471 NAC 35-011. SUBSTANCE USE DISORDER COMMUNITY SUPPORT

011. SUBSTANCE USE DISORDER COMMUNITY SUPPORT. Substance use disorder community support interventions provide direct rehabilitation and support services to beneficiaries in the community to assist the beneficiary in maintaining abstinence, stabilizing community living, and preventing exacerbation of symptoms and admissions to more restrictive levels of care. Services are based upon medical necessity as identified in the beneficiary’s treatment and recovery plan and must be provided in 15-minute increments. 011.01 PROGRAM COMPONENTS. The substance use disorder community support program must: (A)Facilitate communication and coordination among all health care professionals providing services to the beneficiary; (B)Ensure completion of a strength-based needs assessment completed within 30 days of admission by the rehabilitation team or team member; (C)Develop and implement strategies to encourage the beneficiary to become engaged and remain engaged in necessary substance use and mental health treatment services as recommended and included in the treatment and recovery plan; (D)Have access to the comprehensive substance use disorder assessment conducted prior to admission by an independently licensed practitioner practicing within their scope of practice, which must be reviewed and updated within 30 days of admission into the program. As appropriate, a substance use disorder addendum must be developed to clarify or update the treatment needs and recommendations and gather information that covers any time frame where a beneficiary was not receiving treatment; (E)Participate with and report to the treatment and recovery team on the beneficiary’s progress and response to community support intervention in areas of relapse prevention of substance use and application of education and skills in the recovery environment; (F)Review and update the treatment and recovery plan and discharge plan with the beneficiary and other approved family supports every 90 days or more often as clinically necessary; (G)Coordinate with the providers of mental health services when the beneficiary has a co-occurring diagnosis and receiving mental health services by a licensed practitioner either located in the agency or in a separate program; (H)Assist in facilitating the transfer to and the transition to other levels of treatment service; (I) Assist in the development, evaluation, and update in a crisis and relapse plan with the beneficiary; (J)Provide contact as needed with other providers, beneficiary family members, and other significant individuals in the beneficiary’s life to facilitate communication necessary to support the beneficiary in maintaining community living; (K)When prescribed, monitor medication compliance, and report compliance issues as necessary; (L)Assist the beneficiary with all health insurance issues; and (M)Assist in the discharge plan for the beneficiary and support development of community-based resources. 011.02 PROGRAM AVAILABILITY. The substance use disorder Community Support program must establish hours of service delivery that ensure program staff availability and accessibility to the treatment, rehabilitation, and recovery needs of the beneficiary. The frequency of face-to-face contacts with the beneficiary is based upon clinical need. 011.03 STAFFING REQUIREMENTS. Substance use disorder Community Support programs must employ a licensed practitioner to provide supervision of the substance use disorder Community Support program. The licensed practitioner must supervise any individualized treatment and recovery service interactions provided by a community support worker. The licensed clinical supervisor will review community support beneficiary’s clinical needs and progress toward their goals with the community support worker every 30 days. The support worker must have a minimum of: (i) Bachelor’s degree in psychology, sociology, or related human service field, or (ii) Two years coursework in a human services field and two years of training or training, or (iii) Two years of lived recovery experience with demonstrated skills and competencies in the provision of substance use disorder services and demonstrated skill in competency in working with chronic substance dependence. 011.03(A) CLINICAL DOCUMENTATION. Direct care staff employed by the agency before the effective date of these regulations will be considered to meet staffing requirements when the provider submits documentation identifying the name, address and provider number of the provider, service provided, names of direct care staff employed before the effective date of these regulations, and their date of hire. Documentation must be submitted 30 days following the effective date of these regulations. 011.04 ASSESSMENT AND TREATMENT PLANNING. Outpatient substance use disorder treatment must be delivered following the completion of the comprehensive substance use disorder assessment. Prior to delivery of services, an individual treatment and recovery plan must be developed by the provider with the beneficiary. The plan must be individualized, reviewed, and approved by the beneficiary and therapist, and adjusted as clinically necessary. As appropriate, a substance use disorder addendum must be developed to clarify or update the treatment needs and recommendations and gather information that covers any time frame where a beneficiary was not receiving treatment. 011.05 DOCUMENTATION. Outpatient substance use disorder treatment providers must document in a summary the treatment service delivered in an individualized progress note. The progress note must describe the treatment intervention provided, the beneficiary's response to the intervention, and must be placed in the beneficiary’s clinical record. Documentation must clearly reflect the implementation of the treatment and recovery plan. Discharge planning must be an essential part of the treatment and recovery plan and the documentation of the progress toward discharge must be documented in the clinical record. .011.06 PROVIDER ENROLLMENT. Outpatient adult substance use disorder providers must comply with all applicable provider participation requirements. Providers of outpatient services must provide annual cost information as a requirement by Nebraska Medicaid at the time of enrollment and maintain any licensure requirements in order to continue participation with Nebraska Medicaid. 011.07 PRIOR AUTHORIZATION. Outpatient substance use disorder treatment services must be prior authorized by Nebraska Medicaid or its designee before treatment service delivery. 011.08 PAYMENT FOR COMMUNITY SUPPORT ABUSE TREATMENT SERVICES. Providers must bill community support services in 15-minute increments for a maximum of 144 units for 180 days.