405 IAC 5-21.5-12 - Alcohol or drug (substance-related disorder) counseling
Authority: IC 12-15
Affected: IC 12-13-7-3
Sec. 12.
(a) The
services reimbursable as individual or group alcohol or drug counseling are
services where addiction professionals and clinicians provide counseling
intervention that work toward goals identified in the individualized integrated
care plan. Services are designed to be a less intensive alternative to
intensive outpatient treatment as follows:
(1)
The requirements for alcohol or drug counseling shall be as follows:
(A) Services may be provided for members of
all ages with a substance-related disorder and with minimal or manageable
medical conditions; minimal withdrawal risk; or emotional, behavioral, and
cognitive conditions that will not prevent the member from benefiting from this
level of care.
(B) Providers must
meet any of the following qualifications:
(i)
A licensed professional.
(ii) A
QBHP.
(C) Programming
standards shall be as follows:
(i) The member
is the focus of the service.
(ii)
Documentation must support how the service specifically benefits the member,
including when services are provided in a group setting.
(iii) Services must demonstrate progress
toward or achievement of member treatment goals identified in the
individualized integrated care plan.
(iv) Service goals must be rehabilitative in
nature.
(v) Services are intended
to be a less intensive alternative to intensive outpatient treatment.
(vi) Services must be provided in an age
appropriate setting for a member less than eighteen (18) years of age receiving
services.
(vii) A licensed
professional must supervise the program and approve the content and curriculum
of the program.
(viii) Treatment
must consist of regularly scheduled services.
(2) Exclusions shall be as follows:
(A) Members with withdrawal risk or symptoms
whose needs cannot be managed at this level of care or who need detoxification
services.
(B) Members at imminent
risk of harm to self or others.
(C)
Group addiction counseling will not be reimbursed for members who receive
intensive outpatient treatment on the same day.
(D) Counseling sessions that consist of
education only services will not be reimbursed.
(b) The services reimbursable as family or
couple alcohol or drug counseling are services where addiction professionals
and clinicians provide face-to-face counseling intervention, with or without
the member present, that work toward the goals identified in the individualized
integrated care plan. The face-to-face interaction may be with family members
or nonprofessional caregivers. Services are designed to be a less intensive
alternative to intensive outpatient treatment. The requirements for alcohol or
drug counseling shall be as follows:
(1)
Services may be provided for family members or nonprofessional caregivers of
members of all ages with a substance-related disorder and with minimal or
manageable medical conditions; minimal withdrawal risk; or emotional,
behavioral, and cognitive conditions that will not prevent the member from
benefiting from this level of care.
(2) Services may be provided in an individual
or group setting.
(3) Providers
must meet any of the following qualifications:
(A) A licensed professional.
(B) A QBHP.
(4) Programming standards shall be as
follows:
(A) The member is the focus of
treatment.
(B) Documentation must
support how the service specifically benefits the member, including services
provided in a group setting or without the member present.
(C) Services must demonstrate progress toward
or achievement of the member's treatment goals identified in the individualized
integrated care plan.
(D) Service
goals must be rehabilitative in nature.
(E) Services are intended to be a less
intensive alternative to outpatient treatment services.
(F) Services must be provided in an age
appropriate setting for a member eighteen (18) years of age and under receiving
services.
(G) A licensed
professional must supervise the program and approve the content and curriculum
of the program.
(H) Treatment must
consist of regularly scheduled services.
(5) Exclusions shall be as follows:
(A) Members with withdrawal risk or symptoms
whose needs cannot be managed at this level of care or who need detoxification
services.
(B) Members at imminent
risk of harm to self or others.
(C)
Services may not be provided to professional caregivers.
(D) Counseling sessions that consist of
education only services will not be reimbursed.
(E) Family or couple group alcohol or drug
counseling will not be reimbursed for members who receive intensive outpatient
treatment on the same day.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.