Services & Programs
Substance Abuse Intensive Outpatient Program

Outreach Management Services, LLC will provide structured individual and group addiction activities and services that are provided at an outpatient program designed to assist adult and adolescent consumers to begin recovery and learn skills for recovery maintenance.

This program will be offered at least three (3) hours per day at least three (3) days per week with no more than two consecutive days between offered services, and distinguishes between those individuals needing no more than 19 hours per week of structured services per week (ASAM Level II.1).

The consumer will be in attendance for a minimum of three (3) hours per day in order to bill for this service. SAIOP services will include a structured program consisting of, but not limited to, the following services:

1. Individual counseling and support;
2. Group counseling and support;
3. Family counseling, training or support;
4. Biochemical essays to identify recent drug use
(e.g. urine drug screens);
5. Strategies for relapse prevention to include community and social support systems in treatment;
6. Life skills;
7. Crisis contingency planning;
8. Disease management; and
9. Treatment support activities that have been adapted or specifically designed for persons with physical disabilities, or persons with co-occurring disorders of mental illness and substance abuse/dependence or mental retardation/developmental disability and substance abuse/dependence.

This service is designed for homogenous groups of consumers e.g., pregnant women, and women and their children; individuals with co-occurring MH/SA disorders; individuals with HIV; or individuals with similar cognitive levels of functioning. Group counseling shall be provided each day this service is offered. Case Management services are included and are intended to arrange, link or integrate multiple services as well as assessment and reassessment of the consumer’s need for services.

Outreach Management Services, LLC will also inform the consumer about benefits, community resources, and services; assists the consumer in accessing benefits and services; arranges for the consumer to receive benefits and services; and monitors the provision of services. Consumers may be residents of their own home, a substitute home, or a group care setting; however, this service will be provided in a setting separate from the consumer’s residence. This program will be provided over a period of several weeks or months.

A service order will be obtained by a physician, licensed psychologist, physician’s assistant or nurse practitioner according to their scope of practice prior to or on the day that the services are to be provided.

Provider Requirements
All staff/practitioners who provide this service will meet OMS qualification policies, procedures, and standards established by DMH and the requirements of 10A NCAC 27G. In order to provide this service, Outreach Management Services, LLC will be endorsed by the LME.

In addition, within three years of enrollment as a provider, National Accreditation from CARF will be achieved. Lastly, OMS will remain a legal entity in the United States and qualified/registered to do business as a corporate entity in the State of NC.

OMS will provide “first responder” crisis response on a 24/7/365 basis to recipients who are receiving this service.

Staffing Requirements
All staff who provide this service will meet the requirements for CCS, CCAS, and CSAC under Article 5C. This program will be under the clinical supervision of a CCS or a CCAS who is on site a minimum of 50% of the hours the service is in operation. This service may also be provided by staff who meet the requirements specified for QP or AP status for Substance Abuse according to 10A NCAC, under the supervision of a CCAS or CCS.

The maximum face-to-face staff-to-consumer ratio is not more than 12 adult consumers to 1 QP based on an average daily attendance. The ratio for adolescents will be 1:6. Paraprofessional staff may also provide this service as long as they have the knowledge, skills, and abilities required for the population and age to be served and will be under the supervision of a CCAS or CCS. However, Paraprofessional staff will not provide services in lieu of on-site service provision by a QP, CCAS, CCS, or CSAC.

Service Type/Setting
Outreach Management Services, LLC will be licensed to provide this service under 10A NCAC 27G .3700.

Utilization Management
Authorization to provide this service will be obtained by the statewide vendor or the DHHS approved LME contracted with the Medicaid agency. The amount, duration and frequency of this service will be included in the individual’s Person Centered Plan. This service will not be delivered less frequently than the structured program set forth in the service description above.

Initial authorization for services will not exceed a duration of 12 weeks. Under exceptional circumstances, one additional reauthorization up to 2 weeks can be approved. This service will be billed with a minimum of three (3) hours per day as an event.

Admission Criteria
In order to receive SAIOP services from OMS, the consumer must have an Axis I substance abuse disorder and meet the level of care criteria, level II.1 NC modified A/ASAM.

Continued Stay Criteria
If the desired outcome or level of functioning has not been restored, improved, or sustained over the time frame outlined in the consumer’s PCP or the consumer continues to be at risk for relapse based on history or the tenuous nature of the functional gains or any one of the following apply:

1. Consumer has achieved positive life outcomes that support
stable and ongoing recovery, and additional goals are indicated.
2. Consumer is making satisfactory progress toward meeting goals.
3. Consumer is making some progress, but the PCP (specific interventions)
needs to be modified so that greater gains, which are consistent
with the consumer’s premorbid level of functioning, are
possible or can be achieved.
4. Consumer is not making progress; the PCP must be modified
to identify more effective interventions
5. Consumer is regressing; the PCP must be modified to
identify more effective interventions.

Expected Outcomes
The goal of this service is to achieve abstinence. Secondary outcomes (i.e., in abstinent consumers) include: sustained improvement in health and psychosocial functioning, reduction in any psychiatric symptoms (if present), reduction in public health and/or safety concerns, and a reduction in the risk of relapse as evidenced by improvement in empirically supported modifiable relapse risk factors.

Documentation Requirements
There will be a full service note written on each day this service is provided. The service note will include the consumer’s name, Medicaid identification number, date of service, purpose of contact, a description of the interventions; the time spent performing the intervention, the effectiveness of the interventions, and the signature and credentials of the staff providing the service. A documented discharge plan will be discussed with the consumer and will be included in the record.

Discharge Criteria
A consumer will be discharged from services once the consumer’s level of functioning has improved with respect to the goals outlined in the PCP, inclusive of a transition plan to step down, or no longer benefits, or has the ability to function at this level of care and any of the following apply:

1. Consumer has achieved positive life outcomes
that support stable and ongoing recovery.
2. Consumer is not making progress, or is regressing and all realistic treatment options have been exhausted indicating
a need for more intensive services.
3. Consumer no longer wishes to receive this service.

Service Exclusions/Limitations
This service will not be billed during the same authorization period as SA Comprehensive Outpatient Treatment, all detoxification services, Non-Medical Community Residential Treatment or Medically Monitored Community Residential Treatment.

If OMS is the Community Support provider, CS can be billed for a maximum of 8 units per month in accordance with the PCP. The purpose of CS will be to facilitate transition into the service, admission to the service, meeting with the person as soon as possible upon admission, providing coordination during the provision of service, and discharge planning.

 

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