PART I - Department of Behavioral Health and Developmental ...

ClinicalExclusionsDocumentationRequirementsIndividuals with the following conditions are excluded from admission unless there is clearly documented evidence of psychiatric condition overlaying the primarydiagnosis: developmental disability, autism, organic mental disorder, traumatic brain injury.1. If the individual supported is sharing rent with another person, then agency may only utilize and report the assistance provided to the served individual (rounded tothe nearest dollar).2. The individual clinical record must have documentation of the actual payment by the agency to the leaser/landlord. A receipt for this payment must also be kept inthe clinical record.Opioid Maintenance TreatmentTransactionCode Detail Code Mod Mod Mod Mod Rate Code Detail Code Mod Mod Mod Mod RateCode1 2 3 41 2 3 4Alcohol and/orH0020 U2 U6 33.40 H0020 U4 U6 17.40Drug Services;MethadoneAdministrationH0020U3U625.39and/or ServiceUnit Value 1 encounter Maximum Daily Units 1 unitInitialAuthorizationWith the submission of MICP New Episode: 180 units Re-Authorization 180 unitsAuth Period 180 days Utilization Criteria LOCUS scores:1-3An organized, usually ambulatory, addiction treatment service for opiate-addicted individuals. (For Medicaid consumers, the actual administration of the opioidmaintenance medication is conducted under the Medication Administration service code). The nature of the services provided (such as dose, level of care, length ofservice or frequency of visits) is determined by the patient's clinical needs, but such services always include regularly scheduled psychosocial treatment sessions anddaily medication visits within a structured program. Services function under a defined set of policies and procedures, including admission, discharge and continuedServiceDefinitionservice criteria stipulated by state law and regulation and the federal regulations at FDA 21 CFR Part 291. Length of service varies with the severity of the individual'sillness, as well as his or her response to and desire to continue treatment. Treatment with methadone or LAAM is designed to address the individual’s need to achievechanges in his or her level of functioning, including elimination of illicit opiate and other alcohol or drug use. To accomplish such change, the IndividualizedRecovery/Resiliency Plan must address major lifestyle, attitudinal and behavioral issues that have the potential to undermine the goals of recovery and inhibit theindividual's ability to cope with life. The Individualized Recovery/Resiliency Plan should also include individualized treatment, resource coordination, and personal healtheducation specific to addiction recovery (including education about human immunodeficiency virus [HIV], tuberculosis [TB], and sexually transmitted diseases [STD]).AdmissionCriteriaContinuingStay CriteriaMust meet criteria established by the Georgia Regulatory body for opioid administration programs (Department of Human Resources, Office of Regulatory Services) andthe Food and Drug Administration’s guidelines for this service.FY2013 Provider Manual for Community Behavioral Health Providers Page 111