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

Substance Abuse Intensive Outpatient Package: (SA Adolescent Day Treatment)Service AccessAdditionalMedicaidRequirementsDocumentationRequirements1. This package is to be available at least 5 days per week to allow youth’s access to support and treatment within his/her community, school, and family.2. These services should follow Adolescent ASAM Level Guidelines II.1 (at least 6 hours of structured programming/week) and II.5 (at least 20 hrs of structuredactivity/week).The Substance Abuse C&A Intensive Outpatient Package allows providers to select all services that will be offered in a substance abuse outpatient setting. Billableservices and daily limits within SA C&A Intensive Outpatient are as follows:Service Maximum Authorization Units Maximum Daily UnitsBehavioral Health Assessment & Service PlanDevelopment32 24Diagnostic Assessment 4 2Psychiatric Treatment 12 1Nursing Assessment & Care 48 16Community Support 600 96Individual Outpatient Services 36 1Group Outpatient Services 1170 20Family Outpatient Services 100 8Structured Activity Support 320 81. Every admission and assessment must be documented.2. Progress notes must include written daily documentation of important occurrences; level of functioning; acquisition of skills necessary for recovery; progress on goalsidentified in the IRP including acknowledgement of addiction, progress toward recovery and use/abuse reduction and/or abstinence; use of drug screening results bystaff; and evaluation of service effectiveness.3. Daily attendance of each youth participating in the program must be documented showing the number of units in attendance for billing purposes.4. Documentation of a structured activity support is also required (see specific guideline for detail).FY2013 Provider Manual for Community Behavioral Health Providers Page 59