Definitions

The following terms used in 130 CMR 418.000 have the meanings given in 130 CMR 418.402 unless the context clearly requires a different meaning. Acupuncture Withdrawal Management. The insertion of metal needles through the skin at certain points on the body, with or without the use of herbs, with or without the application of an electric current, and with or without the application of heat to the needles, skin, or both, for members experiencing the dysfunctional effects of the use of alcohol and/or other drugs, whose primary need is management of withdrawal symptoms, and thereafter, support services for the establishment and maintenance of recovery. Acute Treatment Services (ATS). ASAM Level 3.7 Medically Managed Residential Treatment, a 24-hour, seven days-a-week, medically managed inpatient addiction treatment service that provides evaluation and medically supervised withdrawal management services and/or induction onto maintenance treatment. These services are delivered by nursing, case management, recovery support, and counseling staff under a physician-approved protocol and physician-directed procedures and under the direction of a licensed medical professional (i.e., physician, advanced practice registered nurse, physician assistant). Services include biopsychosocial assessment, induction onto FDA-approved medications for substance use disorders as clinically indicated, treatment planning, individual and group counseling, psychoeducational groups, and discharge planning. Advanced Practice Registered Nurse. An individual licensed by the Massachusetts Board of Registration in Nursing pursuant to M.G.L. c. 112, § 80B and 244 CMR 4.00: Advanced Practice Registered Nursing. Adverse Incident. An occurrence that represents actual or potential serious harm to the well- being of a member, or to others under the care of a provider. Adverse incidents may be the result of the actions of a member served, actions of a staff member providing services, incidents that compromise the health and safety of the member receiving treatment at the program, or the operations of the provider. American Society of Addiction Medicine (ASAM). A professional society in the field of addiction medicine that sets diagnostic and dimensional criteria for the delivery of substance use disorder treatment which includes a continuum of five basic levels of care from Early Intervention to Medically Managed Intensive Inpatient Treatment. At Risk for Homelessness. Any member who does not have sufficient resources or support networks (e.g., family, friends, faith-based or other social networks) immediately available to prevent them from moving to an emergency shelter or another place not meant for human habitation. Behavioral Health Disorder. Any disorder pertaining to mental health or substance use, as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Case Consultation. Intervention, including scheduled audio-only telephonic, audio-video, or in- person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers. Case Management or Care Coordination. Coordinated approach to the delivery of health, substance abuse, mental health, and social services, linking clients with appropriate services to address specific needs and achieve stated goals. Certified Addiction Counselor (CAC). An individual who has received “Certification of Alcohol and Drug Counselors” provided by the Massachusetts Board of Substance Abuse Counselor Certification (MBSACC). There are three levels of certification: CAC, CADC, CADC II. Clinical Stabilization Services (CSS). ASAM Level 3.5 Clinically Managed High-Intensity Residential Services, a 24-hour, seven-days-a-week, clinically managed high-intensity residential treatment services offered in community settings. The services are delivered by nursing, case management, clinical, and recovery support staff under the direction of a licensed medical provider (i.e., physician, advanced practice registered nurse, physician assistant). The services include comprehensive biopsychosocial multidimensional assessments and treatment planning, therapeutic milieu, intensive psychoeducation, individual and group counseling, outreach to families and significant others, linkage to medications for addiction treatment, case management with connection to primary care, community supports and aftercare planning for members beginning to engage in recovery from substance use disorders, and recovery support services. Clinician. An individual with a minimum of a master’s degree in one of the following disciplines or a closely related field: clinical psychology, education counseling, medicine, psychology, psychiatric nursing, rehabilitative counseling, or social work, and who has a minimum of one year of supervised substance use disorder counseling experience. Community Support Program for Homeless Individuals (CSP-HI). A specialized form of CSP for members who are experiencing homelessness as described in 130 CMR 461.000. CSP-HI includes assistance from specialized professionals who, based on their unique skills, education, or lived experience, have the ability to engage and support individuals experiencing homelessness in searching for permanent supportive housing, preparing for and transitioning to an available housing unit, and, once housed, coordinating access to physical health, behavioral health, and other needed services geared toward helping them sustain tenancy and meet their health needs. Co-occurring Disorder. A diagnosis of both a substance use disorder and one or more behavioral health disorders. Co-occurring Enhanced Residential Rehabilitation Services for Substance Use Disorder (COE- RRS). ASAM Level 3.1 Clinically Managed Low-Intensity Residential Services, a 24-hour, seven-days-per-week, clinically enhanced residential service that provides a safe, structured environment in the community. This service supports a member’s recovery from substance use disorders and moderate to severe mental health conditions while reintegrating them into the community and returning to social, vocation/employment, and/or educational roles. Scheduled, goal-oriented, and evidence-based clinical services are provided in conjunction with ongoing support and assistance in developing and implementing recover skills. Counselor. An individual who has a minimum of a high school diploma or equivalent and a minimum of one year of supervised counseling experience in substance use disorder treatment or a closely related field. Couples Counseling. Rehabilitative counseling provided to a couple whose primary complaint is disruption of their marriage, family, or relationship due to substance use and/or co-occurring disorders. Direct and Continuous Supervision. Ongoing supervision provided to unlicensed staff and not independently licensed staff at a frequency of no less than one hour of supervision per week for full-time employees. Supervision time may be pro-rated based on scheduled hours for employees employed less than full-time. Direct and continuous supervision must be delivered by an independently licensed staff member or certified peer supervisor who is employed by the agency. Enhanced Structured Outpatient Addiction Program (E-SOAP). ASAM Level 2.1 Intensive Outpatient Services, a program that provides short-term, clinically intensive, structured day and/or evening SUD services. E-SOAP specifically serves specialty populations such as members experiencing homelessness and members at risk of experiencing homelessness, members who are pregnant or members who have been pregnant in the last 12 months, and adolescents. Family Counseling. The psychotherapeutic treatment of more than one member of a family simultaneously in the same session where the primary complaint is disruption of the family due to substance use and/or co-occurring disorders. Group Counseling. The use of psychotherapeutic and evidence-based counseling techniques in the treatment of a group of individuals, most of whom are not related by blood, marriage, domestic partnership, or legal guardianship, having a primary complaint that is associated with substance use and/or co-occurring disorders. Homelessness. A condition of any member who lacks a fixed, regular, and adequate nighttime residence, and who has a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car, park, abandoned building, bus or train station, airport, or camping group; or who is living in a supervised publicly or privately operated emergency shelter designated to provide temporary living arrangements, including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, or local government programs for low income individuals. This includes those members who are exiting an institution (e.g., jail, hospital) where they resided for 90 days or less and were residing in an emergency shelter or place not meant for human habitation immediately before entering the institution. Individual Counseling. Psychotherapeutic services provided to a member whose primary complaint is substance use and/or co-occurring disorders. Individual Treatment Plan. A treatment plan based on results of the multidimensional biopsychosocial assessment and created in collaboration with the member, as defined by 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs. Individualized Treatment Stabilization Services (ITS) Tier 1. A program that provides integrated ASAM Level 3.7 (ATS) and ASAM Level 3.5 (CSS) services in a single unit or location for stabilization and continuity of care. ITS Tier 1 programs must meet all expectations for both service models, including licensure requirements. ITS Tier 1 serves members who are involuntarily committed to treatment due to the severity and level of impairment caused by their SUD. Individualized Treatment Stabilization Services (ITS) Tier 2. An integrated program that provides enhanced ASAM Level 3.7 (ATS) and ASAM Level 3.5 (CSS) services in a single unit or location for stabilization and continuity of care. ITS Tier 2 must meet all expectations for both service models. ITS Tier 2 serves members who have co-occurring disorders and multiple unsuccessful treatment episodes at lower levels of care who would benefit from fewer transitions between levels of care and enhanced engagement interventions. Licensed Alcohol and Drug Counselor (LADC). An individual who has applied for and has been deemed qualified as defined under 105 CMR 168.000: Licensure of Alcohol and Drug Counselors and duly licensed by the Department of Public Health to provide treatment for individuals with a substance use disorder as a Licensed Alcohol Drug Counselor I (LADC I), Licensed Alcohol Drug Counselor II (LADC II), or Licensed Alcohol Drug Counselor (LADC) Assistant. Licensed Practical Nurse. An individual licensed by the Massachusetts Board of Registration in Nursing in accordance with M.G.L. c. 112, § 74 and in compliance with 244 CMR 3.00: Registered Nurse and Licensed Practical Nurse. Medical Director. A physician licensed to practice medicine with specialized training in addiction medicine, who assumes responsibility for administering all medical services performed by the program, either by performing them directly or by delegating specific responsibility to authorized program physicians and qualified healthcare professionals functioning under the Medical Director’s direct supervision. Medically Managed Inpatient Treatment ASAM Level 4.0 Services. Intensive inpatient services provided in a hospital setting. These programs treat members with acute medically complex withdrawal management needs, as well as co-occurring biomedical and/or psychiatric conditions. Medically managed intensive inpatient levels of care are licensed by the Massachusetts Department of Public Health under 105 CMR 130.000: Hospital Licensure and 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs. Medication Management. Management of medication including resident self-administration oversight, storage, and coordination of all medication prescribed during treatment. Medication Specialist. A staff member in residential rehabilitation programs who is responsible for the oversight, storage, and coordination of self-administration of medication. Medication Visit. A member visit specifically for prescription review and monitoring of psychotropic medication by a psychiatrist, psychiatric clinical nurse specialist, physician, physician assistant, or advanced practice registered nurse or administration of prescribed intramuscular medication by a physician, nurse, or physician assistant. Medication for Addiction Treatment. Use of a medication approved by the federal Food and Drug Administration (FDA) for the treatment of a substance use disorder. Medication for Opioid Use Disorder. Use of a medication approved by the FDA for the treatment of an opioid use disorder. Mental Health Disorder. Any disorder pertaining to mental health, as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Motivational and Supportive Services. Counseling as a component of acupuncture withdrawal management treatment services that: (1) encourages members to remain in acupuncture withdrawal management treatment; (2) helps members obtain necessary additional medical and social services; (3) includes HIV/AIDS and other risk assessments and education services; and (4) motivates members to participate in ongoing outpatient substance use disorder treatment. Opioid Treatment Program (OTP). A program that provides opioid treatment services. An OTP must be federally certified by the Substance Abuse Mental Health Services Administration (SAMHSA) and must be licensed as an opioid treatment program by the Department of Public Health under 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs. OTPs must conform to the federal opioid treatment standards in 42 CFR 8.12. Opioid Treatment Services. Services rendered in Opioid Treatment Programs, which include a biopsychosocial assessment and treatment of a member, using FDA-approved medications (including methadone, buprenorphine, buprenorphine/naloxone, and naltrexone), along with a comprehensive range of medical and rehabilitative services, when clinically necessary, to alleviate the adverse medical, psychological or physical effects incident to opioid dependence. Opioid Treatment Services encompass withdrawal management services and maintenance treatment. Peer Recovery Coach. An individual currently in recovery who has lived experience with substance use or other addictive disorders and/or co-occurring mental health disorders and has been trained to help their peers with a similar experience to gain hope, explore recovery, and achieve life goals. Peer recovery coaches engage in an equitable, non-clinical relationship with the member focused on removing obstacles to recovery. Peer recovery coaches link members to the recovery community and engage in mentoring. Peer Recovery Coach for Pregnant and Postpartum Members (PRC-PP). A specialized peer recovery coach who has pregnancy and/or postpartum lived experience or has completed specialized training. PRC-PPs provide non-clinical peer recovery support to individuals in or seeking recovery who are pregnant or have been pregnant in the last 12 months. Pharmacotherapy. A type of therapy providing therapeutic treatment with pharmaceutical drugs. Physician Assistant. An individual who is registered by the Board of Registration of Physician Assistants in accordance with M.G.L. c. 112, § 9I and 263 CMR: Board of Registration of Physician Assistants. Program Director. An individual employed by the Licensed or Approved Provider who is responsible for the administrative and programmatic day-to-day operations of a program of substance use disorder treatment services and may provide supervision of all non-clinical staff. Quality Management. A systematic and ongoing process for monitoring, evaluating, and improving the quality and appropriateness of services provided to members, with focused attention on addressing cultural, ethnic, and language needs. Recovery Support Navigator. A paraprofessional who receives specialized training in the essentials of substance use disorder or other addictive disorders and evidence-based techniques such as motivational interviewing, and who supports members in accessing and navigating the SUD treatment system through activities that can include care coordination, case management, and motivational support. Recovery Support Navigator for Pregnant and Postpartum Members (RSN-PP). A specialized recovery support navigator who receives specialized training to provide recovery support navigator services to individuals who are pregnant or have been pregnant in the last 12 months. Registered Nurse. An individual licensed by the Massachusetts Board of Registration in Nursing in accordance with M.G.L. c. 112, § 74 and in compliance with 244 CMR 3.00: Registered Nurse and Licensed Practical Nurse. Release of Information (ROI). A document that allows a patient to authorize and revoke what information they want to release from their patient record, who it can be released to, how long it can be released for, and under what statutes and guidelines it is released. Residential Rehabilitation Services (RRS). ASAM Level 3.1 Clinically Managed Low-Intensity Residential Services, are clinically managed low-intensity residential services that provide a 24 hour, seven-days-a-week, supervised structured and comprehensive rehabilitative environment. These services support members’ independence and resilience to help them fully stabilize in recovery. Scheduled, goal-oriented clinical services are provided in conjunction with ongoing support and assistance to help members develop and maintain interpersonal skills necessary for developing and implementing recovery skills. Specialized RRS services tailored for the needs of youth, transitional age youth, young adults, families, and pregnant and port-partum individuals are also available to eligible members. Structured Outpatient Addiction Program (SOAP). ASAM Level 2.1 Intensive Outpatient Services, a substance use disorder treatment service that provides short-term, multi-disciplinary, clinically intensive structured treatment to address the sub-acute needs of members with substance use disorders and/or co-occurring disorders. These services may be used as a transition service in the continuum of care toward lower intensity outpatient programs or accessed directly. Substance Use Disorder (SUD). Any disorder pertaining to substance use as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Substance Use Disorder Outpatient Counseling Service. ASAM Level 1.5, an outpatient counseling service that is a rehabilitative treatment service for members and their families experiencing the effects of substance use and/or co-occurring disorders. Substance Use Disorder Treatment Organization (Organization). An entity that owns and operates one or more substance use disorder treatment program(s). Substance Use Disorder Treatment Program (Program). A provider that holds a license or approval under 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs, that delivers a comprehensive group of medical, clinical, and psychosocial treatment services to members seeking treatment for substance use disorders, which may include co-occurring mental health disorders. Telehealth. The use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (1) interactive audio-video technology; (2) remote patient monitoring devices; (3) audio-only telephone; and (4) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating, or monitoring a patient’s physical health, oral health, mental health, or substance use disorder condition. Transitional Support Services (TSS). ASAM Level 3.1 Clinically Managed Low-Intensity Residential Services, are active treatment and reassessment services provided on a short-term basis in a 24-hour community-based setting to members with a substance use disorder.