Opioid Maintenance TreatmentDischargeCriteriaRequiredComponentsAdditionalMedicaidRequirementsDocumentationRequirements1. This service must be licensed by DCH/HFR under the Rules <strong>and</strong> Regulations for Drug Abuse Treatment Programs, 290-4-2.2. Must meet <strong>and</strong> follow criteria established by the Georgia regulatory body for opioid administration programs (<strong>Department</strong> <strong>of</strong> Human Resources, Office <strong>of</strong> RegulatoryServices) <strong>and</strong> the Food <strong>and</strong> Drug Administration’s guidelines for this service.Core providers who are approved to bill Medication Administration may bill H0020 for Medicaid recipients who receive this service.If medically necessary for the individual, the Individualized Recovery/Resiliency Plan should also include individualized treatment, resource coordination, <strong>and</strong> personalhealth education specific to addiction recovery (including education about human immunodeficiency virus [HIV], tuberculosis [TB], <strong>and</strong> sexually transmitted diseases[STD]).Peer Support ServicesTransactionCode Detail Code Mod Mod Mod Mod Rate Code Detail Code Mod Mod Mod Mod RateCode1 2 3 41 2 3 4Peer Support Practitioner Level 4, In-Clinic H0038 HQ U4 U6 $4.43 Practitioner Level 4, Out-<strong>of</strong>-Clinic H0038 HQ U4 U7 $5.41Services Practitioner Level 5, In-Clinic H0038 HQ U5 U6 $3.30 Practitioner Level 5, Out-<strong>of</strong>-Clinic H0038 HQ U5 U7 $4.03Unit Value 15 minutes Maximum Daily Units 96InitialAuthorization3600 units Re-Authorization 3600 unitsAuthorizationPeriod180 days Utilization Criteria LOCUS scores: 1-4ServiceDefinitionAdmissionCriteriaThis service provides structured activities within a peer support center that promote socialization, recovery, wellness, self-advocacy, development <strong>of</strong> natural supports, <strong>and</strong>maintenance <strong>of</strong> community living skills. Activities are provided between <strong>and</strong> among individuals who have common issues <strong>and</strong> needs, are consumer motivated, initiated<strong>and</strong>/or managed, <strong>and</strong> assist individuals in living as independently as possible. Activities must promote self-directed recovery by exploring consumer purpose beyond theidentified mental illness, by exploring possibilities <strong>of</strong> recovery, by tapping into consumer strengths related to illness self-management (including developing skills <strong>and</strong>resources <strong>and</strong> using tools related to communicating recovery strengths, communicating health needs/concerns, self-monitoring progress), by emphasizing hope <strong>and</strong>wellness, by helping consumers develop <strong>and</strong> work toward achievement <strong>of</strong> specific personal recovery goals (which may include attaining meaningful employment ifdesired by the individual), <strong>and</strong> by assisting consumers with relapse prevention planning. A Consumer Peer Support Center may be a st<strong>and</strong>-alone center or housed as a“program” within a larger agency, <strong>and</strong> must maintain adequate staffing support to enable a safe, structured recovery environment in which consumers can meet <strong>and</strong>provide mutual support.1. Individual must have a primary mental health issue; <strong>and</strong> one or more <strong>of</strong> the following:2. Individual requires <strong>and</strong> will benefit from support <strong>of</strong> peer pr<strong>of</strong>essionals for the acquisition <strong>of</strong> skills needed to manage symptoms <strong>and</strong> utilize community resources; or3. Individual may need assistance to develop self-advocacy skills to achieve decreased dependency on the mental health system; orFY2013 Provider Manual for Community <strong>Behavioral</strong> <strong>Health</strong> Providers Page 112
Peer Support Services4. Individual may need assistance <strong>and</strong> support to prepare for a successful work experience; or5. Individual may need peer modeling to take increased responsibilities for his/her own recovery; orContinuingStay CriteriaDischargeCriteriaServiceExclusionsClinicalExclusionsRequiredComponents6. Individual needs peer supports to develop or maintain daily living skills.1. Individual continues to meet admission criteria; <strong>and</strong>2. Progress notes document progress relative to goals identified in the Individualized Recovery/Resiliency Plan, but treatment/recovery goals have not yet beenachieved.1. An adequate continuing care plan has been established; <strong>and</strong> one or more <strong>of</strong> the following:2. Goals <strong>of</strong> the Individualized Recovery Plan have been substantially met; or3. Consumer/family requests discharge; or4. Transfer to another service/level is more clinically appropriate.Crisis Stabilization Unit (however, those utilizing transitional beds within a Crisis Stabilization Unit may access this service).1. Individuals diagnosed with a Substance-Related Disorder <strong>and</strong> no other concurrent mental illness; or2. Individuals with the following conditions are excluded from admission unless there is clearly documented evidence <strong>of</strong> a psychiatric condition overlaying the primarydiagnosis: developmental disability, autism, organic mental disorder, or traumatic brain injury1. A Peer Supports service may operate as a program within:• A freest<strong>and</strong>ing Peer Support Center• A Peer Support Center that is within a clinical service provider• A larger clinical or community human service provider administratively, but with complete programmatic autonomy.2. A Peer Supports service must be operated for no less than 3 days a week, no less than 12 hours a week, no less than 4 hours per day, typically during day, evening<strong>and</strong> weekend hours. Any agency may <strong>of</strong>fer additional hours on additional days in addition to these minimum requirements.3. The governing board <strong>of</strong> a freest<strong>and</strong>ing Peer Center must be composed <strong>of</strong> 75% consumers <strong>and</strong> represent the cultural diversity <strong>of</strong> the population <strong>of</strong> the communitybeing served. The board is encouraged to have either board members or operating relationships with someone with legal <strong>and</strong> accounting expertise. For programsthat are part <strong>of</strong> a larger organizational structure that is not consumer led <strong>and</strong> operated, the Peer Supports Program must have an advisory body with the samecomposition as a freest<strong>and</strong>ing Peer Center’s board. The board or advisory committee must have the ability to develop programmatic descriptions <strong>and</strong> guidelines(consistent with state <strong>and</strong> federal regulations, accreditation requirements, <strong>and</strong> sponsoring agency operating policies), review <strong>and</strong> comment on the Peer SupportProgram’s budgets, review activity <strong>of</strong>ferings, <strong>and</strong> participate in dispute resolution activities for the program.4. Individuals participating in the service at any given time must have the opportunity to participate in <strong>and</strong> make decisions about the activities that are conducted orservices <strong>of</strong>fered within the Peer Supports program, <strong>and</strong> about the schedule <strong>of</strong> those activities <strong>and</strong> services, as well as other operational issues.5. Regardless <strong>of</strong> organizational structure, the service must be directed <strong>and</strong> led by consumers themselves.6. Peer Supports may include meals or other social activities for purpose <strong>of</strong> building peer relationships, but meals cannot be the central or core activity <strong>of</strong>fered. Thefocus <strong>of</strong> the service must be skill maintenance <strong>and</strong> enhancement <strong>and</strong> building individual consumer’s capacity to advocate for themselves <strong>and</strong> other consumers.7. Peer Supports cannot operate in isolation from the rest <strong>of</strong> the programs within the facility or affiliated organization. The Program Leader must be able to callmultidisciplinary team meetings regarding a participating individual’s needs <strong>and</strong> desires, <strong>and</strong> a Certified Peer Specialist providing services for <strong>and</strong> with a participatingindividual must be allowed to participate in multidisciplinary team meetings.FY2013 Provider Manual for Community <strong>Behavioral</strong> <strong>Health</strong> Providers Page 113
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Georgia Department of Behavioral He
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UPDATED FOR JULY 1, 2013SUMMARY OF
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C&A Core ServicesBehavioral Health
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Community Supportsupports;9) Assist
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Community SupportServiceAccessibili
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Community Transition Planningv. App
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CHILD & ADOLESCENT SPECIALTY SERVIC
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Behavioral AssistanceAssistance.Ser
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Crisis Stabilization Unit (CSU) Ser
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Intensive Family Intervention5. Bec
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Intensive Family Interventionconfid
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Intensive Family Intervention10. Th
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Structured Activity SupportsService
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Structured Residential SupportsClin
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Substance Abuse Intensive Outpatien
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Substance Abuse Intensive Outpatien
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Addiction CounselorTrainees (ACT)Hi
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CADC, CCADC, CAC II or MAC and is r
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practitioner), s/he could bill as a
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COMMUNITY SERVICE STANDARDS FOR ALL
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4. ORDER/RECOMMENDATION FOR COURSE
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ii. Services, supports, and treatme
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xv.xvi.xvii.Recorded changes - Any