Common use of Substance Use Disorders Clause in Contracts

Substance Use Disorders. (1) Contractor shall provide Substance Use Disorders services to Members, which include outpatient, intensive outpatient, medication assisted treatment including, Opiate Substitution Services, residential and detoxification treatment services. For purposes of this Contract, OHA rules and criteria applicable to outpatient treatment services are located in OAR Chapter 309 Divisions 18, 19 and 22, the OHA rules and criteria applicable to synthetic opiate treatment services located in OAR Chapter 415 Division 20, and the AMH rules and criteria applicable to detoxification centers located in OAR Chapter 415 Division 50. For technical assistance related to this section of this Contract, the OHA contact will be the Medicaid Substance Use Disorders Specialist. (2) Contractor shall make decisions about access to Substance Use Disorders services, continued stay, discharges, and referrals based upon OHA approved criteria, which are deemed to be Medically Appropriate. Contractor shall ensure that employees or (3) Contractor shall consider each Member’s needs and, to the extent appropriate and possible, provide specialized Substance Use Disorders services designed specifically for the following groups as set forth in OHA administrative rules: a) adolescents, taking into consideration adolescent development, b) women, and women’s specific issues, c) ethnic and racial diversity and environments that are culturally and linguistically relevant, d) intravenous drug users, e) people involved with the criminal justice system, f) individuals with co-occurring disorders, g) parents accessing residential treatment with an accompanying dependent child(ren), and h) individuals accessing residential treatment with medication assisted therapy. (4) Consistent with Exhibit B, Part 2, Section 6, Non-Covered Services with Care Coordination, Contractor shall coordinate referral and follow-up of Members to Non- Covered Services. Contractor’s employees or Subcontractors providing Substance Use Disorders services shall provide to Member, to the extent of available community resources and as clinically indicated, information and referral to community services which may include, but are not limited to: child care, elder care, housing, transportation, employment, vocational training, educational services, mental health services, financial services, and legal services. (5) Contractor shall where Medically Appropriate provide detoxification in a non-hospital based facility. Facilities or programs providing detoxification services must have a letter of approval or license from OHA. (6) Contractor shall authorize and pay for at least culturally and linguistically appropriate outpatient Substance Use Disorders services to eligible Members who meet ASAM PPC- 2R criteria for residential treatment services, when residential treatment services are not immediately available. (7) Contractor shall require employees or Subcontractors providing Substance Use Disorders services to provide OHA, within 30 days of admission or discharge, with all information required by OHA’s most current data system. (8) Contractor shall use OHA approved Substance Use Disorders screening tools for prevention, early detection, brief intervention and referral to Substance Use Disorders treatment. Contractor may submit alternative screening tools to the Medicaid Substance Use Disorders Specialist, for review and possible approval. For a list of the OHA approved screening tools, Contractor shall contact the Medicaid Substance Use Disorders Specialist. (9) Contractor shall make a good faith effort to screen all Members and provide prevention, early detection, brief intervention and referral to Substance Use Disorders treatment who are in any of the following circumstances: a) at an initial contact or routine physical exam, b) at an initial prenatal exam, c) when the Member shows evidence of Substance (10) Contractor shall ensure that individuals or programs have a letter of approval or license from OHA for the Substance Use Disorders services they provide and meet all other applicable requirements of this Contract, except that Providers under The Drug Addiction Treatment Act of 2000, Title 42 Section 3502 Waiver may treat and prescribe Buprenorphine for opioid addiction in any appropriate practice setting in which they are otherwise credentialed to practice and in which such treatment would be Medically Appropriate. (11) Contractor shall inform all Members using culturally and linguistically appropriate means that Substance Use Disorders outpatient, intensive outpatient, residential, detoxification and medication assisted treatment services, including opiate substitution treatment, are included in the Benefit Package consistent with OAR 410-141-3300. (12) Contractor shall provide covered culturally and linguistically appropriate Substance Use Disorders services for any Member who meets admission criteria for outpatient, intensive outpatient, residential, detoxification and medication assisted treatment including opiate substitution treatment, regardless of prior alcohol/other drug treatment or education. (13) Contractor shall comply with the following access requirements: Members are seen the same day for emergency Substance Use Disorders treatment care. Members, including pregnant women, are seen within 48 hours for urgent Substance Use Disorders treatment care. Members, including intravenous drug users, are seen within 10 Business Days or the Community Standard for routine Substance Use Disorders treatment care. (14) In addition to any other confidentiality requirements described in this Contract, Contractor shall follow the federal (42 CFR Part 2) confidentiality laws and regulations governing the identity and medical/Client records of Members who receive Substance Use Disorders services. (15) Contractor shall identify and ensure that Members have access to culturally and linguistically appropriate specialized programs in each Service Area in the following categories: drug court referrals, Child Welfare referrals, Job Opportunities and Basic Skills (JOBS) referrals, and referrals for persons with co-occurring disorders. (16) Contractor shall provide Members with culturally and linguistically appropriate alcohol, tobacco, and other drug abuse prevention/education that reduces Substance Use Disorders risk to Members. Contractor’s prevention program shall meet or model national quality assurance standards. Contractor shall have mechanisms to monitor the use of its preventive programs and assess their effectiveness on its Members.

Substance Use Disorders. (1) Contractor shall provide Substance Use Disorders services to Members, which include outpatient, intensive outpatient, medication assisted treatment including, Opiate Substitution Services, residential and detoxification treatment services. For purposes of this Contract, OHA rules and criteria applicable to outpatient treatment services are located in OAR Chapter 309 309, Divisions 18, 19 and 22, the OHA rules and criteria applicable to synthetic opiate treatment services located in OAR Chapter 415 Division 20, and the AMH rules and criteria applicable to detoxification centers located in OAR Chapter 415 Division 50. For technical assistance related to this section of this Contract, the OHA contact will be the Medicaid Substance Use Disorders Specialist. (2) Contractor shall make decisions about access to Substance Use Disorders services, continued stay, discharges, and referrals based upon OHA approved criteria, which are deemed to be Medically Appropriate. Contractor shall ensure that employees oror Subcontractors who evaluate Members for access to, and length of stay in, Substance Use Disorders services have the training and background in Substance Use Disorders services and working knowledge of American Society of Addiction Medicine (ASAM) Patient Placement Criteria for the Treatment of Substance-Related Disorders, Second Edition- Revised (PPC-2R). Contractor shall participate with OHA in a review of OHA provided data about the impact of these criteria on service quality, cost, outcome, and access. (3) Contractor shall consider each Member’s needs and, to the extent appropriate and possible, provide specialized Substance Use Disorders services designed specifically for the following groups as set forth in OHA administrative rules: a) adolescents, taking into consideration adolescent development, b) women, and women’s specific issues, c) ethnic and racial diversity and environments that are culturally and linguistically relevant, d) intravenous drug users, e) people involved with the criminal justice system, f) individuals with co-occurring disorders, g) parents accessing residential treatment with an accompanying dependent child(ren), and h) individuals accessing residential treatment with medication assisted therapy. (4) Consistent with Exhibit B, Part 2, Section 6, Non-Covered Services with Care Coordination, Contractor shall coordinate referral and follow-up of Members to Non- Covered Services. Contractor’s employees or Subcontractors providing Substance Use Disorders services shall provide to Member, to the extent of available community resources and as clinically indicated, information and referral to community services which may include, but are not limited to: child care, elder care, housing, transportation, employment, vocational training, educational services, mental health services, financial services, and legal services. (5) Contractor shall where Medically Appropriate provide detoxification in a non-hospital based facility. Facilities or programs providing detoxification services must have a letter of approval or license from OHA. (6) Contractor shall authorize and pay for at least culturally and linguistically appropriate outpatient Substance Use Disorders services to eligible Members who meet ASAM PPC- 2R criteria for residential treatment services, when residential treatment services are not immediately available.PPC- (7) Contractor shall require employees or Subcontractors providing Substance Use Disorders services to provide OHA, within 30 days of admission or discharge, with all information required by OHA’s most current data system. (8) Contractor shall use OHA approved Substance Use Disorders screening tools for prevention, early detection, brief intervention and referral to Substance Use Disorders treatment. Contractor may submit alternative screening tools to the Medicaid Substance Use Disorders Specialist, for review and possible approval. For a list of the OHA approved screening tools, Contractor shall contact the Medicaid Substance Use Disorders Specialist. (9) Contractor shall make a good faith effort to screen all Members and provide prevention, early detection, brief intervention and referral to Substance Use Disorders treatment who are in any of the following circumstances: a) at an initial contact or routine physical exam, b) at an initial prenatal exam, c) when the Member shows evidence of SubstanceSubstance Use Disorders or abuse (as noted in the OHA approved screening tools), or d) when the Member over-utilizes Covered Services. (10) Contractor shall ensure that individuals or programs have a letter of approval or license from OHA for the Substance Use Disorders services they provide and meet all other applicable requirements of this Contract, except that Providers under The Drug Addiction Treatment Act of 2000, Title 42 Section 3502 Waiver may treat and prescribe Buprenorphine for opioid addiction in any appropriate practice setting in which they are otherwise credentialed to practice and in which such treatment would be Medically Appropriate. (11) Contractor shall inform all Members using culturally and linguistically appropriate means that Substance Use Disorders outpatient, intensive outpatient, residential, detoxification and medication assisted treatment services, including opiate substitution treatment, are included in the Benefit Package consistent with OAR 410-141-3300. (12) Contractor shall provide covered culturally and linguistically appropriate Substance Use Disorders services for any Member who meets admission criteria for outpatient, intensive outpatient, residential, detoxification and medication assisted treatment including opiate substitution treatment, regardless of prior alcohol/other drug treatment or education. (13) Contractor shall comply with the following access requirements: Members are seen the same day for emergency Substance Use Disorders treatment care. Members, including pregnant women, are seen within 48 hours for urgent Substance Use Disorders treatment care. Members, including intravenous drug users, are seen within 10 Business Days or the Community Standard for routine Substance Use Disorders treatment care. (14) In addition to any other confidentiality requirements described in this Contract, Contractor shall follow the federal (42 CFR Part 2) confidentiality laws and regulations governing the identity and medical/Client records of Members who receive Substance Use Disorders services. (15) Contractor shall identify and ensure that Members have access to culturally and linguistically appropriate specialized programs in each Service Area in the following categories: drug court referrals, Child Welfare referrals, Job Opportunities and Basic Skills (JOBS) referrals, and referrals for persons with co-occurring disorders. (16) Contractor shall provide Members with culturally and linguistically appropriate alcohol, tobacco, and other drug abuse prevention/education that reduces Substance Use Disorders risk to Members. Contractor’s prevention program shall meet or model national quality assurance standards. Contractor shall have mechanisms to monitor the use of its preventive programs and assess their effectiveness on its Members.

Substance Use Disorders. (1) Contractor shall provide Substance Use Disorders services to Members, which include outpatient, intensive outpatient, medication assisted treatment including, Opiate Substitution Services, residential and detoxification treatment services. For purposes of this Contract, OHA rules and criteria applicable to outpatient treatment services are located in OAR Chapter 309 309, Divisions 18, 19 and 22, the OHA rules and criteria applicable to synthetic opiate treatment services located in OAR Chapter 415 Division 20, and the AMH rules and criteria applicable to detoxification centers located in OAR Chapter 415 Division 50. For technical assistance related to this section of this Contract, the OHA contact will be the Medicaid Substance Use Disorders Specialist. (2) Contractor shall make decisions about access to Substance Use Disorders services, continued stay, discharges, and referrals based upon OHA approved criteria, which are deemed to be Medically Appropriate. Contractor shall ensure that employees oror Subcontractors who evaluate Members for access to, and length of stay in, Substance Use Disorders services have the training and background in Substance Use Disorders services and working knowledge of American Society of Addiction Medicine (ASAM) Patient Placement Criteria for the Treatment of Substance-Related Disorders, Second Edition- Revised (PPC-2R). Contractor shall participate with OHA in a review of OHA provided data about the impact of these criteria on service quality, cost, outcome, and access. (3) Contractor shall consider each Member’s needs and, to the extent appropriate and possible, provide specialized Substance Use Disorders services designed specifically for the following groups as set forth in OHA administrative rules: a) adolescents, taking into consideration adolescent development, b) women, and women’s specific issues, c) ethnic and racial diversity and environments that are culturally and linguistically relevant, d) intravenous drug users, e) people involved with the criminal justice system, f) individuals with co-occurring disorders, g) parents accessing residential treatment with an accompanying dependent child(ren), and h) individuals accessing residential treatment with medication assisted therapy. (4) Consistent with Exhibit B, Part 2, Section 6, Non-Covered Services with Care Coordination, Contractor shall coordinate referral and follow-up of Members to Non- Covered Services. Contractor’s employees or Subcontractors providing Substance Use Disorders services shall provide to Member, to the extent of available community resources and as clinically indicated, information and referral to community services which may include, but are not limited to: child care, elder care, housing, transportation, employment, vocational training, educational services, mental health services, financial services, and legal services., (5) Contractor shall where Medically Appropriate provide detoxification in a non-hospital based facility. Facilities or programs providing detoxification services must have a letter of approval or license from OHA. (6) Contractor shall authorize and pay for at least culturally and linguistically appropriate outpatient Substance Use Disorders services to eligible Members who meet ASAM PPC- 2R criteria for residential treatment services, when residential treatment services are not immediately available. (7) Contractor shall require employees or Subcontractors providing Substance Use Disorders services to provide OHA, within 30 days of admission or discharge, with all information required by OHA’s most current data system. (8) Contractor shall use OHA approved Substance Use Disorders screening tools for prevention, early detection, brief intervention and referral to Substance Use Disorders treatment. Contractor may submit alternative screening tools to the Medicaid Substance Use Disorders Specialist, for review and possible approval. For a list of the OHA approved screening tools, Contractor shall contact the Medicaid Substance Use Disorders Specialist. (9) Contractor shall make a good faith effort to screen all Members and provide prevention, early detection, brief intervention and referral to Substance Use Disorders treatment who are in any of the following circumstances: a) at an initial contact or routine physical exam, b) at an initial prenatal exam, c) when the Member shows evidence of SubstanceSubstance Use Disorders or abuse (as noted in the OHA approved screening tools), or d) when the Member over-utilizes Covered Services. (10) Contractor shall ensure that individuals or programs have a letter of approval or license from OHA for the Substance Use Disorders services they provide and meet all other applicable requirements of this Contract, except that Providers under The Drug Addiction Treatment Act of 2000, Title 42 Section 3502 Waiver may treat and prescribe Buprenorphine for opioid addiction in any appropriate practice setting in which they are otherwise credentialed to practice and in which such treatment would be Medically Appropriate. (11) Contractor shall inform all Members using culturally and linguistically appropriate means that Substance Use Disorders outpatient, intensive outpatient, residential, detoxification and medication assisted treatment services, including opiate substitution treatment, are included in the Benefit Package consistent with OAR 410-141-3300. (12) Contractor shall provide covered culturally and linguistically appropriate Substance Use Disorders services for any Member who meets admission criteria for outpatient, intensive outpatient, residential, detoxification and medication assisted treatment including opiate substitution treatment, regardless of prior alcohol/other drug treatment or education. (13) Contractor shall comply with the following access requirements: Members are seen the same day for emergency Substance Use Disorders treatment care. Members, including pregnant women, are seen within 48 hours for urgent Substance Use Disorders treatment care. Members, including intravenous drug users, are seen within 10 Business Days or the Community Standard for routine Substance Use Disorders treatment care.including (14) In addition to any other confidentiality requirements described in this Contract, Contractor shall follow the federal (42 CFR Part 2) confidentiality laws and regulations governing the identity and medical/Client records of Members who receive Substance Use Disorders services. (15) Contractor shall identify and ensure that Members have access to culturally and linguistically appropriate specialized programs in each Service Area in the following categories: drug court referrals, Child Welfare referrals, Job Opportunities and Basic Skills (JOBS) referrals, and referrals for persons with co-occurring disorders. (16) Contractor shall provide Members with culturally and linguistically appropriate alcohol, tobacco, and other drug abuse prevention/education that reduces Substance Use Disorders risk to Members. Contractor’s prevention program shall meet or model national quality assurance standards. Contractor shall have mechanisms to monitor the use of its preventive programs and assess their effectiveness on its Members.