Regulation text
9107 SUBSTANCE ABUSE COUNSELING – INDIVIDUAL, GROUP AND FAMILY
Substance abuse counseling services shall include individual, group, and family counseling. These services shall incorporate a face-to-face, interactive process focused on assisting a beneficiary who manifests substance use disorder.
The goal of substance abuse counseling shall be the cultivation of awareness, skills, and supports that are necessary in order to facilitate long-term recovery from substance use disorder.
Substance abuse counseling services shall address the specific issues identified in a treatment plan and shall meet applicable requirements established in Chapter 23 of Title 29 DCMR.
A unit of substance abuse counseling service shall be one (1) fifteen (15) minute increment, pursuant to DHCF’s billing requirement.
Substance abuse counseling services shall not be provided in conjunction with Medication Management, described in § 9108 of this chapter.
Group and family substance abuse counseling services shall be exclusively for the recovery of a Medicaid beneficiary enrolled in ASARS treatment.
Limitations for substance abuse counseling services, by level of care, per treatment episode are as follows:
Level IV:
Individual: Shall not exceed twenty (20) units;
Group: Shall not exceed twelve (12) units; and
Family: Shall not exceed four (4) units;
Level III:
Individual: Not to exceed thirty-two (32) units;
Group: Not to exceed eight hundred ninety-six (896) units; and
Family: Not to exceed sixteen (16) units;
Level II:
Individual: Not to exceed twenty-four (24) units;
Group: Not to exceed two hundred sixteen (216) units; and
Family: Not to exceed twenty-four (24) units;
Level I for beneficiaries who are also receiving Medication Assisted Treatment:
Individual: Not to exceed forty-eight (48) units;
Group: Not to exceed one hundred ninety-two (192) units; and
Family: Not to exceed twelve (12) units;
Level I for beneficiaries who are not receiving Medication Assisted Treatment:
Individual: Not to exceed thirty-two (32) units;
Group: Not to exceed three hundred eighty-four (384) units; and
Family: Not to exceed sixteen (16) units and
Additional units for substance abuse counseling services shall be prior authorized through a request from the clinical care coordinator, subject to the beneficiary’s level of care.
Substance abuse counseling services shall be provided in APRA-certified substance abuse treatment facilities or programs; community-based settings otherwise approved or designated by APRA; and private practices with qualified practitioners authorized to provide substance abuse counseling according to their licensure pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01, et seq. (2007 Repl. & 2012 Supp.)).
Substance abuse counseling services shall be delivered by the following practitioners who shall be certified in substance abuse counseling:
Physician;
Psychologist;
Licensed Independent Clinical Social Worker;
Advanced Practice Registered Nurse;
Registered Nurse;
Licensed Independent Social Worker;
Licensed Professional Counselor; and
Certified Addiction Counselor I and II.
SOURCE: Final Rulemaking published at 59 DCR 11144 (September 28, 2012).