405 IAC 5-21.5-11 - Intensive alcohol or drug (substance-related disorder) outpatient treatment

Authority: IC 12-15

Affected: IC 12-13-7-3

Sec. 11.

(a) The services reimbursable as intensive alcohol or drug outpatient treatment services are treatment programs that operate at least three (3) hours per day, and at least three (3) days per week, and are based on an individualized integrated care plan.

(b) Services are planned and organized with addiction professionals and clinicians providing multiple treatment service components for the rehabilitation of alcohol and drug abuse or dependence in a group setting.

(c) Requirements for intensive alcohol or drug outpatient treatment shall be as follows:

(1) Services may be provided for members of all ages with a substance-related disorder; minimal or manageable medical conditions; minimal or manageable withdrawal risk; or emotional, behavioral, and cognitive conditions that will not prevent the member from benefiting from this level of care.

(2) Providers must meet any of the following qualifications:

(A) A licensed professional.

(B) A QBHP.

(C) An OBHP.

(d) Programming standards shall be as follows:

(1) Regularly scheduled sessions within a structured program must be at least three (3) hours per day and at least three (3) days per week.

(2) The program shall include the following components:

(A) Referral to twelve (12) step programs, peer and other community supports.

(B) Education on addiction disorders.

(C) Skills training in communication, anger management, stress management, and relapse prevention.

(D) Individual, group, and family counseling. Counseling must be provided by a licensed professional or QBHP.

(3) An individual who is a licensed professional is responsible for the overall management of the clinical program.

(4) Treatment must be individualized.

(5) Services must be provided in an age appropriate setting for a member less than eighteen (18) years of age receiving services.

(6) At least one (1) of the direct service providers must be a licensed addiction counselor or a licensed clinical addiction counselor.

(7) The member if [sic, is] the focus of the service.

(8) Documentation must support how the service benefits the member, including when the service is provided in a group setting.

(9) Services must demonstrate movement toward or achievement of member treatment goals identified in the individualized integrated care plan.

(10) Service goals must be rehabilitative in nature.

(e) Exclusions shall be as follows:

(1) Members with withdrawal risk or symptoms whose needs cannot be managed at this level of care or who need detoxification services.

(2) Members at imminent risk of harm to self or others.

(3) Intensive outpatient treatment will not be reimbursed for members who receive group addiction counseling or family/couple group addiction counseling on the same day.

Notes

405 IAC 5-21.5-11

Office ofthe Secretary of Family and Social Services; 405 IAC 5-21.5-11; filed May 27, 2010, 9:15 a.m.: 20100623-IR-405100045FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA Readopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFA Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA