Comprehensive Substance Treatment and Rehabilitation (CSTAR)

PURPOSE: This rule establishes requirements for service delivery as a Comprehensive Substance Treatment and Rehabilitation (CSTAR) program. PUBLISHER’S NOTE: The secretary of state has determined that publication of the entire text of the material that is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here. (1) Program Requirements. In order to be certified by the department to provide CSTAR services, the organization must— (A) Comply with 9 CSR 10-7, 9 CSR 10-5, and 9 CSR 30-3, as applicable; (B) Be accredited to provide substance use disorder treatment services by Commission on Accreditation of Rehabilitation Facilities (CARF) International, The Joint Commission, Council on Accreditation, or other entity recognized by the department; (C) Have the capacity to collect, analyze, and report outcome and other data related to the population served to the department in accordance with established protocol; (D) Incorporate evidence-based, best, and promising practices into its service array. 1. At a minimum, the organization shall employ or have a formal contract with the following: A. Licensed and credentialed professionals with expertise and specialized training in the treatment of traumarelated disorders; B. Licensed and credentialed professionals with expertise and specialized training in the treatment of cooccurring disorders (substance use and mental illness); C. Licensed prescribers to provide FDA-approved medications which can be provided in an outpatient setting for the treatment of opioid use and other substance use disorders (methadone must be provided by a certified opioid treatment program). Long-term medications shall be offered and prescribed, as medically appropriate; D. Certified Peer Specialists who have completed department-approved training and credentialing; E. Clinical staff who have completed departmentapproved training on smoking cessation; F. Clinical staff who have completed departmentapproved training on suicide prevention; and (E) Have clinical staff who are trained and qualified to utilize The ASAM Criteria: Treatment Criteria for Addictive, SubstanceRelated, and Co-Occurring Conditions, 2013, hereby incorporated by reference and made a part of this rule, published by and available from The American Society of Addiction Medicine, 11400 Rockville Pike, Suite 200, Rockville, MD 20852, (301) 656-3920. This rule does not incorporate any subsequent amendments or additions to this publication. (2) Other Applicable Program Requirements. A CSTAR program shall meet the following additional requirements when the department determines they are applicable: (A) Services offered on a residential basis shall comply with requirements for residential treatment; and (B) Requirements as a specialized program for adolescents or as a specialized program for women and children shall be met, where applicable. (3) Medicaid Eligibility. An organization must be certified as a CSTAR program to qualify for Medicaid reimbursement for delivery of substance use disorder treatment services to eligible persons. (A) A CSTAR program shall comply with applicable state and federal Medicaid requirements. (B) If there is a change in the Medicaid eligibility or financial status of a person served, the individual shall not be prematurely discharged from the CSTAR program or otherwise denied CSTAR services. The program shall— 1. Continue to provide all necessary and appropriate services until the individual meets treatment plan goals and criteria for discharge; or 2. Transition the individual to another provider and document in the individual’s record there is continuity of clinically appropriate treatment services. (C) A CSTAR program acknowledges and accepts that not all required services may be reimbursed by Medicaid. (4) Temporary Waiver. Upon the effective date of this rule, the department will grant a one- (1-) year waiver from the requirements specified in subsections (1)(B) and (1)(E) of this rule to programs that have a current and valid CSTAR contract with the department and continue to meet certification and contract requirements. (A) Waivers shall be temporary and time limited. 1. The initial waiver period of one (1) year may be renewed or extended by the department annually thereafter. 2. The total period of waiver shall not exceed three (3) years unless otherwise determined by the department. AUTHORITY: sections 630.050, 630.655, and 631.010, RSMo 2016.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001. Amended: Filed March 25, 2021, effective Sept. 30, 2021. Amended: Filed Aug. 7, 2023, effective Feb. 29, 2024. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008; 630.655, RSMo 1980; and 631.010, RSMo 1980.