................27LEVEL3.7MEDICALLYMONITOREDINTENSIVEINPATIENTTREATMENT(H0018)....................................28LEVEL3.7MEDICALLYMONITOREDHIGHINTENSITYINPATIENTTREATMENT(H0018)...........................28LEVEL3.7-WMMEDICALLYMONITOREDINPATIENTWITHDRAWALMANAGEMENT(H0011).................29OPIOIDUSEDISORDERTREATMENTSERVICES(H0020)............................................................................30

UNBUNDLEDSERVICES

ACTIVITYTHERAPY(H2032).......................................................................................................................32BASICLIVINGSKILLS(H0036).....................................................................................................................33BEHAVIORALHEALTHOUTREACHSERVICE(H0023)..................................................................................34BUPRENORPHINEMONOPRODUCT(J0571)..............................................................................................35BUPRENORPHINEMONOPRODUCT<3MG(J0572)....................................................................................36BUPRENORPHINE/NALOXONE>3MG<6MG(J0573)..................................................................................37BUPRENORPHINE/NALOXONE>6MG<10MG(J0574)................................................................................38BUPRENORPHINE/NALOXONE>10MG(J0575)..........................................................................................39

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CASEMANAGEMENT/TARGETEDCASEMANAGEMENT(H0006,G9012)..................................................40CHILDSITTINGSERVICES(T1009)...............................................................................................................47CRISISINTERVENTION(H2011)..................................................................................................................48DEVELOPMENTALDELAYPREVENTIONACTIVITIESFORDEPENDENTCHILDREN(H2037)........................59FAMILYCOUNSELING(90846,90847,90849)............................................................................................50FAMILYTRAININGANDCOUNSELING-FORCHILDDEVELOPMENT(T1017).............................................52GROUPCOUNSELING(90853)....................................................................................................................53INDIVIDUALCOUNSELING(90832,90834,90837).....................................................................................54INJECTABLEMEDICATIONADMINISTRATION(96372)...............................................................................55MEDICATIONMONITORING(H0034).........................................................................................................56MEDICATIONTRAININGANDSUPPORT(H0034).......................................................................................57MENTALHEALTHCONSULTATION(H0046)...............................................................................................58NALTREXONE-ORAL(J8499).......................................................................................................................59NALTREXONE-EXTENDEDRELEASEINJECTABLE(J2315)............................................................................60NARCAN(J3535).........................................................................................................................................61NON-EMERGENCYTRANSPORTATION(A0120,T2002)..............................................................................62ORALMEDICATIONADMINISTRATION(H0033).........................................................................................64PARENTINGSKILLSDEVELOPMENT(S9444)...............................................................................................65PEERCOUNSELING(H0038).......................................................................................................................66PHYSICIANRETAINER(H0016)...................................................................................................................71PHYSICIANSERVICES-INDUCTION(99205).................................................................................................72PHYSICIANSERVICES-STABILIZTION(90833)..............................................................................................73PHYSICIAN-MAINTENANCE(99213)...........................................................................................................74PSYCHOEDUCATIONALSERVICES(H2027).................................................................................................75TREATMENTPLANREVIEW(H0032)..........................................................................................................76TUBERCULOSISRISKSCREENINGANDINTERVENTION(T1023,97799).....................................................77

PREVENTION

PREVENTION(H0024,H0025,H0027,H0028,H0029)...............................................................................80

CHANGESMADETOBILLMANUAL…………………………………………………………………………………………………………….83

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INTRODUCTION

ThisdocumentistheContractBillingManualandisintendedtofunctionasacompaniontotheADMHSubstanceAbuseServicespurchaseofservicecontract.Itservestodefinebillableservices,eligiblestaff(whereappropriate),reportingcodes,units,unitrates,restrictions(ifany),andanyotherconditionofbillingtheservice.

Whileitisrecognizedthatinvolvementoffamilymembersintherehabilitationofrecipientswithmentalhealthandsubstanceusedisordersmaybenecessaryandappropriate,provisionofserviceswherethefamilyisinvolvedmustbeclearlydirectedtomeetingtheidentifiedrecipient’sneeds.Servicesprovidedtonon-Medicaideligiblefamilymembersindependentofmeetingtheidentifiedrecipient’sneedsarenotcoveredbyMedicaid.QuestionsrelativetothismanualshouldbedirectedtotheappropriateOfficeofSubstanceusedisordertreatmentServices(OSATS)teammember.

Noresidentialprogramswith17bedsormoreareeligibletobillMedicaid(IMDExclusion). Listingofmodifiercodes:59–SpecialMedicaidModifier(NCCI)AM-BuprenorphineCG–Probation(methadone)DY–DepartmentofYouthServicesGZ–BedHoldDayH9–DrugCourtHA–AdolescentHD–SpecialWomen’sHF–SubstanceAbuseHG–MethadoneHH–Co-occurringEnhancedHQ–GroupHV–StateOnlyHW:QJ–InstitutionalAssessmentHZ–IndigentOffenderSR–SORTS–Guestdosing(methadone)U6–HIVUF–Phase2-3(methadone)V1–ForuseasneededV2–ForuseasneededV3–Foruseasneeded

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DIAGNOSTICTESTINGADMINISTEREDBYCOMPUTER

Definition:Psychologicaltesting(includespsycho-diagnosticassessmentofemotionality,intellectualabilities,personalityandpsychopathology,e.g.MMPI),administeredbyacomputer,withqualifiedhealthcareprofessionalinterpretationandreport.EligibleStaff: QSAPISASReportingCode: 96103:HF,HF:HD,HF:HV,HF:H9,HF:HH,orHF:HZ-Adult 96103:HF:HA,HF:HA:DY,HF:HA:HHorHF:HA:H9-AdolescentSASReportingUnit: HourSASContractBillingRate:$85.53perhourMaximumBillableUnit(s):1hourperyearSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.NotallowableinLevelIII.01Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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DIAGNOSTICTESTINGADMINISTEREDBYPHYSICIAN

Definition:Administrationofastandardizedobjectiveand/orprojectivetestofanintellectual,personality,orrelatednatureinaface-to-faceinteractionbetweenarecipientandaqualifiedpractitioner.EligibleStaff: PhysicianorPsychologist SASReportingCode: 96101:HF,HF:HD,HF:HV,HF:H9,HF:HH,orHF:HZ--Adult 96101:HF:HA,HF:HA:DY,HF:HA:HHorHF:HA:H9–AdolescentSASReportingUnit: HourSASContractBillingRate:$150.00perhourMaximumBillableUnit(s):5hoursperyearperrecipientSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.NotallowableinLevelIII.01Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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DIAGNOSTICTESTINGADMINISTEREDBYTECHNICIAN

Definition:Administrationofastandardizedobjectiveand/orprojectivetestofanintellectual,personality,orrelatednatureinaface-to-faceinteractionbetweenarecipientandaqualifiedpractitioner.EligibleStaff: QSAPISASReportingCode: 96102:HF,HF:HD,HF:HV,HF:H9,HF:HH,orHF:HZ-Adult 96102:HF:HA,HF:HA:DY,HF:HA:HHorHF:HA:H9–AdolescentSASReportingUnit: HourSASContractBillingRate:$85.53perhourMaximumBillableUnit(s):5hoursperyearperrecipientSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.NotallowableinLevelIII.01Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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INTAKEEVALUATION(BEHAVIORALHEALTHPLACEMENTASSESSMENT)Definition: Aninitialclinicalevaluationoftherecipient’srequestforassistance,presentingpsychologicalandsocialfunctioningstatus,physicalandmedicalcondition,needforadditionalevaluationand/ortreatment,andappropriatenessfortreatmentofsubstanceusedisorders.Evaluationmayincorporatetheuseofplayequipment,physicaldevices,languageinterpreter,orotheraidstoenhancetherapeuticinteraction.EligibleStaff: QSAPISASReportingCode: 90791HF,HF:H9,HF:HD,HF:HG,HF:HH,HF:HV,orHF:HZ-Adult 90791HF:SR,HF:HD:SR,HF:HH:SR,HF:HZ:SRorHF:H9:SR-Adult

90791:HF:HA,HF:HA:DY,HF:HA:HHorHF:HA:H9–AdolescentAssessmentInstrument: ADMHIntegratedPlacementAssessmentSASReportingUnit: EpisodeSASContractBillingRate: $128.54perepisodeMaximumBillableUnit(s):1episodeperfiscalyearforstate/blockgrant;UnlimitedforMedicaid.NOTE-itisnotnecessarytoupdatetheassessmentperyearifthereisnotabreakinservice.Transferbetweenprogramsdonotrequireanewintake/assessment.SASReportingCombinationRestrictions:ThisservicecannotbebilledinconjunctionwithIndividualCounseling(90832,90834,90837),GroupCounseling(90853),FamilyCounseling(90846,90847),MultiFamilyGroupPsychotherapy(90849)orTBservices(T1023or97799).

Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.Level0.5EarlyIntervention:ThisservicecanbebilledforrecipientwithaZ03.89code.

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INTAKEEVALUATION-SORONLY(BEHAVIORALHEALTHPLACEMENTASSESSMENT)

Definition:AnADMHapprovedASAMplacementassessmentconductedinresponsetoreferralsfromtheAlabama24/7helpline.Aninitialclinicalevaluationoftherecipient’srequestforassistance,presentingpsychologicalandsocialfunctioningstatus,physicalandmedicalcondition,needforadditionalevaluationand/ortreatment,andappropriatenessfortreatmentofsubstanceusedisorders.Evaluationmayincorporatetheuseofplayequipment,physicaldevices,languageinterpreter,orotheraidstoenhancetherapeuticinteraction.Tobeeligiblefortheidentifiedrateofpayment,theevaluationmustbecompletedwithin24hoursofthereferralfromthe24/7helpline.EligibleStaff: QSAPISASReportingCode: H0001:HF:SR-Adult H0001:HF:HD:SR-SpecialWomen’s H0001:HF:HH:SR-Co-Occurring H0001:HF:HZ:SR-Indigent H0001:HF:H9:SR-DrugCourt AssessmentInstrument: ADMHIntegratedPlacementAssessmentSASReportingUnit: EpisodeSASContractBillingRate: $150perUnitMaximumBillableUnit(s): Asaccordingtotherecipient’sassessedneeds.SASReportingCombinationRestrictions:ThisservicecannotbebilledinconjunctionwithIndividualCounseling(90832,90834,90837),MultiFamilyGroupPsychotherapy(90849)orTBservices(T1023or97799).Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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INTAKE/BEHAVIORALHEALTHPLACEMENTASSESSMENTININSTITUTIONS(JAILS,PRISONS,HOSPITALS)

Definition:TheAlabamaDepartmentofMentalHealthhasenabledpaymentforthisserviceinresponsetorequestsfrompartneragenciestoassistrecipientswhoneedsubstanceusedisordertreatmentintransitioningfromaninstitutionalsettingtocommunity-basedcare.Assessmentsdoneininstitutionalsettingsarenotallowableforthepurposeofcasefinding.Theseassessmentsmustbecompletedattherequestofapotentialrecipient,familymemberonbehalfofarecipient,institutionalstaff,oranagencyorentityseekingservicesonbehalfofapotentialrecipient.Ineachofthesecases,thepersonmusthaveanindicatedneedfortransitioningfromhis/hercurrentinstitutionalsettingtoasubstanceusedisordertreatmentprogram.AllrulespublishedintheAlabamaDepartmentofMentalHealthAdministrativeCodefortheprovisionoftheIntakeEvaluation(BehavioralHealthPlacementAssessment)andrelateddocumentationareapplicabletothisservice.EligibleStaff: QSAPISASReportingCodes: 90791:HF:HW:QJ–Adult 90791:HF:HA:HW:QJ-AdolescentsAssessmentInstrument: ADMHIntegratedPlacementAssessmentSASReportingUnit: EpisodeSASContractBillingRate: $140.00perepisodeMaximumBillableUnit(s): Asaccordingtotherecipient’sassessedneedsSASReportingCombinationRestrictions:ThisservicecannotbebilledinconjunctionwithIndividualCounseling(90832,90834,90837),MultiFamilyGroupPsychotherapy(90849)orTBservices(T1023or97799).Location:Jails,Prisons,Hospitals,Locationofindividualsunderhousearrest

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MENTALHEALTHANDSUBSTANCEUSEDISORDERSASSESSMENTUPDATE

Definition:Astructuredinterviewprocessthatfunctionstoevaluatearecipient’spresentleveloffunctioningand/orpresentingneeds.Theassessmentisusedtoestablishadditionalormodifyexistingdiagnoses,establishneworadditionalrehabilitationservicegoals,assessprogresstowardgoals,and/ortodeterminetheneedforcontinuedcare,transfer,ordischarge.

EligibleStaff: QSAPISASReportingCode: H0031:HF,HF:HV,HF:H9,HF:HZ,HF:HHorHF:HD-Adult H0031:HF:SR,HF:H9:SR,HF:HH:SR,HF:HZ:SRorHF:HD:SR–Adult

H0031:HF:HA,HF:HA:DYorHF:HA:HH-AdolescentSASReportingUnit: 15min

SASContractBillingRate:$10.00per15-minuteunit

MaximumBillableUnit(s): 8unitsperday,56peryear

SASReportingCombinationRestrictions:Maynotbebilledincombinationwithintakeevaluation.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,state,andlocalcodes.

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MEDICALASSESSMENTANDTREATMENT

Definition:Face-tofacecontactwitharecipientduringwhichaqualifiedpractitionerprovidespsychotherapyand/ormedicalmanagementservices.Servicesmayincludephysicalexaminations,evaluationofco-morbidmedicalconditions,developmentormanagementofmedicationregimens,theprovisionofinsightoriented,behaviormodifying,supportive,orinteractivepsychotherapeuticservices,ortheprovisionofeducationalservicesrelatedtomanagementofaphysicalorsubstanceusedisorder.EligibleStaff: Physician

PhysicianAssistantCertifiedRegisteredNursePractitioner(CRNP)

SASReportingCode: H0004:HF,HF:HD,HF:HG,HF:HH,HF:HV,HF:HZ,HF:H9-AdultH0004:HF:HA,HF:HA:DY,orHF:HA:HH-Adolescent

SASReportingUnit: 15minutes

SASContractBillingRate:$52.00perunit

MaximumBillableUnit(s): 6unitsperday/52unitsperyear

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.NotbillablewithLevel1-WM,Level2-WM,Level3.7-WM,Level3.01,99205,90833,and99213.MayonlybebilledwithcodesJ0571,J0572,J0573,J0574andJ0575if99205,90833or99213arenotusedinanytimeframe.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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ACCOMMODATIONSFORCHILDRENINRESIDENTIALSPECIALWOMEN’SPROGRAM Definition:Overnightaccommodations(roomandboard/lodging)forchildrenofrecipientswhoareinspecialwomen’sresidentialprograms. SASReportingCode: S9976-OneChild S9976:HF-TwoChildren S9976:HF:HD-ThreeChildren SASReportingUnit: DaySASContractBillingRate: $30.00OneChild $60.00TwoChildren $90.00ThreeChildrenMaximumBillableUnit(s): OneperchildperdaySASReportingCombinationRestrictions:Parent/legalguardianmustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.OnlybillableinprogramcertifiedasaSpecialWomen’sProgramwhosewrittenprogramdescriptionallowsforchildrentocometotreatmentwiththerecipient.Location:Inaresidentialstructurethatcomplieswithallapplicablefederal,stateandlocalcodesandiscertifiedatLevel3.I,3.3,or3.5.

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BEHAVIORALHEALTHACCOMMODATION(FORMERLYRESIDENTIALBED,BOARDANDPROTECTION)

Definition: Ahighlystructured,twenty-four-hour,supervisedlivingarrangementoperatedbythefacilityusingemployeesaroundtheclock,awakestaff,anddesignedtoinitiateandpromoteasafeandsoberlivingenvironmentfortherecipients,includingfoodandhousing.Academicservicesarealsotobeprovidedwhereapplicable.

EligibleLevelsofCare: UnbundledLevel3.1,Level3.3,Level3.5,Level3.7,andLevel3.7-WM

SASReportingCode: 1003:HF,HF:HD,HF:HV,HF:H9HF:HH,orHF:HZ–AdultSupervised

Living

1003:HF:HA,HF:HA:HHorHF:HA:H9–AdolescentSASReportingUnit: Day

SASContractBillingRate:$37.42perday

MaximumBillableUnit(s): Themaximumunitsbillableinonedaycannotexceedthenumberofcertifiedbeds

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithanotherresidentialrate(MH,SAorDD).

Indisastersituationswhererecipientsmustbesentawayfromthefacilityforabrieftime,thisservicecanbebilledforuptothree(3)days.Billingmorethanthree(3)daysmustbeapprovedbytheADMHOfficeofSubstanceAbuseTreatmentServices.

Location: Level3.1,Level3.3,Level3.5,Level3.7-WMcertifiedresidentialprograms

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RESIDENTIALBEDHOLDDAY

Definition: BedHoldisdefinedfortheResidentialTreatmentProgramsContractBillingastheactofreservingabedspaceforarecipientthatisadmittedtothefacilitybutmustbetemporarilyabsentfromtheprogram.Absenceisdefinedastimeawayfromtheprogramduetoillnessthatresultsina(psychiatricorgeneral)hospitalstay,familyillness/emergency,weather-relateddisasters,temporaryincarceration,orphysicaldamageresultinginlossofpowerorwatertothefacility.Allotherconditionsmustcomplywiththegeneralrulesforbedoccupancy.TheResidentialBedHoldDayPolicyisapplicabletoallresidentiallevelsofcare.

BillingRestriction: Bedspaceforadmittedrecipientsisapprovedforpaymentforuptofour(4)beddayswithoutapprovalfromtheADMHOfficeofSubstanceusedisordertreatmentServices.ThecontractorwillsubmitonatimelybasistoMHSAStheappropriaterequestforapprovalofadditionaldayspastthefour(4)daytimelimitforthesignatureandapprovaloftheappropriatestaffmember.Requestsforapprovalmaybemadebyfaxore-mailbeforeservicesareenteredintotheAlabamaSubstanceAbuseInformationSystem(ASAIS)forpayment.

Required/EligibleStaff: Programand/orclinicaldirectorsasdefinedinthecurrentversionof

theSAAdministrativeCode.

ADMHReportingCode: AddtheGZmodifiertoanybundledresidentialcodeorBehavioralHealthAccommodationcode(i.e.H0018:HF:GZ,H0019:HF:GZ,H2036:HF:GZ,etc.).

SASReportingUnit: 1BedDay

SASContractBillingRate: $45.00Adult $60.00Co-OccurringEnhanced,AdolescentandSpecialWomen’s

DocumentationRequirements: Writtennotificationintherecipientrecordwillbenecessarywheneverarecipientisabsentfromtheprogramformorethana24-hourperiod.Documentationshouldcoverthereasonfortherecipient’sabsenceandnotethattheprogramisutilizingtheBedDayPolicy.Onoccasionswhentherecipientwillbeabsentfromtheprogramformorethanthefour(4)daysallowedbythispolicy,writtendocumentationofthereason(s)fortheabsence,alongwiththeapprovalfromtheADMHOfficeofSubstanceUseServices,mustbeincludedintherecipient’srecord.

MaximumBillingUnit(s): 4BedDays(96hours)WithoutStateApproval

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithanotherresidentialrate(MH,SAorDD).Location:Onlyappropriateforresidentialsettings.

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HOSPITALDETOXIFICATIONDefinition:Anorganizedservicedeliveredbymedicalandnursingprofessionals,whichprovides24-hourmedicallysupervisedevaluationandwithdrawalmanagementinapermanentfacilitywithinpatientbedsforindividualswhohaveopioidusedisorders,alcoholusedisordersorsedative,hypnotic,oranxiolyticusedisorder.Servicesaredeliveredunderadefinedsetofphysicianapprovedpoliciesandphysicianmonitoredproceduresorclinicalprotocols.Thislevelprovidescaretorecipientswhoseopioidwithdrawalsignsandsymptomsare,orhistoricallyhavebeen,sufficientlyseveretorequire24-hourinpatientcarewithobservation,monitoringandtreatmentbeingavailable.IfaSORmodifier(SR)isusedforopioidusedisorders,atransitionplanfromdetoxificationtotreatmentmustbeimplementedandincludetheuseofextendedreleasenaltrexone.Essentialtothislevelofcareistheavailabilityofappropriatelycredentialedandlicensednurseswhomonitorrecipientsoveraperiodofseveralhourseachdayofservice.EligibleStaff: SeeADMHAdministrativeCode.SASReportingCode: H0009:HF–Adult H0009:HF:SR-Adult H0009:HF:HH:SR–Co-Occurring H0009:HF:HZ:SR-Indigent H0009:HF:H9:SR-DrugCourtSASReportingUnit: 1daySASContractBillingRate: $425.00/Unit MaximumBillableUnit(s): 1perdaySASReportingCombinationRestrictions:Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).Location:Servicescanbedeliveredinahospitalsettingonly.Itmustaffordanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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LEVEL1:WMAMBULATORYWITHDRAWALMANAGEMENTWITHOUTEXTENDEDON-SITEMONITORING

Definition:LevelI-WMisanorganizedoutpatientservice,deliveredbytrainedclinicianswhoprovidemedicallysupervisedassessment,medicationornon-medicationmethodsofwithdrawalmanagement,recipienteducation,non-pharmacologicalclinicalsupport,involvementoffamilymembersorsignificantothersinthewithdrawalmanagementprocess,anddischargeortransferplanning,includingreferralforcounselingandinvolvementincommunityrecoverysupportgroupsforthoseindividualswithadiagnosedopioidusedisorder,alcoholusedisorderorsedative,hypnotic,oranxiolyticusedisorder.Therapiesalsoincludephysicianand/ornursemonitoring,assessment,andmanagementofsignsandsymptomsofintoxicationandwithdrawal

EligibleStaff: SeeADMHAdministrativeCode.SASReportingCodes: H0014:HF,HF:HV,HF:H9,orHF:HZ-Adult H0014:HF:HD–SpecialWomen’s H0014:HF:HH–Co-occurringSASReportingUnit: 1daySASContractBillingRate: $45.00Adult$54.00Co-occurringEnhancedorSpecialWomen’sSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).MaximumBillableUnit(s):1perday

Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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LEVEL2.5:PARTIALHOSPITALIZATIONSERVICES

Definition: Partialhospitalizationprogramsgenerallyfeature20ormorehoursofclinicallyintensiveprogrammingperweek,aswellasdailyornear-dailycontact,asspecifiedintherecipient’streatmentplan.Theseprogramstypicallyhavedirectaccesstoorclosereferralrelationshipwithpsychiatric,medicalandlabservices.

EligibleStaff: SeeADMHAdministrativeCode.SASReportingCode: H0035:HF,HF:HV,HF:H9,orHF:HZ-Adult H0035:HF:HD–SpecialWomen’s H0035:HF:HH–Co-OccurringEnhancedSASReportingUnit: Hour

SASContractBillingRate:$16.25Adult$19.50Co-occurringEnhancedandSpecialWomen’s


SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).Theserestrictionsapplywhilearecipientisattending/activelyenrolledinPartialHospitalizationwhethertherestrictedservicesoccuronthesamedayasPartialHospitalization.


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LEVEL2WM:AMBULATORYWITHDRAWALMANAGEMENTWITHEXTENDEDON-SITEMONITORING

Definition:Level2WMdetoxificationisanorganizedoutpatientservice,whichmaybedeliveredbymedicalandnursingprofessionalswhoprovidemedicallysupervisedevaluation,detoxificationandreferralservicesforthoseindividualswithadiagnosedopioidusedisorder,alcoholusedisorderorsedative,hypnotic,oranxiolyticusedisorder.Outpatientwithdrawalmanagementservicesshallbedesignedtotreattherecipient'slevelofclinicalseverityandtoachievesafeandcomfortablewithdrawalfrommood-alteringsubstances,aswellaseffectivelyfacilitatetherecipient'sentryintoongoingtreatmentandrecovery.IfSORmodifierisused,transitionplanmustincludetheuseofextendedreleasenaltrexone.Essentialtothislevelofcareistheavailabilityofappropriatelycredentialedandlicensednurseswhomonitorrecipientsoveraperiodofseveralhourseachdayofservice.Adetaileddescriptionoftheservicestypicallyofferedinthislevelofcare,thecaresettingandhowtoidentifywhichrecipientswouldbenefitbestfromtheseservicesbasedonanASAMdimensionalneedsassessment,isdescribedinthemostrecentpublicationoftheASAMcriteria.

EligibleStaff: SeeADMHAdministrativeCode.SASReportingCode: H0013:HF,HF:HV,HF:H9,HF:HZ,orHF:SR-Adult H0013:HF:HH–Co-OccurringEnhanced H0013:HF:HD–SpecialWomen’sSASReportingUnit: 1daySASContractBillingRate: $145.00Adult $174.00Co-OccurringEnhancedorSpecialWomen’sMaximumBillableUnit(s): 1perdaySASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).


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LEVEL3.01:TRANSITIONALRESIDENTIALTREATMENT

Definition: Aresidentialservicethatprovidessubstanceusedisordersupportiveservicesandtherapeuticactivitiesconductedinaresidentialsettingdesignedtoprovideanenvironmentconducivetorecoveryandtopromotereintegrationintothemainstreamofsociety.

EligibleStaff: SeeADMHAdministrativeCode.SASReportingCode: T2048:HF,HF:HV,HF:H9,orHF:HZ-Adult T2048:HF:HD–SpecialWomen’s T2048:HF:HH–Co-OccurringEnhanced

SASReportingUnit: DaySASContractBillingRate: $40.00perdayAdult

$48.00perdayCo-OccurringEnhancedandSpecialWomen’s

MaximumBillableUnit(s): Themaximumunitsbillableinonedaycannotexceedthenumberofcertifiedbeds.

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).Location:Inaresidentialstructurethatcomplieswithallapplicablefederal,state,andlocalcodes.

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LEVEL3.1:CLINICALLYMANAGEDLOWINTENSITYRESIDENTIALTREATMENTADULT

Definition: Programoffersatleast5hoursperweekoflowintensitytreatmentofsubstanceusedisorders.Treatmentischaracterizedbyservicessuchasindividual,group,andfamilytherapy;medicationmanagement;andpsychoeducation.Theseservicesfacilitatetheapplicationofrecoveryskills,relapseprevention,andemotionalcopingstrategies.Theypromotepersonalresponsibilityandreintegrationoftherecipientintothenetworksystemsofwork,education,andfamilylife.Mutual/self-helpmeetingsareavailableon-site,oreasilyaccessibleinthelocalcommunity.Adetaileddescriptionoftheservicestypicallyofferedinthislevelofcare,thecaresettingandhowtoidentifywhichrecipientswouldbenefitbestfromtheseservicesbasedonanASAMdimensionalneedsassessment,isdescribedinthemostrecentpublicationoftheASAMCriteria.

EligibleStaff: SeeADMHAdministrativeCode.

SASReportingCode: H2034:HF,HF:HV,HF:H9,orHF:HZ-Adult H2034:HF:HD–SpecialWomen’s H2034:HF:HH–Co-OccurringEnhanced

SASReportingUnit: Day

SASContractBillingRate: $54.00Adult$65.00Co-occurringEnhancedandSpecialWomen’s

MaximumBillableUnit(s): Themaximumunitsbillableinonedaycannotexceedthenumberofcertifiedbeds.SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).Location:Inaresidentialstructurethatcomplieswithallapplicablefederal,state,andlocalcodes.

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LEVEL3.3:CLINICALLYMANAGEDPOPULATION-SPECIFICHIGHINTENSITYADULTRESIDENTIALTREATMENT

Definition:Provideastructuredrecoveryenvironmentincombinationwithhighintensityclinicalservicesprovidedinamannertomeetthefunctionallimitationsofrecipientstosupportrecoveryfromsubstance-relateddisorders.ForthetypicalrecipientinaLevel3.3program,theeffectsofthesubstanceuseorotheraddictivedisorderoraco-occurringdisorderresultingincognitiveimpairmentontheindividual’slifearesosignificant,andtheresultinglevelofimpairmentsogreat,thatoutpatientmotivationaland/orrelapsepreventionstrategiesarenotfeasibleoreffective.Similarly,therecipient’scognitivelimitationsmakeitunlikelythatheorshecouldbenefitfromotherlevelsofresidentialcare.ThefunctionallimitationsseeninindividualswhoareappropriatelyplacedinLevel3.3areprimarilycognitiveandcanbeeithertemporaryorpermanent.Whenassessmentindicatesthatsuchanindividualisnolongercognitivelyimpaired,heorshecanbetransferredtoahigherorlowerlevelofcarebasedupontheseverityofillnessandrehabilitativeneeds.Adetaileddescriptionoftheservicestypicallyofferedinthislevelofcare,thecaresettingandhowtoidentifywhichrecipientswouldbenefitbestfromtheseservicesbasedonanASAMdimensionalneedsassessment,isdescribedinthemostrecentpublicationoftheASAMcriteria.


SASReportingCode: H0019:HF,HF:HV,HF:HZ,orHF:H9-Adult H0019:HF:HH–Co-OccurringEnhanced H0019:HF:HD–SpecialWomen’sSASReportingUnit: 1day

SASContractBillingRate:$90.00Adult$115.00Co-OccurringEnhancedandSpecialWomen’s


SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).

Location:Inaresidentialstructurethatcomplieswithallapplicablefederal,state,andlocalcodes.

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LEVEL3.5:CLINICALLYMANAGEDHIGHINTENSITYRESIDENTIALTREATMENT-ADULTS

LEVEL3.5:CLINICALLYMANAGEDMEDIUMINTENSITYRESIDENTIALTREATMENT-ADOLESCENTS

Definition: Programsaredesignedtoserverecipientswho,becauseofspecificfunctionallimitations,needsafeandstablelivingenvironmentstodevelopand/ordemonstratesufficientrecoveryskillssothattheydonotimmediatelyrelapseorcontinuetouseinanimminentlydangerousmannerupontransfertoalessintensivelevelofcare.Thislevelassistsrecipientswhoseaddictioniscurrentlysooutofcontrolthattheyneeda24-hoursupportivetreatmentenvironmenttoinitiateorcontinuearecoveryprocessthathasfailedtoprogress.Theirmultidimensionalneedsareofsuchseveritythattheycannotsafelybetreatedinlessintensivelevelsofcare.Manyrecipientstreatedinthislevelhavesignificantsocialandpsychologicalproblems.Adetaileddescriptionoftheservicestypicallyofferedinthislevelofcare,thecaresettingandhowtoidentifywhichrecipientswouldbenefitbestfromtheseservicesbasedonanASAMdimensionalneedsassessment,isdescribedinthemostrecentpublicationoftheASAMcriteria.EligibleStaff: SeeADMHAdministrativeCode.SASReportingCode H2036:HF,HF:HA,HF:HV,HF:H9,orHF:HZ-Adult H2036:HF:HA,HF:HA:H9–Adolescent H2036:HF:HH–Co-OccurringEnhanced H2036:HF:HD–SpecialWomen’s H2036:HF:HA:HH–AdolescentCo-OccurringEnhancedSASReportingUnit: DaySASContractBillingRate: $120.00Adult

$144.00Adolescent,Co-OccurringEnhanced,TANFandSpecialWomen’s

MaximumBillableUnit(s): Cannotexceednumberofcertifiedbeds.

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).Location:Inaresidentialstructurethatcomplieswithallapplicablefederal,state,andlocalcodes.

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LEVEL3.7:MEDICALLYMONITOREDINTENSIVEINPATIENTTREATMENT-ADULTS

LEVEL3.7:MEDICALLYMONITOREDHIGH-INTENSITYINPATIENTTREATMENT-ADOLESCENTSDefinition:Programsprovideaplannedandstructuredregimeof24-hourprofessionallydirectedevaluation,observation,medicalmonitoringandaddictiontreatmentinaninpatientsetting.Thislevelofcareisappropriateforthoserecipientswhosesub-acute,biomedicalandemotional,behavioralorcognitiveproblemsaresoseverethattheyrequireinpatienttreatment,butwhodonotneedthefullresourcesofanacutecaregeneralhospitaloramedicallymanagedinpatienttreatmentprogram.Adetaileddescriptionoftheservicestypicallyofferedinthislevelofcare,thecaresettingandhowtoidentifywhichrecipientswouldbenefitbestfromtheseservicesbasedonanASAMdimensionalneedsassessment,isdescribedinthemostrecentpublicationoftheASAMcriteria.

EligibleStaff: SeeADMHAdministrativeCode.SASReportingCode: H0018:HF,HF:HV,HF:H9,orHF:HZ–Adult H0018:HF:HH–Co-Occurring H0018:HF:HD–SpecialWomen’s H0018:HF:HA-AdolescentSASReportingUnit: 1day

SASContractBillingRate:$145.00Adult$190.00Adolescent,SpecialWomen’sCo-OccurringEnhanced



Location:Inaresidentialstructurethatcomplieswithallapplicablefederal,state,andlocalcodes.

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LEVEL3.7-WMMEDICALLYMONITOREDINPATIENTWITHDRAWALMANAGEMENT

Definition:Level3.7-WMisanorganizedservicedeliveredbymedicalandnursingprofessionals,whichprovides24-hourmedicallysupervisedevaluationandwithdrawalmanagementinapermanentfacilitywithinpatientbedsforthoseindividualswithadiagnosedopioidusedisorder,alcoholusedisorderorsedative,hypnotic,oranxiolyticusedisorder.Servicesaredeliveredunderadefinedsetofphysician-approvedpoliciesandphysician-monitoredproceduresorclinicalprotocols.Thislevelprovidescaretorecipientswhosewithdrawalsignsandsymptomsaresufficientlyseveretorequire24-hourinpatientcarewithobservation,monitoringandtreatmentbeingavailable.IfSORmodifierisused,transitionplanmustincludetheuseofextendedreleasenaltrexone.

Adetaileddescriptionoftheservicestypicallyofferedinthislevelofcare,thecaresettingandhowtoidentifywhichrecipientswouldbenefitbestfromtheseservicesbasedonanASAMdimensionalneedsassessment,isdescribedinthemostrecentpublicationoftheASAMcriteria.


SASReportingCode: H0011:HF,HF:GZ,HF:HV,HF:HZ,HF:SR,HF:H9:SR,HF:HD:SR,HF:HH:SRorHF:HZ:SR–Adult

SASReportingUnit: 1day

SASContractBillingRate:DeterminedperagencySASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).MaximumBillableUnit(s):Maximumof15daysperepisode;ADMHapprovalrequiredforepisodeslastinglongerthan15daysLocation:Inaresidentialstructurethatcomplieswithallapplicablefederal,state,andlocalcodes.

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OpioidUseDisorderTreatment

Definition:Forthepurposesofthisdefinitionandbillingcode,themedicationsreferencedaremethadoneandbuprenorphine.OpioidUseDisorderTreatmentisdefinedastheadministrationofmedicationtorecipientswhohaveadiagnosedopioidusedisorder.Medicationisadministeredtosupporttherecipient’seffortstorestoreadequatefunctioninginmajorlifeareasthathavebeendebilitatedbecauseofopioidaddiction.Thisserviceincludesmedicationadministrationandconcurrentrelatedmedicalandclinicalservices.Treatmentwiththeuseofmethadoneorbuprenorphineisdesignedtooffertherecipientanopportunitytoeffectconstructivechangesinhis/herlifethroughtheprovisionofmedicationassistanceinconjunctionwithcounselingandmedicalservices.

EligibleStaff: SeeADMHAdministrativeCode.EligibleProviderTypeforAdministrationofMedication: Physician,Physician’sAssistant,CRNP, RN,LPNSASReportingCode: H0020:HF,HF:HD,HF:HG,HF:HH,HF:HD:HG,HF:HH:HG

HF:HG:V1,HF:HG:UF,HF:HG:V3,HF:HG:CG,HF:HG:TS,HF:SR,HF:HD:SR,HF:HH:SR,HF:HZ:SR,HF:H9:SR-MethadoneH0020:HF:AM-Buprenorphine

SASReportingUnit: DaySASContractMaximumBillingRate: $17.00perdayformethadone $27.00perdayforbuprenorphine MaximumBillableUnit(s): 1perdaySASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHandSAMHSAcertifiedopioidtreatmentprogram.MayonlybebilledinconjunctionwithH0013,H0014,T2408,H2034,H0019,H2036,andH0018.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.Locationandservicesshouldfollowallapplicablefederal,state,andlocalcodes.

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ACTIVITYTHERAPYDefinition:ActivityTherapy–Structured,object-oriented,music,dance,art,social,orplaytherapeuticactivitiesconducted,notforrecreationalpurposes,byaqualifiedsubstanceabuseprofessionalwithdocumentedspecializedtraining,toengagetherecipientincreativeendeavorsthathelptoalterthethoughtprocessesoftherecipientinapositivemanner,toassistarecipientindevelopingorenhancingpsychosocialcompetencies,toalleviateemotionaldisturbance,tochangemaladaptivepatternsofbehavior,and/ortoassistinrestoringtherecipienttoaleveloffunctioningcapableofsupportingandsustainingrecovery.EligibleStaff: QSAPI,QSAPII,orQSAPIII(withdocumentedspecializedtraining)SASReportingCode: H2032:HF:HA,HF:HA:H9,HF:HA:DY,HF:HA:HZ-Adolescent H2032:HF:HD-SpecialWomen’s H2032:HF:HH-Co-occurringEnhanced H2032:HF:HA:HH–AdolescentCo-occurringEnhanced

H2032:HF:HA:HQ,HF:HA:H9:HQ,HF:HA:DY:HQ,HF:HA:HZ:HQ–AdolescentGroup

H2032:HF:HD:HQ-SpecialWomen’s-Group H2032:HF:HH:HQ-Co-occurringEnhanced–Group H2032:HF:HA:HH:HQ-AdolescentCo-occurringEnhanced-GroupSASReportingUnit: 15-minuteunitsSASContractBillingRate: $14.00–Individual $4.00–GroupMaximumBillableUnit(s):4unitsperday/832unitsperyearforIndividual 10unitsperday/1040unitsperyearforGroup.

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srighttoprivacyandconfidentiality.

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BASICLIVINGSKILLS

Definition:Servicesprovidedonanindividualorgroupbasistoenablearecipienttomaintaincommunitytenureandtoimprovehisorhercapacityforindependentliving.Keyservicesfunctionsincludetrainingandassistanceindevelopingormaintainingskillssuchaspersonalhygiene,housekeeping,mealpreparation,shopping,laundry,moneymanagement,usingpublictransportation,medicationmanagement,healthylifestyle,stressmanagement,andbehavioreducationappropriatetotheageandsettingoftherecipient,aswellasrecipienteducationaboutthenatureoftheillness,symptoms,andtherecipient’sroleinmanagementoftheillnessEligibleStaff: QSAPI,QSAPII,QSAPIII,QPP,RNorADMHCertifiedRecovery

SupportSpecialist(CRSS)SASReportingCode: H0036:HF,HF:HV,HF:H9,HF:HZ,HF:CU,HF:H9:CUorHF:HZ:CU–

Adult H0036:HF:HD–SpecialWomen’s H0036:HF:HH–Co-OccurringEnhanced

H0036:HF:HA–AdolescentH0036:HF:HA:HH–AdolescentCo-occurringEnhancedH0036:HF:HA:H9–AdolescentDrugCourtH0036:HF:HQ,HF:HV:HQ,HF:H9:HQ,orHF:HZ:HQ–AdultGroupH0036:HF:HD:HQ–SpecialWomen’sGroupH0036:HF:HH:HQ–Co-OccurringEnhancedGroupH0036:HF:HA:HQ–AdolescentGroupH0036:HF:HA:HH:HQ–AdolescentCo-OccurringEnhancedGroupH0036:HF:HA:H9:HQ–AdolescentDrugCourtGroup


SASContractBillingRate:$14.00Individual

$4.00Group

MaximumBillableUnit(s): 20unitsperday/2080unitsperyearforIndividual 8unitsperday/2080unitsperyearforGroup



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BEHAVIORALHEALTHOUTREACHSERVICEDefinition:Behavioralhealthoutreachservicesareaplannedapproachtoreachatargetedpopulation.Contractedprovidersmustuseoutreachmodelsthatarescientificallysound.Federalregulationsidentifythreeexamplesofscientificallysoundmodelsthatmaybeused.Theyare:

1. TheStandardInterventionModel2. TheHealthEducationModel3. TheIndigenousLeaderModel

Noonemodelfitsallcommunitiesorallsituations.Ifnoneofthemodelslistedaboveareapplicabletothelocalsituation,thecontractedprovidermayuseanapproachwhichreasonablycanbeexpectedtobeeffectiveandwhichhasbeenapproved,inwriting,byADMH.Whenothermodelsareused,theprovidersmustshowhow,withinthatcommunity,thechosenmodelhastheexpectationtobeeffective.

Asoutreachdemonstratesanagency’swillingnesstogotothecommunityratherthanthecommunitycomingtoit,providersmustensurethattheiroutreachefforts:

a. Consistofcontracting,communicatingwith,andfollowingupwithhigh-risksubstanceabusers,theirassociates,andtheneighborhoodresidents.

b. Adheretofederalandstateconfidentialityrequirements.c. Promoteawarenessabouttherelationshipbetweeninjectingdrugabuseand

communicablediseases.d. RecommendstepsthatcanbetakentopreventHIVtransmission.e. Addresstheselection,training,andsupervisionoftheiroutreachworkers.f. Encouragerecipiententryintotreatment.

Thisserviceisnotbilledperrecipient,itisbilled(likeprevention)ona“dummy”recipientthatindicatesservicestounknownrecipients.EligibleStaff: MaybeconductedbystaffwhomeetsthequalificationsforQSAPI,

QSAPII,QSAPIII,QualifiedParaprofessional,orCertifiedRecoverySupportSpecialist(CRSS).

SASReportingCode: H0023:HF,HF:HA,HF:HV,HF:H9,orHF:HZ-Adult H0023:HF:HD–SpecialWomen’s H0023:HF:HH–Co-occurringenhanced H0023:HF:HA–Adolescent


SASContractBillingRate:$9Adults$12Adolescents,Co-OccurringEnhanced&SpecialWomen’s

MaximumBillableUnit(s): 12unitsperdayperprovider

SASReportingCombinationRestrictions:NoneLocation:Thisservicewillbedeliveredinasafecommunityenvironment.

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BUPRENORPHINEMONOPRODUCTDefinition:PurchaseofBuprenorphineMonoproductfromanappropriatelyauthorized,licensedAlabamadispenser.EligibleStaff: RegisteredNurse(RN)orLicensedPracticalNurse(LPN)orPhysician

whoisappropriatelyauthorized/licensed.SASReportingCode: J0571:HF:SR-Adult J0571:HF:HD:SR-SpecialWomen’s J0571:HF:HH:SR-Co-Occurring J0571:HF:HZ:SR-Indigent J0571:HF:H9:SR-DrugCourtSASReportingUnit: Dose/daySASContractBillingRate: $4.00perdoseMaximumBillableUnits: Onedoseperday;cannotexceedthenumberofdaysinamonthSASReportingCombinationRestrictions: MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Onedoseperday.MaynotbebilledinconjunctionwithH0020,J0572,J0573,J0574orJ0575.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient’srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,stateandlocalcodes.

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BUPRENORPHINE/NALOXONE(COMBINATIONPRODUCT<3MG)

Definition:PurchaseofBuprenorphine/NaloxonecombinationProductsfromanappropriatelyauthorized,licensedAlabamadispenser.EligibleStaff: RegisteredNurse(RN)orLicensedPracticalNurse(LPN)orPhysician

whoisappropriatelyauthorized/licensed.SASReportingCode: J0572:HF:SR-Adult J0572:HF:HD:SR-SpecialWomen’s J0572:HF:HH:SR-Co-Occurring J0572:HF:HZ:SR-Indigent J0572:HF:H9:SR-DrugCourtSASReportingUnit: DoseSASContractBillingRate: $14.00perdoseMaximumBillableUnits: OnedoseperdaySASReportingCombinationRestrictions: MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Onedoseperday.MaynotbebilledinconjunctionwithH0020,J0571,J0573,J0574orJ0575.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient’srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,stateandlocalcodes.

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BUPRENORPHINE/NALOXONE

(COMBINATIONPRODUCT>3mg-<6mg)Definition:PurchaseofBuprenorphine/NaloxonecombinationProductsfromanappropriatelyauthorized,licensedAlabamadispenser.EligibleStaff: RegisteredNurse(RN)orLicensedPracticalNurse(LPN)ORPhysician

whoisappropriatelyauthorized/licensed.SASReportingCode: J0573:HF:SR-Adult J0573:HF:HD:SR-SpecialWomen’s J0573:HF:HH:SR-Co-Occurring J0573:HF:HZ:SR-Indigent J0573:HF:H9:SR-DrugCourtSASReportingUnit: DoseSASContractBillingRate: $14.00perdoseMaximumBillableUnits: OnedoseperdaySASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Onedoseperday.MaynotbebilledinconjunctionwithH0020,J0571,J0572,J0574orJ0575.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient’srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,stateandlocalcodes.

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BUPRENORPHINE/NALOXONE(COMBINATIONPRODUCTS>6mg-<10mg)

Definition:PurchaseofBuprenorphine/NaloxonecombinationProductsfromanappropriatelyauthorized,licensedAlabamadispenser.EligibleStaff: RegisteredNurse(RN)orLicensedPracticalNurse(LPN)ORPhysician


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BUPRENORPHINE/NALOXONE

(COMBINATIONPRODUCT>10MG)Definition:PurchaseofBuprenorphine/NaloxonecombinationProductsfromanappropriatelyauthorized,licensedAlabamadispenser.EligibleStaff: RegisteredNurse(RN)orLicensedPracticalNurse(LPN)ORPhysician


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CASEMANAGEMENT

Definition:Acasemanagerassistsarecipientinidentifyingtherecipient'sgoals,strengthsandneeds;planswiththerecipientwhatservicesandcommunityresourcesmighthelptherecipienttoaccomplishtherecipient'sgoals;helpsrefer(andoftenaccompanies)therecipienttoobtainservicesandresources;andthenmonitorsandcoordinatestheservicesandresourcesreceivedtoassurethattherecipientisgettingthehelpneededtoaccomplishtherecipient'sgoalsandtoaddresstherecipient’sneeds.

Thesearethefourservicecomponentstoservicesthatcasemanagersprovidetotheirrecipients:

• Assessment• Planning• Referralandlinkage• Monitoringandcoordination.

ASSESSMENT:Comprehensiveassessmentandperiodicreassessmentofrecipientneeds,todeterminetheneedforanymedical,educational,socialorotherservices.Theseassessmentactivitiesinclude:

• takingrecipienthistory;• identifyingtherecipient’sneedsandcompletingrelateddocumentation;and• gatheringinformationfromothersourcessuchasfamilymembers,medicalproviders,

socialworkers,andeducators(ifnecessary),toformacompleteassessmentoftheeligiblerecipient.

Reassessment/follow-up–Thecasemanagershallevaluate,atintervalsofsixmonthsorless,throughinterviewsandobservations,theprogressoftherecipienttowardaccomplishingthegoalslistedinthecaseplan.Inaddition,thepersonsand/oragenciesprovidingservicestotherecipientwillbecontactedandtheresultsofthesecontacts,togetherwiththechangesinneedshowninthereassessments,willbeutilizedtoaccomplishanyneededrevisionstothecaseplan.PLANNING:Development(andperiodicrevision)ofaspecificcaseplan,thatisbasedontheinformationcollectedthroughtheassessment,that:

• specifiesthegoalsandactionstoaddressthemedical,social,educational,andotherservicesneededbytherecipient;

• includesactivitiessuchasensuringtheactiveparticipationoftheeligiblerecipient,andworkingwiththerecipient(ortherecipient’sauthorizedhealthcaredecisionmaker)andotherstodevelopthosegoals;and

• identifiesacourseofactiontorespondtotheassessedneedsoftheeligiblerecipient;REFERRALANDLINKAGE:Referralandrelatedactivities(suchasschedulingappointmentsfortherecipient)tohelptheeligiblerecipientobtainneededservicesincluding:

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• activitiesthathelplinktherecipientwithmedical,social,andeducationalproviders,orotherprogramsandservicesthatarecapableofprovidingneededservicestoaddressidentifiedneedsandachievegoalsspecifiedinthecaseplan;and

MONITORINGANDCOORDINATION:Monitoringandfollow-upactivitiesinclude:• activitiesandcontactsthatarenecessarytoensurethecaseplanisimplementedand

adequatelyaddressestheeligiblerecipient’sneeds,andwhichmaybewiththerecipient,familymembers,serviceproviders,orotherentitiesorrecipientsandisconductedasfrequentlyasnecessary,andincludingatleastoneannualmonitoring,todeterminewhetherthefollowingconditionsaremet:o servicesarebeingfurnishedinaccordancewiththerecipient’scaseplan;o servicesinthecaseplanareadequate;ando changesintheneedsorstatusoftherecipientarereflectedinthecaseplan.

Monitoringandfollow-upactivitiesincludemakingnecessaryadjustmentsinthecaseplanandservicearrangementswithproviders.

EligibleStaff: StaffmemberswhohavesuccessfullycompletedanADMH,

OSATS,approvedCaseManagerTrainingprogramandwhomeetthequalificationsofaQSAPI,QSAPIIQSAPIII,QPPorCertifiedRecoverySupportSpecialist(CRSS).

SASReportingCodes: H0006:HF,HF:HD,HF:HG,HF:HH,HF:HV,H0006:HF:TB,

HF:HZorHF:H9-AdultH0006:HF:HA,HF:HA:DY,HF:HA:HHorHF:HA:H9–Adolescent

SASReportingUnit: Five(5)minuteincrementsSASContractBillingRate: $4.63perunit-Adult $5.35perunit–Adolescent,Special’sWomen.Co-occurring EnhancedMaximumBillableUnit(s): NoneSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.ThecompletionofaHumanServicesNeedsAssessmentisrequiredforenhancedbilling.


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CaseManagement

TargetedCaseManagement–SOROnly

Definition:Acasemanagerassistsarecipientinidentifyingtherecipient'sgoals,strengthsandneeds;planswiththerecipientwhatservicesandcommunityresourcesmighthelptherecipienttoaccomplishtherecipient'sgoals;helpsrefer(andoftenaccompanies)therecipienttoobtainservicesandresources;andthenmonitorsandcoordinatestheservicesandresourcesreceivedtoassurethattherecipientisgettingthehelpneededtoaccomplishtherecipient'sgoalsandtoaddresstherecipient’sneeds.

Thesearethefourservicecomponentstoservicesthatcasemanagersprovidetotheirrecipients:

• Assessment• Planning(includestheuseofADMHapprovedHumanServicesNeedsAssessment)• Referralandlinkage• Monitoringandcoordination.

ASSESSMENT:Comprehensiveassessmentandperiodicreassessmentofrecipientneeds,todeterminetheneedforanymedical,educational,socialorotherservices.Theseassessmentactivitiesinclude:

• takingrecipienthistory;• identifyingtherecipient’sneedsandcompletingrelateddocumentation;and• gatheringinformationfromothersourcessuchasfamilymembers,medicalproviders,

socialworkers,andeducators(ifnecessary),toformacompleteassessmentoftheeligiblerecipient.

Reassessment/follow-up–Thecasemanagershallevaluate,atintervalsofsixmonthsorless,throughinterviewsandobservations,theprogressoftherecipienttowardaccomplishingthegoalslistedinthecaseplan.Inaddition,thepersonsand/oragenciesprovidingservicestotherecipientwillbecontactedandtheresultsofthesecontacts,togetherwiththechangesinneedshowninthereassessments,willbeutilizedtoaccomplishanyneededrevisionstothecaseplan.PLANNING:Development(andperiodicrevision)ofaspecificcaseplan,thatisbasedontheinformationcollectedthroughtheassessmentandtherequiredADMHHumanServicesNeedsassessment,that:

• specifiesthegoalsandactionstoaddressthemedical,social,educational,andotherservicesneededbytherecipient;

• includesactivitiessuchasensuringtheactiveparticipationoftheeligiblerecipient,andworkingwiththerecipient(ortherecipient’sauthorizedhealthcaredecisionmaker)andotherstodevelopthosegoals;and

• identifiesacourseofactiontorespondtotheassessedneedsoftheeligiblerecipient;

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REFERRALANDLINKAGE:Referralandrelatedactivities(suchasschedulingappointmentsfortherecipient)tohelptheeligiblerecipientobtainneededservicesincluding:

• activitiesthathelplinktherecipientwithmedical,social,andeducationalproviders,orotherprogramsandservicesthatarecapableofprovidingneededservicestoaddressidentifiedneedsandachievegoalsspecifiedinthecaseplan;and

MONITORINGANDCOORDINATION:Monitoringandfollow-upactivitiesinclude:• activitiesandcontactsthatarenecessarytoensurethecaseplanisimplementedand

adequatelyaddressestheeligiblerecipient’sneeds,andwhichmaybewiththerecipient,familymembers,serviceproviders,orotherentitiesorrecipientsandisconductedasfrequentlyasnecessary,andincludingatleastoneannualmonitoring,todeterminewhetherthefollowingconditionsaremet:o servicesarebeingfurnishedinaccordancewiththerecipient’scaseplan;o servicesinthecaseplanareadequate;ando changesintheneedsorstatusoftherecipientarereflectedinthecaseplan.

Monitoringandfollow-upactivitiesincludemakingnecessaryadjustmentsinthecaseplanandservicearrangementswithproviders.

EligibleStaff: StaffmemberswhohavesuccessfullycompletedanADMH,

OSATS,approvedCaseManagerTrainingprogramandwhomeetthequalificationsofaQSAPI,QSAPIIQSAPIII,QPPorCertifiedRecoverySupportSpecialist(CRSS).

SASReportingCodesforSOR: G9012:HF:SRAdult G9012:HF:HD:SRSpecialWomen’s G9012:HF:HH:SRCo-Occurring G9012:HF:HZ:SRIndigent G9012:HF:H9:SRDrugCourtSASReportingUnitforSOR: Five(5)minuteincrementsSASContractBillingRateforSOR: $5.82/UnitMaximumBillableUnit(s)forSOR:12UnitsperdaySASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogramwhichprovidesMAT.ThecompletionofaHumanServicesNeedsAssessmentisrequired.


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CASEMANAGEMENT

TargetedCaseManagement–MedicaidRecipientsOnly(Target9) Definition–MedicaidTCM-9:Casemanagementservicesarecomprehensiveservicesthatassisteligible individualsingainingaccesstoneededmedical,social,educationalandother services.TargetedCaseManagement(TCM)servicesassistspecificeligible recipients,ortargetedindividuals,toaccessotherservices.

TargetGroup9consistsofMedicaid-eligibleindividualswhohaveadiagnosedsubstanceusedisorderorsubstanceinduceddisorder,inaccordancewithcriteriasetforthbythemostrecenteditionoftheDiagnosticandStatisticalManualofMentalDisorders(DSM)publishedbytheAmericanPsychiatricAssociation,andwhomeetthefollowingadditionalcriteria.

(1)Individualswho:

(a) Havebeenunabletoindependentlymaintainasustainedperiodofrecoveryafterrepeatedtreatmentepisodes;or

(b) Havelittleornoaccesstocommunityresourcesnecessarytosupportsustainedrecoveryefforts;or

(c) Haveco-morbidconditions,asmentalillness,emotionaldisorders,intellectualdisabilities,medicalconditions,sensoryimpairments,ormobilityimpairments;or

(d) Havesignificantresponsibilityforthecareofdependents,aswellasthemselves.CoreServices–MedicaidTCM-9:

• Needsassessment

• Caseplanning

• Servicearrangement• Socialsupport

• Reassessmentandfollow-up

• MonitoringNEEDSASSESSMENT–MedicaidTCM-9:

ATCMproviderperformsawrittencomprehensiveassessmentofthe recipient’sassets,deficits,andneeds.TheTCMprovidergathersthe followinginformation:

• Identifyinginformation

• Socializationandrecreationalneeds

• Trainingneedsforcommunityliving

• Vocationalneeds

• Physicalneeds

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• Medicalcareconcerns

• Socialandemotionalstatus

• Housingandphysicalenvironment

• ResourceanalysisandplanningCASEPLANNING–MedicaidTCM-9:

TCMprovidersmustdevelopasystematic,recipient-coordinatedplanofcare thatliststheactionsrequiredtomeettheidentifiedneedsoftherecipient basedontheneedsassessment.Theplanisdevelopedthrougha collaborativeprocessinvolvingtherecipient,hisfamilyorothersupport system,andthecasemanager.Itmustbecompletedinconjunctionwiththeneedsassessmentwithinthefirst30daysofcontactwiththerecipient.SERVICEARRANGEMENT–MedicaidTCM-9:

Throughlinkageandadvocacy,thecasemanagercoordinatescontacts betweentherecipientandtheappropriatepersonoragency.Thesecontactsmaybefacetoface,phonecalls,orelectroniccommunication.MONITORING–MedicaidTCM-9:

Thecasemanagerdetermineswhatserviceshavebeendeliveredandwhethertheyadequatelymeettheneedsoftherecipient.Theplanofcare mayrequireadjustmentsbecauseofmonitoring.SOCIALSUPPORT–MedicaidTCM-9:

Throughinterviewswiththerecipientandsignificantothers,thecasemanager determineswhethertherecipientpossessesanadequatepersonalsupport system.Ifthispersonalsupportsystemisinadequateornonexistent,thecase managerassiststherecipientinexpandingorestablishingsuchanetwork throughadvocacyandlinkingtherecipientwithappropriatepersons,support groups,oragencies.REASSESSMENTANDFOLLOWUP–MedicaidTCM-9:Throughinterviewsandobservations,thecasemanagerevaluatesthe recipient’sprogresstowardaccomplishingthegoalslistedinthecaseplanat intervalsofsixmonthsorless.Inaddition,thecasemanagercontacts personsoragenciesprovidingservicestotherecipientandreviewstheresultsofthesecontacts,togetherwiththechangesintherecipient’sneeds showninthereassessmentsandrevisesthecaseplanifnecessary.

EligibleStaff–MedicaidTCM-9 StaffmemberswhohavesuccessfullycompletedanADMH,

OSATS,approvedCaseManagerTrainingprogramandwhopossessaminimumofaBachelorofArtsoraBachelorofSciencedegree,preferablyinahumanservicerelatedfieldorsocialworkprogram.MustreceiveapprovalofADMH

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priortoprovisionofservices.SASReportingCodesforMedicaidTCM-9: G9008:U9SASReportingUnitforMedicaidTCM-9: Five(5)minuteincrementsSASContractBillingRateforMedicaidTCM-9: $6.85/UnitMaximumBillableUnit(s): NoneSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.ThecompletionofaHumanServicesNeedsAssessmentisrequired.

Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.TCM-9servicescannotbeprovidedintotalcareenvironments,suchasnursingfacilities,hospitals,andresidentialprograms.

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CHILDSITTINGSERVICESDefinition: Careofthechildoftherecipientwhilereceivingsubstanceusedisordertreatment.EligibleStaff: Mustbe18yearsofage,currentlycertifiedinFirstAidandCPRattimeofhire,andpassacriminalbackgroundcheck. SASReportingCode: T1009:HF:HDSpecialWomen’s SASReportingUnit: 1-hourunitSASContractBillingRate: $12.00SASReportingCombinationRestrictions:Parent/guardianmustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.OnlybillableinprogramcertifiedasaSpecialWomen’sProgramwhosewrittenprogramdescriptionallowsforchildrentocometotreatmentwiththerecipient.

Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,whichaffordsanadequatetherapeuticenvironmentwhichprotectstherecipient'srightstoprivacyandconfidentialityandisseparatefromadultclinicalservices.

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CRISISINTERVENTIONDefinition: Immediateemergencyinterventionwitharecipient,ortherecipient’sfamily,legalguardian,and/orsignificantotherstoameliorateamaladaptiveemotional/behavioralreactionbytherecipient.Serviceisdesignedtoresolveacrisisanddevelopsymptomaticrelief,increaseknowledgeofresourcestoassistinmitigatingafuturecrisis,andfacilitatethereturntopre-crisisroutinefunctioning.Keyservicefunctionsincludethefollowing:

• Specifyingfactorsthatledtotherecipient’scrisisstate,whenknown

• Identifyingthemaladaptivereactionsexhibitedbytherecipient

• Evaluatingthepotentialforrapidregression

• Resolvingthecrisis

• Referringtherecipientfortreatmentatanalternativesetting,whenindicated

EligibleStaff: QSAPI,QSAPII,QSAPIII,CRNP,RN,LPNorCRSSSASReportingCode: H2011:HF,HF:HV,HF:H9,orHF:HZ–Adult H2011:HF:HD–SpecialWomen’s H2011:HF:HH–Co-occurringEnhanced H2011:HF:HA,HF:HA:HHorHF:HA:H9–AdolescentSASReportingUnit: 15minutes

SASContractBillingRate: $22.00

MaximumBillableUnit(s): Limitedto12unitsperday/4380unitsperyear.

SASReportingCombinationRestrictions:Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).


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DEVELOPMENTALDELAYPREVENTIONACTIVITIESFORDEPENDENTCHILDRENDefinition:Structuredactivitiesprovidedforchildrenofrecipientsintreatment,duringthesametimeasthespecificoccurrenceoftheparent’streatment.Theseservicesfunctiontofosterhealthypsychological,emotional,social,andintellectualdevelopmentofthechild.EligibleStaff: QSAPI,QSAPII,QSAPIII,

QPP,orCertifiedRecoverySupportSpecialist(CRSS),withspecializedtraining,andco-signatureofQSAPIorQSAPII

SASReportingCode: H2037:HF:HDIndividual

H2037:HF:HD:HQGroupSASReportingUnit(s): 15minutesSASContractBillingRate: $18.75Recipient $5.00GroupMaximumBillableUnit(s): Four(4)perday,perchildSASReportingCombinationRestrictions:Parent/guardianmustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.OnlybillableinprogramcertifiedasaSpecialWomen’sProgramwhosewrittenprogramdescriptionallowsforchildrentocometotreatmentwiththerecipient.Location:Servicesmaybeprovidedinanyappropriatesettingthatprotectstherecipients’rightstoprivacy,confidentiality,andsafety,andmeetstheADMHfacilitycertificationstandards.

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FAMILYCOUNSELINGDefinition:Arecipientfocusedinterventionthatmayincludetherecipient,his/herfamilyunitand/orsignificantothers,andaqualifiedpractitioner.Thisserviceisdesignedtomaximizestrengthsandtoreducebehaviorproblemsand/orfunctionaldeficitsstemmingfromtheexistenceofasubstanceusedisorder(andanyco-occurringmentalhealthdisorder)thatinterfereswiththerecipient’spersonal,familial,vocational,and/orcommunityfunctioning.Whileitisrecognizedthatinvolvementoffamilymembersintherehabilitationofrecipientswithmentalhealthandsubstanceusedisordersmaybenecessaryandappropriate,provisionofserviceswherethefamilyisinvolvedmustbeclearlydirectedtomeetingtheidentifiedrecipient’sneeds.Servicesprovidedtonon-Medicaideligiblefamilymembersindependentofmeetingtheidentifiedrecipient’sneedsarenotcoveredbyMedicaid.

EligibleStaff: QSAPIorQSAPII

SASReportingCode: 90846:HF,HF:HD,HF:HG,HF:HH,HF:HV,HF:HZ,HF:H9,orHF:59–Adultwithoutrecipientpresent

90847:HF,HF:HD,HF:HG,HF:HH,HF:HV,HF:HZ,HF:H9,orHF:59-Adultwithrecipientpresent

90849:HF,HF:HD,HF:HG,HF:HH,HF:HV,HF:HZ,HF:H9,orHF:59-MultipleFamilyGroupPsychotherapyAdult

90846:HF:HA,HF:HA:DY,HF:HA:H9,HF:HA:HHorHF:HA:59-Adolescentwithoutrecipientpresent

90847:HF:HA,HF:HA:DY,HF:HA:H9,HF:HA:HHorHF:HA:59-Adolescentwithrecipientpresent

90849:HF:HA,HF:HA:DY,HF:HA:H9,HF:HA:HHorHF:HA:59-MultipleFamilyGroupPsychotherapyAdolescent

SASReportingUnit: 1Episode

SASContractBillingRate: WithoutRecipientPresent(90846)Adult-$80.05perepisode,60minutesminimumAdolescent,SpecialWomen’sandCo-occurringEnhanced-$100.59

perepisode,60minutesminimum

WithRecipientPresent(90847)Adult-$83.34perepisode,60minutesminimumAdolescent,SpecialWomen’sandCo-occurringEnhanced-$104.17perepisode,60minutesminimum

MultipleFamilyGroup(90849)-$32.57perepisode,90minutesminimum,perRecipient

MaximumBillableUnit(s):Foreachcode–1episodeperday,104episodesperyear

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).MaynotbebilledinconjunctionwithIntakeEvaluation/BehavioralHealthPlacementAssessment(90791).

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Level0.5EarlyIntervention:ThisservicecanbebilledforrecipientwithZ03.89code.MaximumBillableUnits:4episodesperyear.

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FAMILYTRAININGANDCOUNSELING-FORCHILDDEVELOPMENTDefinition: Theprovisionofchild-focusedtrainingandcounselingforparentsor/significantotherstosupportageappropriatechilddevelopment.Interventionsaddresstheassesseddevelopmental,bio-psychosocial,andemotionalneedsofinfants,toddlers,andchildrenthroughageeighteenandprovideguidanceandageappropriatestrategiestosupporthealthydevelopmentandfunctioningofthispopulation.EligibleStaff: QSAPI,QSAPII,orQSAPIIIwithspecializedtrainingasapprovedby

ADMHOfficeofSubstanceusedisordertreatmentServicesSASReportingCode: T1017:HF:HD–SpecialWomen’sSASReportingUnit: 15minutesSASContractBillingRate: $18.75MaximumBillableUnit(s): Eight(8)perdaySASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.OnlybillableinprogramcertifiedasaSpecialWomen’sProgramwhosewrittenprogramdescriptionallowsforchildrentocometotreatmentwiththerecipient.Location:Servicesmaybeprovidedinanyappropriatesettingthatprotectstherecipients’rightstoprivacy,confidentiality,andsafety,andmeetstheADMHfacilitycertificationstandards.

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GROUPCOUNSELING

Definition:Theutilizationofprofessionalskillsbyaqualifiedpractitionertoassisttwoormoreunrelatedrecipientsinagroupsettinginachievingspecificobjectivesoftreatmentorcareforamentalhealthand/orsubstanceusedisorder.Servicesaregenerallydirectedtowardalleviatingmaladaptivefunctioningandbehavioral,psychological,and/oremotionaldisturbances,andutilizationofthesharedexperiencesofthegroup’smemberstoassistinrestorationofeachrecipienttoaleveloffunctioningcapableofsupportingandsustainingrecovery.GroupCounselingmayconsistofinsightoriented,behaviormodifying,supportive,orinteractivepsychotherapeuticservicestrategies.EligibleStaff: QSAPIorQSAPIISASReportingCode: 90853:HF,HF:HD,HF:HG,HF:HH,HF:HV,HF:HZ,HF:H9,orHF:59HF

Adult

90853:HF:HA,HF:HA:DY,HF:HA:H9,HF:HA:HHorHF:HA:59-Adolescent

SASReportingUnit: 1Episode(eachepisodeisa90-minuteminimum)

SASContractBillingRate:$25.05perepisode

MaximumBillableUnit(s): 1episodeperday/104episodesperyear

GroupSizeLimit: 15pertherapist

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).MaynotbebilledinconjunctionwithIntakeEvaluation/BehavioralHealthPlacementAssessment(90791).


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INDIVIDUALCOUNSELING

Definition:Theutilizationofprofessionalskillsbyaqualifiedpractitionertoassistarecipientinaface-to-face,one-to-onepsychotherapeuticencounterinachievingspecificobjectivesoftreatmentorcareforamentalhealthand/orasubstanceusedisorder.Servicesaregenerallydirectedtowardalleviatingmaladaptivefunctioningandemotionaldisturbancesrelativetoamentalhealthand/orsubstanceusedisorder,andrestorationoftherecipienttoaleveloffunctioningcapableofsupportingandsustainingrecovery.IndividualCounselingmayconsistofinsightoriented,behaviormodifying,supportive,orinteractivepsychotherapeuticservices.

EligibleStaff: QSAPIorQSAPII

SASReportingCode: 90832:HF,HF:HD,HF:HG,HF:HH,HF:HV,HF:HZ,HF:H9,orHF:59Adult90834:HF,HF:HD,HF:HG,HF:HH,HF:HV,HF:HZ,HF:H9,orHF:59Adult90837:HF,HF:HD,HF:HG,HF:HH,HF:HV,HF:HZ,HF:H9,orHF:59Adult

90832:HF:HA,HF:HA:DY,HF:HA:HH,HF:HA:H9,HF:HA:59–Adolescent90834:HF:HA,HF:HA:DY,HF:HA:HH,HF:HA:H9,HF:HA:59–Adolescent90837:HF:HA,HF:HA:DY,HF:HA:HH,HF:HA:H9,HF:HA:59–Adolescent

SASReportingUnit: 1unitbasedontimespentinactivity

SASContractBillingRate: Adult$49.93fortimespentbetween16and37minutes(use90832)$66.38fortimespentbetween38and52minutes(use90834)$99.79fortimeof53minutesandmore(use90837)

Adolescent,SpecialWomen’s,EnhancedCo-occurring$62.41fortimespentbetween16and37minutes(use90832)$82.97fortimespentbetween38and52minutes(use90834)

$124.73fortimeof53minutesormore(use90837)MaximumBillableUnit(s): 1unitperday/52unitsperyear

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).Onlyoneofthethreecodes(90832,90834and90837)maybebilledperday.90832,90834,and90837maynotbebilledinconjunctionwithIntakeEvaluation/BehavioralHealthAssessment(90791).


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INJECTABLEMEDICATIONADMINISTRATION

Definition: Administrationofinjectablemedicationunderthedirectionofaphysician,physicianassistantorcertifiedregisterednursepractitioner.

EligibleStaff: RegisteredNurse(RN)orLicensedPracticalNurse(LPN)

SASReportingCode: 96372:HF,HF:HD,HF:HV,HF:H9,HF:HH,orHF:HZAdult

96372:HF:HA,HF:HA:DY,HF:HA:HH,orHF:HA:H9AdolescentSASReportingUnit: Episode

SASContractBillingRate:$23.12

MaximumBillableUnit(s): 1perdaySASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.CannotbebilledinconjunctionwithcodeJ2315Extendedreleasenaltrexone. Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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MEDICATIONMONITORING

Definition: Face-to-facecontactbetweenaqualifiedprofessional,otherthanaphysician,andarecipientforthepurposeofreviewingmedicationefficacy,monitoringcompliancewithdosageinstructions,educatingtherecipientandfamily/significantothersoftheexpectedeffectofspecifiedmedication,and/oridentifyingneededchangesinthemedicationregimen.EligibleStaff: QSAPI,QSAPII,andQSAPIII,

RegisteredNurse(RN),LicensedPracticalNurse(LPN)LicensedPharmacist

SASReportingCode: H0034:HF,HF:HV,HF:H9,HF:HHorHF:HZ-Adult H0034:HF:HD–SpecialWomen’s

H0034:HF:HA,HF:HA:HHorHF:HA:H9–AdolescentSASReportingUnit: 15minutes



SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.NotbillableinLevelIII.01orinconjunctionwithcodesH0020,J0571,J0572,J0573,J0574,J0575,J8499orJ2315.


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MEDICATIONTRAININGANDSUPPORT(SHAREDDECISIONMAKING)

Definition:AnindividualsessioninwhichtheDecisionsinRecovery(SAMHSA)supporttoolisutilizedtoprovidearecipientwhohasanopioidusedisorderwithinformationabouttheroleofmedicationsintreatingthisdisorder.Recipientswillreceivefactsonvariousoptionsformedicationassistedtreatment,comparetreatmentoptionsinrelationtohis/heridentifiedneeds,discusspreferenceswiththeprovider,anddecidewhichoptionisbestforhim/her.Therecipient’sdecisionswillbeincorporatedintothetreatmentplanningprocess.EligibleStaff: QSAPI,QSAPII,andQSAPIII,RegisteredNurse(RN), LicensedPracticalNurse(LPN),CRSSSASReportingCode: H0034:HF:SR-Adult H0034:HF:HD:SR–SpecialWomen’s H0034:HF:HH:SR-Co-Occurring H0034:HF:HZ:SR-Indigent H0034:HF:H9:SR-DrugCourtSASReportingUnit: 15minutesSASContractBillingRate:$22.00/UnitMaximumBillableUnit(s): 4unitsperday SASReportingCombinationRestrictions:MusthavereceivedapprovedtrainingontheuseofSharedDecisionMaking.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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MENTALHEALTHCARECOORDINATIONDefinition:Assistingotherexternalserviceagencyprovidersorindependentpractitionersinprovidingappropriateservicestoanidentifiedrecipientbyprovidingclinicalconsultation.Keyservicefunctionsincludewrittenorverbalinteractioninaclinicalcapacitytoassistanotherprovidertomeetthespecifictreatmentneedsofanindividualrecipientandtoassurecontinuityofcaretoanothersetting.EligibleStaff: QSAPI,QSAPIIorQSAPIII,

CRNP,RN

SASReportingCode: H0046:HF,HF:HV,orHF:HZ–Adult H0046:HF:HD–SpecialWomen’s H0046:HF:HH–Co-occurringEnhanced H0046:HF:HA,HF:HA:HHorHF:HA:H9–AdolescentSASReportingUnit: 15minutes



SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.

Location:Servicescanbedeliveredinanysettingthatisacceptableforbothparties,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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NALTREXONE-ORALDefinition:PurchaseofOralNaltrexonefromanappropriatelyauthorized,licensedAlabamadispenser.EligibleStaff: RegisteredNurse(RN)orLicensedPracticalNurse(LPN)ORPhysician

whoisappropriatelyauthorized/licensed.SASReportingCode: J8499:HF:SR-Adult J8499:HF:HD:SR-SpecialWomen’s J8499:HF:HH:SR-Co-Occurring J8499:HF:HZ:SR-Indigent J8499:HF:H9:SR-DrugCourtSASReportingUnit: DoseSASContractBillingRate: $2.00perdoseMaximumBillableUnits: OnedoseperdaySASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Onedoseperday.MaynotbebilledinconjunctionwithH0020,J0571,J0572,J0573,J0574orJ0575.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient’srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,stateandlocalcodes.

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NALTREXONE-EXTENDEDRELEASEINJECTABLEDefinition:Theadministrationofmedication,includingtheuseofFDAapprovedmedicationsfortheuseofopioidusedisorders,torecipientswhohaveadiagnosedopioidusedisorder.Medicationisadministeredtosupporttherecipient’seffortstorestoreadequatefunctioninginmajorlifeareasthathavebeendebilitatedbecauseofopioidusedisorder.EligibleStaff: RegisteredNurse(RN),LicensedPracticalNurse(LPN),Physician’s

Assistant,CRNPORPhysicianwhoisappropriatelyauthorized/licensed.

SASReportingCode: J2315:HF:SR-Adult J2315:HF:HD:SR-SpecialWomen’s J2315:HF:HH:SR-Co-Occurring J2315:HF:HZ:SR-Indigent J2315:HF:H9:SR-DrugCourtSASReportingUnit: InjectionSASContractBillingRate: $1300.00MaximumBillableUnits: Oneinjectioneveryfourweeks.SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.MaynotbebilledinconjunctionwithH0020,J0571,J0572,J0573,J0574orJ0575.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient’srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,stateandlocalcodes.

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NARCANNASALSPRAYDefinition:AdministrationofNARCANNasalSprayfortreatmentofanopioidemergency,suchasanoverdoseorapossibleopioidoverdose.Mayalsobedistributedtorecipientaspartofwrittenoverdosepreventionplan.EligibleStaff: RegisteredNurse(RN)orLicensedPracticalNurse(LPN)ORPhysician

whoisappropriatelyauthorized/licensed.SASReportingCode: J3535:HF:SRAdult J3535:HF:HD:SRSpecialWomen’s J3535:HF:HH:SRCo-Occurring J3535:HF:HZ:SRIndigent J3535:HF:H9:SRDrugCourtSASReportingUnit: 4mgDoseSASContractBillingRate: $37.50/DoseMaximumBillableUnits: Asaccordingtorecipient’sassessedneed.SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogramforanopioidusedisorderdiagnosis.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient’srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,stateandlocalcodes.

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NON-EMERGENCYTRANSPORTATION

Definition-State/Block/SORGrant:Servicesutilizedtotransportarecipienttoand/orfromatreatmentprogramortootherservicesassessedasneededandspecifiedintheserviceplan.Theagencymustdemonstratethattherecipienthasnoothermeansoftransportationtoand/orfromneededservicesandtheservicemustbelistedasaninterventionontheserviceplan.

Definition-Medicaid:TheNon-EmergencyTransportationprovidesnecessarynon-ambulancetransportationservicestoMedicaidrecipients.MedicaidpaysfortransportationofaMedicaidrecipienttoanauthorizedlocationforreceiptofacoveredmentalillnessorsubstanceabuserehabilitationserviceasspecifiedinChapter105oftheAlabamaMedicaidProviderBillingManual.RequirementsforprovisionanddocumentationofthisservicearespecifiedinAppendixDoftheAlabamaMedicaidProviderBillingManual.EligibleStaff: Appropriatelyscreenedagencystaffmemberswho:areatleast19yearsold;

areinpossessionofavaliddriver’slicenseforthetypeofvehicleusedforthisservice;carry,atalltimes,thename(s)andtelephonenumber(s)oftheperformingprovider’sstafftonotifyincaseofamedicalorotheremergency;areprohibitedfromtheuseofalcohol,drugs,tobaccoproducts,cellularphonesorothermobiledevices,orfromeatingwhiledriving;andareprohibitedfromleavingaminorunattendedinthevehicleatanytime.

State/BlockGrant/CURES/SORReportingCodes: A0120:HF:HVorHF:SR–AdultA0120:HF:HDorHF:HD:SR–SpecialWomen’sA0120:HF:HHorHF:HH:SR–Co-occurringA0120:HF:HZorHF:HZ:SR-IndigentA0120:HF:H9orHF:H9:SR-DrugCourtA0120:HF:HA:HV–Adolescent

A0120:HF:HA:HH–AdolescentCo-Occurring

MedicaidReportingCodes: T2002:HF–AdultT2002:HF:HD–SpecialWomen’sT2002:HF:HH–AdultCo-occurringEnhancedT2002:HF:HA–AdolescentT2002:HF:HA:HH–AdolescentCo-occurringEnhanced

SASReportingUnit(s): 1episode,onewayorroundtrip

SASContractBillingRateforState/BlockGrant/Medicaid: $17perepisode

SASContractBillingRateforSOR: $20perepisode

MaximumBillableUnit(s): Oneepisodeperday,perrecipient

SASReportingCombinationRestrictions: MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.

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Location:Servicemaybeprovidedinanyappropriatesettingthatprotectstherecipients’rightstoprivacy,confidentiality,andsafety,andmeetstheADMHfacilitycertificationstandards.

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ORALMEDICATIONADMINISTRATION

Definition: Administrationoforalmedicationunderthedirectionofaphysician,physicianassistant,orcertifiedregisterednursepractitioner.EligibleStaff: QSAPI,QSAPII,QSAPIII,QualifiedParaprofessionalQPPorCertified

RecoverySupportSpecialist(CRSS)mustholdacurrentMACcertification.CRNP,RN,orLPN.

SASReportingCode: H0033:HF-Adult

H0033:HF:HA–AdolescentH0033:HF:HD-SpecialWomen’sH0033:HF:HH-AdultCo-occurringH0033:HF:HA:HH–AdolescentCo-occurring

SASReportingUnit: EpisodeSASContractBillingRate:$14.00perepisodeMaximumBillableUnit(s): 1perdaySASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.CannotbebilledinconjunctionwithcodesH0020,J0571,J0572,J0573,J0574,J0575,J8499orJ2315.CannotbebilledforrecipientswhomtheMASnursehasdeterminedarecapableofself-administrationofmedication.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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PARENTINGSKILLSDEVELOPMENT

Definition:Astructuredface-to-faceencounterconductedforenhancingtheparentingcompetencyofrecipientswhoareparentsofdependentchildren,andwhohaveasubstanceusedisorder.Thisservicemayincludeinteractiveactivitiesinvolvingtherecipients’children.EligibleStaff: QSAPI,QSAPIIorQSAPIII.

QPP,orCertifiedRecoverySupportSpecialist(CRSS),withspecializedtraining,andco-signatureofQSAPIorQSAPII

SASReportingCode: S9444:HF:HD–SpecialWomen’sIndividual S9444:HF:HD:HQ–SpecialWomen’sGroupSASReportingUnit(s): Episode(50-minutesession)SASContractBillingRate: $37.50Recipient $12.00GroupMaximumBillableUnit(s): TwoperdaySASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.OnlybillableinprogramcertifiedasaSpecialWomen’sProgramwhosewrittenprogramdescriptionallowsforchildrentocometotreatmentwiththerecipient.Location:Servicesmaybeprovidedinanyappropriatesettingthatprotectstherecipients’rightstoprivacy,confidentiality,andsafety,andmeetstheADMHfacilitycertificationstandards.

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PEERCOUNSELING

Definition:AserviceprovidedtorecipientsandtheirfamiliesinanindividualorgroupsettingbyaCertifiedRecoverySupportSpecialistCRSSwhouseshis/herlifeexperiencewithmentalhealthand/orsubstanceusedisorders,alongwithspecializedtraining,topromoterecovery.Whileitisrecognizedthatinvolvementoffamilymembersintherehabilitationofrecipientswithmentalhealthandsubstanceusedisordersmaybenecessaryandappropriate,provisionofserviceswherethefamilyisinvolvedmustbeclearlydirectedtomeetingtheidentifiedrecipient’sneeds.Servicesprovidedtonon-Medicaideligiblefamilymembersindependentofmeetingtheidentifiedrecipient’sneedsarenotcoveredbyMedicaid.

EligibleStaff: ADMHCertifiedAdult,Child/AdolescentorFamilyCertifiedRecoverySupportSpecialist(CRSS)[CRSSCertificationtobeobtainedwithin6monthsofhire]

SASReportingCode: H0038:HF–AdultHF:HV–AdultStateHF:HZ–AdultIndigentHF:H9–AdultDrugCourt

HF:HD–SpecialWomen’s HF:HH–Co-OccurringEnhanced HF:HA,HF:HA:DYorHF:HA:H9–Adolescent HF:HA:HH–AdolescentCo-occurringEnhanced

H0038:HF:HQ–AdultGroupHF:HV:HQ–AdultStateGroupHF:HZ:HQ–IndigentGroupHF:H9:HQ–DrugCourtGroup

HF:HD:HQ–SpecialWomen’sGroup HF:HH:HQ–CoOccurringEnhancedGroup HF:HA:HQ-AdolescentGroup

HF:HA:H9:HQ–AdolescentDrugCourtGroupHF:HA:DY:HQ–AdolescentDYSGroup

HF:HA:HH:HQ–AdolescentCo-occurringEnhancedGroup


SASContractBillingRate:$9.00-AdultIndividual$12.00forAdolescents,SpecialWomen’sandCo-occurringEnhanced–Individual

$3.00forAdultGroup$4.00forAdolescent,SpecialWomen’sandCo-occurringEnhanced-Group

MaximumBillableUnit(s):20unitsperday/2080peryearforIndividual 8unitsperday/2080unitsperyearforGroup

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GroupSizeLimit: 30perpeercounselorSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.


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PEERSUPPORTSERVICES-SORONLYDefinition:Aserviceprovidedtorecipientswhohaveopioidusedisorders,andtheirfamilies,inanindividualorgroupsettingbyaCertifiedRecoverySupportSpecialist(CRSS).TheCRSSuseshis/herlivedexperiencewithsubstanceusedisorders,alongwithspecialized,toassisttherecipientinattainmentoftreatmentgoals,enhancelifeskillsdevelopment,supporttreatmentretentionandpromoterecovery.EligibleStaff: ADMHCertifiedAdult,Child/AdolescentorFamilyCertifiedRecovery

SupportSpecialist[CRSSCertificationtobeobtainedwithin6monthsofhire]

SASReportingCode: H0038:HF:SR-Adult H0038:HF:HD:SR–SpecialWomen’s H0038:HF:HH:SR–Co-OccurringEnhanced H0038:HF:HZ:SR-Indigent H0038:HF:H9:SR-DrugCourt H0038:HF:SR:HQ–AdultGroup H0038:HF:HD:SR:HQ–SpecialWomen’sGroup H0038:HF:HH:SR:HQ–CoOccurringEnhancedGroup H0038:HF:HZ:SR:HQ-IndigentGroup H0038:HF:H9:SR:HQ-DrugCourtGroup SASReportingUnit:15minutesSASContractBillingRate:$11.00-IndividualforAdults,Adolescents,SpecialWomen’sandCo- OccurringEnhanced

$4.00-GroupforAdult,Adolescent,SpecialWomen’sandCo-occurringEnhanced

MaximumBillableUnit(s):20unitsperday/2080peryearforIndividual 8unitsperday/2080unitsperyearforGroupGroupSizeLimit: 30perpeercounselorSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisorderMATprogram.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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PEERSUPPORTSERVICES-SORONLY(CRIMINALJUSTICERE-ENTRY)

Definition:Aserviceprovidedtorecipientswhohaveopioidusedisordersandarere-enteringthecommunityafteraperiodofincarceration,alongwithfamilies,inanindividualorgroupsettingbyaCertifiedRecoverySupportSpecialist(CRSS).TheCRSSwillutilizeanADMHprescribedevidenced-basedpractice,his/herlivedexperiencewithsubstanceusedisorders,alongwithspecializedtraining,toassisttherecipientinattainmentoftreatmentgoals,enhancelifeskillsdevelopment,supporttreatmentretentionandpromoterecovery.EligibleStaff: ADMHCertifiedAdult,Child/AdolescentorFamilyCertifiedRecovery

SupportSpecialist[CRSSCertificationtobeobtainedwithin6monthsofhire]

SASReportingCode: H0038:HF:V1:SR-Adult H0038:HF:HD:V1:SR–SpecialWomen’s H0038:HF:HH:V1:SR–Co-OccurringEnhanced H0038:HF:HZ:V1:SR-Indigent H0038:HF:H9:V1:SR-DrugCourt H0038:HF:V1:SR:HQ–AdultGroup H0038:HD:V1:SR:HQ–SpecialWomen’sGroup H0038:HH:V1:SR:HQ–CoOccurringGroup H0038:HZ:V1:SR:HQ–IndigentGroup H0038:H9:V1:SR:HQ-DrugCourtGroup SASReportingUnit:15minutesSASContractBillingRate:$14.00-AdultIndividualforAdolescents,SpecialWomen’sandCo- OccurringEnhanced $6.00forAdultGroupMaximumBillableUnit(s):8unitsperday/2080peryearforIndividual8unitsperday/2080unitsperyearforGroupGroupSizeLimit: 30perpeercounselorSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisorderMATprogram.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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PEERSUPPORTSERVICES-SORONLY(VETERANS)

Definition:AserviceprovidedforVeteranswhohaveopioidusedisorders,andtheirfamilies,inanindividualorgroupsettingbyaCertifiedRecoverySupportSpecialist(CRSS),utilizinganADMHprescribedevidence-basedpractice.TheCRSSuseshis/herlivedexperiencewithsubstanceusedisorders,alongwithspecializedtraining,toassisttherecipientinattainmentoftreatmentgoals,enhancelifeskillsdevelopment,supporttreatmentretentionandpromoterecovery.EligibleStaff: ADMHCertifiedAdult,Child/AdolescentorFamilyCertifiedRecovery

SupportSpecialist[CRSSCertificationtobeobtainedwithin6months ofhire]SASReportingCode: H0038:HF:V2:SR-Adult H0038:HF:HD:V2:SR–SpecialWomen’s H0038:HF:HH:V2:SR–Co-OccurringEnhanced H0038:HF:HZ:V2:SR-Indigent H0038:HF:H9:V2:SR-DrugCourt H0038:HF:V2:SR:HQ–AdultGroup H0038:HD:V2:SR:HQ–SpecialWomen’sGroup H0038:HH:V2:SR:HQ–CoOccurringEnhancedGroup H0038:HZ:V2:SR:HQ–IndigentGroup H0038:H9:V2:SR:HQ-DrugCourtGroup SASReportingUnit: 15minutesSASContractBillingRate: $14.00-AdultIndividualforAdolescents,SpecialWomen’sand Co-OccurringEnhanced $6.00forAdultGroupMaximumBillableUnit(s): 8unitsperday/2080peryearforIndividual 8unitsperday/2080unitsperyearforGroupGroupSizeLimit: 30perpeercounselorSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisorderMATprogram.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.

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PHYSICIANRETAINER

Definition:Fundstoassuretheservicesofalicensedphysicianasrequiredforresidentialdetoxification.EligibleStaff: AstateofAlabamalicensedphysician.SASReportingCode: H0016:HFSASReportingUnit: MonthSASContractBillingRate: $3,207.36permonthMaximumBillableUnit(s): 12perfiscalyearSASReportingCombinationRestrictions:CanbebilledonlyinconjunctionwithLevel3.7-WMLocation:CertifiedLevel3.7-WMresidentialtreatmentprogramsonly.

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PHYSICIANSERVICES:INDUCTION(BUPRENORPHINE,BUPRENORPHINE/NALOXONECOMBINATIONPRODUCTS,NALTREXONE)

Definition:Servicesprovidedbyanappropriatelyauthorized,licensedphysiciantoidentifythecorrectdoseofmedicationneededbyarecipientinpreparationofstabilizationonFDAapprovedmedicationfortreatmentofopioidaddiction.EligibleStaff: Physicianwhoisappropriatelyauthorized/licensed.SASReportingCode: 99205:HF:SR-Adult 99205:HF:HD:SR-SpecialWomen’s 99205:HF:HH:SR-Co-Occurring 99205:HF:HZ:SR-Indigent 99205:HF:H9:SR-DrugCourtSASReportingUnit: EpisodeSASContractBillingRate: $300.00-UnitMaximumBillableUnits: Oneunit/2peryearSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Maynotbebilledinconjunctionwithabundledrate.MaybenotbebilledinconjunctionwithcodesH0020,90833or99213.MustbebilledinconjunctionwithoverallservicesthatincludecodesJ0571,J0572,J5073,J5074orJ5075.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient’srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,stateandlocalcodes.

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PHYSICIANSERVICES:STABILIZATION(BUPRENORPHINE,BUPRENORPHINE/NALOXONECOMBINATIONPRODUCTS,NALTREXONE)

Definition:Servicesprovidedbyanappropriatelyauthorized,licensedphysiciantostabilizearecipientdependentuponopioidstoadoseofFDAapprovedmedicationusedfortreatmentofanopioidaddiction.EligibleStaff: Physicianwhoisappropriatelyauthorized/licensed.SASReportingCode: 90833:HF:SR-Adult 90833:HF:HD:SR-SpecialWomen’s 90833:HF:HH:SR-Co-Occurring 90833:HF:HZ:SR-Indigent 90833:HF:H9:SR-DrugCourtSASReportingUnit: EpisodeSASContractBillingRate: $175.00-UnitMaximumBillableUnits: Twoepisodespermonthuntilrecipientclinicallystabilized.Maxfourepisodes.SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Maynotbebilledinconjunctionwithabundledrate.MaybenotbebilledinconjunctionwithcodesH0020,99205or99213.MustbebilledinconjunctionwithoverallservicesthatincludecodesJ0571,J0572,J5073,J5074orJ5075.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient’srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,stateandlocalcodes.

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PHYSICIANSERVICES:MAINTENANCE

(BUPRENORPHINE,BUPRENORPHINE/NALOXONECOMBINATIONPRODUCTS,NALTREXONE)Definition:Servicesprovidedbyanappropriatelyauthorized,licensedphysiciantostabilizearecipientdependentuponopioidstoadoseofFDAapprovedmedicationusedfortreatmentofanopioidaddiction.EligibleStaff: Physicianwhoisappropriatelyauthorized/licensed.SASReportingCode: 99213:HF:SR-Adult 99213:HF:HD:SR-SpecialWomen’s 99213:HF:HH:SR-Co-Occurring 99213:HF:HZ:SR-Indigent 99213:HF:H9:SR-DrugCourtSASReportingUnit: EpisodeSASContractBillingRate: $175.00-UnitMaximumBillableUnits: Onevisitpermonth.SASReportingCombinationRestrictions: MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Maynotbebilledinconjunctionwithabundledrate.MaybenotbebilledinconjunctionwithcodesH0020,90833or99205.MustbebilledinconjunctionwithoverallservicesthatincludecodesJ0571,J0572,J5073,J5074orJ5075.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient’srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,stateandlocalcodes.

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PSYCHOEDUCATIONALSERVICESDefinition:Structured,topicspecificeducationalservicesprovidedtoassisttherecipientandthefamiliesofbeneficiariesinunderstandingthenatureoftheidentifiedbehavioralhealthdisorder,andtoidentifystrategiestosupportrestorationoftherecipienttohis/herbestpossibleleveloffunctioning.EligibleStaff: QSAPI,QSAPII,orQSAPIII.

ADMHCertifiedRecoverySupportSpecialist(CRSS)[CRSSCertificationtobeobtainedwithin6monthsofhire].CRNP,RN.

SASReportingCode: H2027:HF,HF:H9,HF:HV,orHF:HZ–AdultIndividual H2027:HF:HD–SpecialWomen’s H2027:HF:HH–CoOccurringEnhanced

H2027:HF:HA,HF:HA:H9,HF:HA:DY,orHF:HA:HH–Adolescent

H2027:HF:HQ,HF:H9:HQ,HF:HV:HQ,HF:HZ:HQ,AdultGroupH2027:HF:HD:HQ–SpecialWomen’sGroupH2027:HF:HH:HQCoOccurringEnhancedGroupH2027:HF:HA:HQ,HF:HA:DY:HQ,orHF:HA:HH:HQ–AdolescentGroup

SASReportingUnit: 15minSASContractBillingRate: $14.00-Individual $4.00-GroupMaximumGroupSize: 30adultsor24adolescentsMaximumBillingUnits: 8unitsperday/416peryearSASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Cannotbebilledinconjunctionwithabundled/residentialrate(MH,SAorDD).Location:Servicescanbedeliveredinanysettingthatisacceptablefortherecipient,recipient’sfamilyandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srighttoprivacyandconfidentiality.Level0.5EarlyIntervention:ThisservicecanbebilledforrecipientwithZ03.89code.

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TREATMENTPLANREVIEW

Definition:Reviewand/orrevisionofarecipient’sindividualizedmentalhealthand/orsubstanceusedisordertreatmentplanbyaqualifiedpractitionerwhoisnottheprimarytherapistfortherecipient.Thisreviewwillevaluatetherecipient’sprogresstowardtreatmentobjectives,theappropriatenessofservicesprovided,andtheneedforcontinuedparticipationintreatment.Thisservicedoesnotincludethoseactivitiesorcostsassociatedwithdirectinteractionbetweenarecipientandhis/herprimarytherapistregardingtherecipient'streatmentplan.Thatinteractionshallbebilledthroughanalternativeservicesuchasrecipientcounseling.EligibleStaff: QSAPI(Master’slevel-licensedonly) Physician,CRNP,orRN.SASReportingCode: H0032:HF,HF:HV,HF:H9,HF:HH,orHF:HZ-Adult H0032:HF:HD–SpecialWomen’s H0032:HF:HA,HF:HA:DY,HF:HA:HHorHF:HA:H9-AdolescentSASReportingUnit: 15minutesSASContractBillingRate:$22.00MaximumBillableUnit(s): 2unitsperquarter/8peryear

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Maynotbebilledincombinationwithintakeevaluation.Location:Servicescanbedeliveredinanysettingthatisacceptableforboththerecipientandstaffmember,thataffordsanadequatetherapeuticenvironment,andthatprotectstherecipient'srightstoprivacyandconfidentiality.Locationshouldfollowallapplicablefederal,state,andlocalcodes.

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TUBERCULOSISRISKSCREENINGANDINTERVENTION

Definition:ImplementationofeffectiveTBpreventionandcontrolmeasuresinsubstanceusedisordertreatmentprogramsisessentialforreductionofTBratesamongthegeneralU.S.populationandformaintainingthegainsmadeinthisareaduringthepastseveralyears.Thus,aspartofitsTBpreventionandcontrolefforts,theAlabamaDepartmentofMentalHealthisrequiringutilizationoftheTuberculosisRiskScreeningQuestionnaire(TRSQ)ineachofitscontractsubstanceusedisordertreatmentprograms.

EligibleStaff:EachagencyshallestablishthequalificationsofitsstafftoadministertheTRSQ.IfnonmedicalpersonneladministertheTRSQ,medicalstaffconsultationshallbereadilyaccessible.

SASReportingCode,SASReportingUnit,SASContractBillingRate,MaximumBillableUnit(s):

TRSQ Reimbursement Service Name Unit Type Restrictions Rate Brief Service Description

Tuberculosis Risk Screening Questionnaire

Episode 1 Per Treatment Admission for Residential and Outpatient. 1 annually for Opioid Use Disorder Treatment

$25.00 A brief examination of recipient provided information to determine the recipient’s risk of being infected or becoming infected by Tuberculosis relative to both personal history and environmental conditions

Service Code: Adult Adolescent T1023 T1023: HF:HV

T1023: HF: HD:HV T1023: HF:H9:HV T1023: HF:HH:HV T1023: HF:HZ:HV T1023: HF:HG:HV

T1023: HF:HA:HV T1023: HF:HA:HH:HV T1023: HF:HA:H9:HV T1023: HF:HA:DY:HV

TRSQ Reimbursement Service Name Unit Type Restrictions Rate Brief Service Description

Medical/somatic intervention in a substance use disorder treatment program.

15 min 4 Per treatment admission by qualified medical personnel: Physician, Physician Extender, RN, LPN. Limited to exclusive use relative to administration of the TRSQ.

$15.00/unit

Onsite medical evaluation of a recipient’s risks/ symptoms of Tuberculosis, of the need for TB testing, or for referral to treatment resulting from administration of the TRSQ. Appropriate documentation of this need should be provided.

Service Code: Adult Adolescent 97799 97799: HF:HV

97799: HF: HD:HV 97799: HF:H9:HV 97799: HF:HH:HV 97799: HF:HZ:HV 97799: HF:HG:HV

97799: HF:HA:HV 97799: HF:HA:HH:HV 97799: HF:HA:H9:HV 97799: HF:HA:DY:HV

SASReportingCombinationRestrictions:MustbeactivelyenrolledinanADMHcertifiedsubstanceusedisordertreatmentprogram.Neithercodemaybebilledinconjunctionwithcode90791.TheT1023canonlybebilleduponadmissionintoanADMHcertifiedsubstanceabuseprogram.


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PREVENTIONDefinition:Aproactiveprocessthatempowersrecipientsandsystemstomeetthechallengesoflifeeventsandtransitionsbycreatingandreinforcingconditionsthatpromotehealthybehaviorsandlifestyles.Thegoalofsubstanceabusepreventionisthefosteringofaclimateinwhichalcoholuseisacceptableonlyforthoseoflegalageandonlywhentheriskofadverseconsequencesisminimal;prescriptionandover-thecounterdrugsareusedonlyforthepurposesforwhichtheywereintended;othersubstancesthatmaybeabusedandnotusedfortheirpurposessuchasaerosols,paintthinners,glue,etc.andotherillegaldrugsandtobaccoarenotusedatall.EligibleStaff: SeeStandardsReportingUnit: 15minutes

PREVENTIONDEFINITIONS(50%oftheoverallpreventionbudgetwillbeallocatedforEnvironmentalstrategies)

1) InformationDissemination(H0024):Thisstrategyinvolvesone-waycommunicationbetweenthesourceandtheaudience,withlimitedcontactbetweenthetwo.Thisstrategyprovidesinformationaboutdruguse,abuseandaddictionandtheeffectsonrecipients,familiesandcommunities.Italsoprovidesinformationonavailablepreventionprogramsandservices.Examplesofthisstrategyinclude:brochures,pamphlets,posters,&flyers;clearinghouse/informationresourcecenters;communityresourcedirectories;healthfairsandotherhealthpromotion;informationlines/hotlines;informationthroughwebsites;information-basedmediacampaign;mediacampaigns;newspaperandnewsletterarticles;radioandtelevisionpublicserviceannouncements;andspeakingengagements.Thisstrategymaybeusedinconjunctionwithotherstrategies,practicesandpoliciestohaveefficacyincommunities.

ContractBillingRate: $12.75per15-minuteunit1

2) EnvironmentalApproaches(H0025):Thisstrategyseekstoestablishorchangecommunitystandards,codesandattitudes,therebyinfluencingthesubstanceuseinthegeneralpopulation.Examplesofthisstrategyinclude:changingnormsorattitudesaboutATOD;changingpublicperceptionsandnormsaboutyouthandtheircapabilities;changingschoolnormsandattitudestoincreaseapositiveschoolclimate;mediastrategiestoassurebalancedresponsiblereportingaboutyou;vendoreducationorbusinesspracticesthatpromotehealth;promotingtheestablishmentsorreviewofalcohol,tobaccoanddrugusepoliciesinschools;guidanceandtechnicalassistanceonmonitoringenforcementgoverningavailabilityanddistributionofalcohol,tobaccoandotherdrugs;modifyingalcoholandtobaccoadvertisingpractices;andproductpricingstrategies.Thisstrategymay

1 All rates include costs for salaries & benefits. Rates do not include travel, operating expense/admin and equipment, which will continue to be a separate line item.

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beusedinconjunctionwithotherstrategies,practicesandpoliciestohaveefficacyincommunities.

Environmentalstrategiesfocusonthecauseandtheconditionsofthecommunityenvironmentthatare:

• Changingeconomicconditions(Howmuchthingscost;howavailablethingsare);• Changingsocialconditions(Whatpeoplethink;howpeoplelive);• Changingmediaconditions(whatpeopleread,watch,hear,andsee);and• Changingpoliticalconditions(Whohaspower;whohasinfluence)

Environmentalstrategiesalsofocusonchangingthenormsandregulationsthatinfluence/controlthesocialandphysicalcontextsoftheuseofalcohol,tobaccoandotherdrugs.Environmentalstrategiescannotbesolelyusedformeetings,informationdisseminationorcommunityawarenesscampaigns.

ContractBillingRate: $21.39per15-minuteunit

3) Community-BasedProcesses(H0026):Thisstrategyaimstoenhancetheabilityofthecommunitytoprovidemoreeffectivepreventionandtreatmentservicesforsubstanceabusedisordersbyincludingactivitiessuchasorganizing,planning,interagencycollaboration,coalitionbuildingandnetworking.Effectiveorganizingandplanningareparamounttothesuccessofpreventionpractices,policiesandprograms.Examplesofthisstrategyinclude:effortstodecreasebarrierstoservices;youth-adultpartnershipsaddressingcommunityissues;needsassessments&communityreadinesssurveys;communityandvolunteertraining;cross-systemsplanning;multi-agencycoordinationandcollaboration/coalition;communityteambuildingactivities;accessingservicesandfunding;andcoalitions,collaborationsand/orwellnessteams.Thisstrategymaybeusedinconjunctionwithotherstrategies,practicesandpoliciestohaveefficacyincommunities.Thisstrategycannotbesolelyusedformeetings,informationdisseminationorcommunityawarenesscampaigns.


4) Education(H0027):Thisstrategyinvolvestwo-waycommunicationandisdistinguishedfrommerelydisseminatinginformationbythefactthatitisbasedonaninteractionbetweentheeducatorandtheparticipants.Activitiesunderthisstrategyaimtoaffectcriticallifeandsocialskills,includingdecisionmaking,refusal,andcriticalanalysisskills.Examplesofthisstrategyinclude:communityserviceactivities;interactivetechnologies;communityandvolunteerworkshops;parentingandfamilymanagementclasses;ongoingclassroomand/orsmallgroupsessions;peerleader/peerhelperprograms;educationprogramsforyouthgroups;childrenofsubstanceabusersgroups;andlifeskills.Thisstrategymaybeusedinconjunctionwithotherstrategies,practicesandpoliciestohaveefficacyincommunities.

ContractBillingRate: $3.50per15-minuteunit H0027

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stand-aloneprogram(1domain,1location) $12.75per15-minuteunit H0027:HF

2ormorestrategiesindifferentdomainswiththesametargetpopulationduringbusinesshours(8am-3pmMonday-Friday).

$21.39per15-minuteunit H0027:HF:HA2ormorestrategiesindifferentdomainswiththesametargetpopulationafterbusinesshours,weekends,summerandspringbreaks.

5) ProblemIdentificationandReferral(H0028):Thisstrategyaimstoidentifythosewhohave

indulgedintheuseofillicitdrugsorunderageuseoftobaccoandalcoholinordertodeterminewhethertheirbehaviorcanbereversedthrougheducation.Thisstrategydoesnotincludeanyactivitydesignedtodeterminewhetherarecipientisinneedoftreatment.Examplesofthisstrategyinclude:alcoholinformationschools;crisislinesorhotlines;depressionandmentalhealthscreeningprograms;drivingwhileintoxicatededucationprograms;drivingwhileundertheinfluence/whileintoxicatedprograms;EmployeeAssistancePrograms;nicotineuseandaddictionscreening;StudentAssistancePrograms;andsupportgroups,talking/healingcircles.Thisstrategymaybeusedinconjunctionwithotherstrategies,practicesandpoliciestohaveefficacyincommunities.


6) Alternatives(H0029):Evidencedoesnotsupporttheuseofanalternativestrategyasasolepreventionstrategywiththeintendedtargetpopulation.Alternativescanandshouldbeusedasapartofacomprehensiveplantomakelivesricherandhealthier.Thegoalofthisstrategyistohavetargetpopulationsparticipateinactivitiesthatarealcohol,tobacco,andotherdrugfreeinnatureandincorporateeducationalmessages.Examplesofthisstrategyinclude:communityserviceactivities;culturally-basedactivities;drugfreedancesandparties;intergenerationaleventsandcelebrations;jobshadowing,internships,workplaceexperiences;leadershipactivities;mentoringprograms;OutwardBound;recognitioneventsthatcelebraterecipientorgroupaccomplishments;social&recreationactivities;youthcenters&communitydrop-incenters.Thisstrategymaybeusedinconjunctionwithotherstrategies,practicesandpoliciestohaveefficacyincommunities.

ContractBillingRate: $3.50per15-minuteunit H0029 stand-aloneprogram(1domain,1location) $12.75per15-minuteunit H0029:HF

2ormorestrategiesindifferentdomainswiththesametargetpopulationduringbusinesshours(8am-3pmMonday-Friday).

$21.38per15-minuteunit H0029:HF:HA

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2ormorestrategiesindifferentdomainswiththesametargetpopulationafterbusinesshours,weekends,summerandspringbreaks

AnapprovedPlanmustbeonfilepriortotheimplementationandreimbursementofstrategies.Documentationofstrategiesmustbefacilitatedonanongoingbasisanddataenteredintheinformationmanagementsystem(ASAIS).SupportingdocumentationmustbemaintainedbytheproviderofservicesinaccordancewiththeguidelineswithinthePreventionStandards.

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ChangesmadetoJuly1,2020BillingManual

1. Level3.7WM(page29)-limitonnumberofdayswithoutapprovalbyADMHwasadded2. ActivityTherapy(page32)-definitionupdated3. Intakeevaluations(BehaviorHealthPlacementAssessment-pages10,11&12)-updated

maximumbillableunits4. TargetedCaseManagement(page45)-clarificationofeligiblestaff

alabama department of mental health mental health … · 7/1/2020 · services, eligible staff...

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