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STATE OF MICHIGANGRETCHEN WHITMERDEPARTMENT OF HEALTH AND HUMAN SERVICESROBERT GORDONGOVERNORLANSINGDIRECTORMay 2, 2019Ed FrancellProject OfficerCenters for Medicare & Medicaid ServicesCenter for Medicaid and CHIP ServicesMail Stop: S2-25-267500 Security BoulevardBaltimore, Maryland 21244-1850Dear Mr. Francell:This letter serves as the State of Michigan’s formal acceptance of the Special Termsand Conditions (STCs) for the Section 1115 Demonstration Waiver know as Pathway toIntegration (Project Number 11-W-00305/5), as provided in the CMS April 5, 2019 letter.The State appreciates the time and effort you and your colleagues at the Centers forMedicare & Medicaid Services (CMS) have provided over the past three years as weworked together to address the substance use disorder needs of individuals inMichigan.At this time, the State would also like to request two technical corrections to the STCs.Given the significant changes to the content of this demonstration since it wassubmitted three years ago, the State does not believe the current name “Pathway toIntegration” describes the focus of the program. The State would like to propose thatthe name be changed to “Pathway to Substance Use Disorder Treatment Expansion” tomore accurately reflect the purpose of the demonstration.As part of the STCs, the initial Substance Use Disorder Implementation Plan (STC 18)that was submitted in 2016 was also approved. The State appreciates CMS’ review ofthat implementation plan and the acknowledgement of the work that was completed atthat time. As a significant amount of time has passed since the initial plan wasdeveloped, the State has updated the implementation plan with current information andwould like this revised plan (included), to replace what has been initially approved. TheState will be available to review this plan with CMS if needed.CAPITOL COMMONS CENTER 400 SOUTH PINE STREET LANSING, MICHIGAN 48913www.michigan.gov/mdhhs 517-284-1188
Ed FrancellMay 2, 2019Page 2 of 2The State looks forward to its continued work with CMS as we implement the terms andconditions of this demonstration. If you have any questions or require any additionalinformation, please contact Jacqueline Coleman at (517) 284-1190 or by e-mail atColemanJ@Michigan.gov.Sincerely,Kathleen Stiffler, Acting DirectorMedical Services Administrationcc:James Scott
STATE OF MICHIGAN1115 DEMONSTRATION WAIVEROPIOID USE DISORDER/SUBSTANCE USE DISORDER IMPLEMENTATIONPLANMAY 2018
Michigan 1115 OUD/SUD Waiver Implementation PlanAccess to Critical Levels of Care for Opioid Use Disorder (OUD) and other Substance Use Disorders (SUD)While Michigan has historically maintained a robust network of SUD providers and services spanning from early intervention through inpatientwithdrawal management services, the 1115 waiver authority will permit the state to broaden the array of treatment services available and provideMedicaid coverage for the full American Society of Addiction Medicine (ASAM) care continuum, including residential and withdrawal managementservices in an IMD setting for adults age 21-64.In acknowledgement of the need to develop a strong SUD network capable of delivering a comprehensive benefit consistent with ASAM Level ofCare requirements, MDHHS is embarking on a process intended to enable the state to generate comprehensive and refreshable reports for futureplanning and decision-making. Through this work, the Michigan Department of Health and Human Services (MDHHS) intends to develop astrategy to effectively utilize existing state-specific and other publicly available data to help with the following:1. Ensure a Comprehensive Evidence-Based Benefit SUD Benefit To guarantee a full continuum of evidence-based practices To ensure use of evidence-based practices including Screening, Brief Intervention, and Referral to Treatment (SBIRT), withdrawalmanagement, medication assisted treatment, care coordination, long-term recovery supports and services To confirm service availability and use of services (e.g., short-term inpatient and short-term residential), including in IMDs2. Ensure that SUD providers meet ASAM Program and Service Requirements By establishing standards of care using ASAM criteria By using ASAM standards to develop residential, withdrawal management, outpatient, early intervention and opioid treatmentprograms By requiring all providers to meet ASAM level of care standards prior to participating in Medicaid3. Ensure the Presence and Maintenance of a Strong SUD Provider Network By developing and implementing a plan and strategy to ensure a sufficient network of providers across all ASAM levels By ensuring that providers have the ability to deliver services consistent with ASAM criteria and provide evidence-based SUD practices By ensuring that the provider network is robust in the event providers stop participating in Medicaid, are suspended or terminated2 Page
Michigan 1115 OUD/SUD Waiver Implementation PlanMichigan provides coverage for an extensive array of SUD treatment and recovery support services. Below we list all of the SUD services availableunder the waiver, including those newly covered under the 1115 waiver. SUD treatment services are arrayed by the ASAM Level of Care.Recovery Support Services are available to individuals regardless of ASAM care level. Unless otherwise noted, all services are available to adultsand children/adolescents. For each service we also provide definitions and components for each service.Table: 1ASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsAvailabilitySUD TREATMENT0.5 - Early InterventionScreening, BriefIntervention, andReferral toTreatment(SBIRT)Assessment and education for at-riskindividuals. A face-to-face service forthe purpose of identifying functional,treatment, and recovery needs and abasis for formulating theIndividualized Treatment Plan.Primary care providers payable under thestate’s managed care/ fee for servicephysical health care cesIncludes stage-based interventionsfor individuals with substance usedisorders and individuals who maynot meet the threshold of abuse ordependence but are experiencingfunctional/social impairment as aresult of use.Provider agency licensed and accredited assubstance abuse treatment program. Stateapproval for ASAM level of care.Services are notsubdivided by thenumber of hoursreceived during aweek. The amountand type of servicesprovided are basedon individual needsbased on thebeneficiary'smotivation to changeand other risk factorsthat may be present.CurrentlyAvailableClinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.3 Page
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsOral medication administration,direct observation, physicianevaluations, individual and personcentered assessments, nursingassessments, counseling andlaboratory testing and access toprimary care (approved for use ofMethadone and/or Buprenorphine).Services must be provided under thesupervision of a physician licensed topractice medicine in Michigan. Programsmust meet applicable state licensure, CSATcertification, DEA licensure and accreditationrequirements.Service limitations asindicated by stateand federalrequirements (e.g.,physical examination,laboratory nPhysician evaluation/examPsychiatrist or psychiatric mental healthnurse practitioner.Services provided asmedically necessary.CurrentlyAvailableAssessmentA face-to-face service for thepurpose of identifying functional,treatment, and recovery needs and abasis for formulating theIndividualized Treatment Plan.Provider agency licensed and accredited assubstance abuse treatment program. Stateapproval for ASAM level of care.CurrentlyAvailableActivities associated with thedevelopment and periodic review ofthe plan of service, including allaspects of the person-centeredProvider agency licensed and accredited assubstance abuse treatment program. Stateapproval for ASAM level of care.ASAM level 1 Servicesfrom one to eighthours during a week.Less than 9 hours ofservice/week (adults);less than 6hours/week(adolescents) forrecovery ices provided asmedically necessary.AvailabilityLevel 1 - Opioid Treatment Program (OTP)Approvedpharmacologicalsupport servicesState approval for ASAM level of care.Level 1 - Outpatient ServicesTreatmentplanningClinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.CurrentlyAvailable4 Page
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService Descriptionplanning process, such as premeeting activities, and externalfacilitation of person-centeredplanning.Provider / Practitioner QualificationsLimitsAvailabilityClinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.This includes writing goals,objectives, and outcomes; designingstrategies to achieve outcomes(identifying amount, scope, andduration) and ways to measureachievement relative to the outcomemethodologies; attending personcentered planning meetings perinvitation; and documentation.Therapy(Individual,Group, Family)Monitoring of the individual plan ofservice including specific services,when not performed by the casemanager or supports coordinator, isincluded in this coverage.Individual - Face to face counselingservices with the beneficiary; Group Face-to-face counseling with three ormore beneficiaries, and can includedidactic lectures, therapeuticinterventions/counseling, and othergroup activities; Family - Face-to-facecounseling with the beneficiary andthe significant other and/ortraditional or nontraditional familymembers.Provider agency licensed and accredited assubstance abuse treatment program. Stateapproval for ASAM level of care.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Services provided asmedically necessary.CurrentlyAvailable5 Page
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsCounseling(Individual,Group)An interpersonal helping relationshipthat begins with the client exploringthe way they think, how they feel,and what they do, for the purpose ofenhancing their life. The counselorhelps the client set the goals thatpave the way for positive change tooccur.Provider agency licensed and accredited assubstance abuse treatment program. Stateapproval for ASAM level of care.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Services can be provided by appropriatelytrained staff when working under thesupervision of a SATS or SATP. A recoverycoach or SUD peer specialist must becertified through an MDHHS-approvedtraining program.Services provided asmedically necessary.CurrentlyAvailableDidactics andeducationServices that are designed orintended to teach information aboutaddiction and/or recovery skills.Provider agency licensed and accredited assubstance abuse treatment program. Stateapproval for ASAM level of care.Services provided asmedically necessary.CurrentlyAvailableAvailabilityClinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Services can be provided by appropriatelytrained staff when working under thesupervision of a SATS or SATP. A recoverycoach or SUD peer specialist must becertified through an MDHHS-approvedtraining program.6 Page
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsCrisisInterventionA service for the purpose ofaddressing problems/issues that mayarise during treatment and couldresult in the beneficiary requiring ahigher level of care if intervention isnot provided.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Services can be provided by appropriatelytrained staff when working under thesupervision of a SATS or SATP. A recoverycoach or SUD peer specialist must becertified through an MDHHS-approvedtraining program.Services provided asmedically ting and monitoringmedications, their effects, and theneed for continuing or changing themedication regimen. Medicationreview includes the administration ofscreening tools for the presence ofextra pyramidal symptoms andtardive dyskinesia secondary tountoward effects of neuroactivemedications.A physician, physician assistant, nursepractitioner, registered nurse, licensedpharmacist, or a licensed practical nurseassisting the physician may performmedication reviews. Only an MD or DO, or alicensed physician's assistant or nursepractitioner under the supervision of aphysician may prescribe medications.Services provided asmedically necessary.CurrentlyAvailableLaboratory TestsLaboratory analysis of specimens todetect presence of alcohol or drugs.Medicaid eligible and enrolled laboratoryservices providers.Services provided asmedically necessary.CurrentlyAvailableAvailability7 Page
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsAvailabilityLevel 2.1 – Intensive Outpatient ServicesIntensiveOutpatientServices (IOP)Includes assessment, counseling,crisis intervention, and activitytherapies or education.Provider agency licensed and accredited assubstance abuse treatment program. Stateapproval for ASAM level of care.Outpatient services can include anyvariety of the covered services andare dependent on the individualneeds of the beneficiary. Theassessment, treatment plan andrecovery support preparations arethe only components that areconsistent throughout the outpatientlevels of care as each beneficiarymust have these as part of theauthorized treatment services.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Provided as 9 to 19hours of structuredprogramming perweek based on anindividualizedtreatment plan. As abeneficiary’s needsincrease, moreservices and/orfrequency/durationof services may beutilized if these aremedically necessary.CurrentlyAvailableAuthorization for thepartial hospitalizationadmission andcontinued stayincludesauthorization for allservices related tothat admission/stay,including laboratory,pharmacy, andradiology services.CurrentlyAvailableLevel 2.5 – Partial Hospitalization tpatient)20 or more hours of service/week formultidimensional instability notrequiring 24-hour care.Provider agency licensed and accredited assubstance abuse treatment program. Stateapproval for ASAM level of care.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.8 Page
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsAvailabilityLevel 3.1 – Clinically Managed Low-intensity Residential ServicesClinicallyManaged LowIntensityResidentialServicesThe services are directed towardapplying recovery skills, preventingrelapse, improving emotionalfunctioning, promoting personalresponsibility, and reintegrating theindividual in work, education, andfamily life. Treatment services aresimilar to low intensity outpatientservices focused on improving theindividual’s functioning and copingskills in Dimension 5 and 6.Functional deficits found in thispopulation may include problems inapplying recovery skills to theireveryday lives, lack of personalresponsibility, or lack of connectionto employment, education, or familylife. The setting allows clientsopportunity to develop and practiceskills while reintegrating into thecommunity.Services are inclusive of structuredsupervision within the 24-hourprogram, provided by availabletrained personnel; at least 5 hours ofclinical service/week in whichservices are preparing individual foroutpatient treatment.Provider agency licensed and accredited assubstance abuse treatment program.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Providers assessed by the state or itsdesignee and confirmed to meet ASAMprogram level requirements for this level ofcare.At least 5 hours perweek of clinicalservices (Assessment;Episode of Care Planaddressingtreatment, recovery,discharge andtransition acrossepisode; interaction/teaching to processskills and informationadapted to theindividual needs;includes alternativetherapies, individual,group and familycounseling, angermanagement, copingskills, recovery skills,relapse triggers, andcrisis intervention);coordination andreferral; medicalevaluation andlinkage to services;connection to nextprovider and medicalservices; preparationfor next step.CurrentlyAvailable9 Page
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsAvailabilityAt least 5 hours of lifeskills and self-care perweek.Level 3.3 – Clinically Managed Population-specific High-Intensity Residential ServicesClinicallyManagedPopulationspecific HighIntensityResidentialServices (Adultonly)The program provides a structuredrecovery environment in combinationwith medium-intensity clinicalservices to support recovery. Servicesmay be provided in a deliberatelyrepetitive fashion to address thespecial needs of individuals who areoften elderly, cognitively impaired, ordevelopmentally delayed. Typically,they need a slower pace of treatmentbecause of mental health problemsor reduced cognitive functioning.Treatment services are directed toprovision of simple interventions toincrease awareness andunderstanding of dangerousconsequences of behavior andimproving functioning and coping inDimensions 4 and 5.The deficits for clients at this level areprimarily cognitive, either temporaryor permanent. Clients in this LOChave needs that are more intensiveand to benefit effectively fromservices, they must be provided at aslower pace and over a longer periodProvider agency licensed and accredited assubstance abuse treatment program.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Providers assessed by the state or itsdesignee and confirmed to meet ASAMprogram level requirements for this level ofcare.Not less than 13hours per week ofcore services(Assessment; Episodeof Care Planaddressing treatment,recovery, dischargeand transition acrossepisode;interaction/teachingto process skills andinformation adaptedto the individualneeds; includesalternative therapies,individual, group andfamily counseling,anger management,coping skills, recoveryskills, relapse triggers,and crisisintervention);coordination andreferral; medicalevaluation andlinkage to services;connection to nextCurrentlyAvailable10 P a g e
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService Descriptionof time. The client’s level ofimpairment is more severe at thislevel, requiring services be provideddifferently in order for maximumbenefit to be received.Services are inclusive of structuredsupervision 24/7, provided by trainedcounselors to stabilize themultidimensional aspects ofimminent danger. Services areoffered within the less intense milieuand group treatment for those withcognitive or other impairmentsunable to use full active milieu or thetherapeutic community as theyprepare for outpatient treatment.Provider / Practitioner QualificationsLimitsAvailabilityprovider and medicalservices; preparationfor next step.Not less than 13hours per week of lifeskills and self-careservices.11 P a g e
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsAvailabilityLevel 3.5 – Clinically Managed High-Intensity Residential ServicesClinicallyManaged HighIntensityResidentialServicesServices are inclusive of structuredsupervision within the 24-hour /7 daya week program, provided byavailable trained counselors whointervene to stabilizemultidimensional aspects ofimminent danger and otherbehaviors that are based indysfunctional actions and requirehabilitation.Staff provide targeted interventionsto rebuild social, psychological,educational/ vocational andemployment limitations and supportpreparation and development foroutpatient treatment.Clients must be able to tolerate anduse full milieu or therapeuticcommunity and began to addressand make progress andimprovements as they master lifeskills.Provider agency licensed and accredited assubstance abuse treatment program.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Providers assessed by the state or itsdesignee and confirmed to meet ASAMprogram level requirements for this level ofcare.Not less than 20CurrentlyAvailablehours per week ofcore services (services(Assessment; Episodeof Care Planaddressing treatment,recovery, dischargeand transition acrossepisode);coordination andreferral; medicalevaluation andlinkage to services;connection to nextprovider and medicalservices; preparationfor next step.Not less than 20hours per week of lifeskills and self-careservices.12 P a g e
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsAvailabilityLevel 3.7 – Medically Monitored High-Intensity Inpatient ervicesServices are inclusive of structuredsupervision within the 24-hour/7 daya week program, provided byavailable trained counselors whointervene to stabilizemultidimensional aspects ofimminent danger and otherbehaviors that are based indysfunctional actions and requirehabilitation. Programs provide aplanned and structured regimen of24-hour professionally directedevaluation, observation, medicalmonitoring and addiction treatment.The service, when clinically indicated,is an alternative to acute medicalcare provided by licensed health careprofessionals in a hospital setting.The skills of the interdisciplinaryteam and the availability of supportservices can accommodatewithdrawal managementProvider agency licensed and accredited assubstance abuse treatment program.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Providers assessed by the state or itsdesignee and confirmed to meet ASAMprogram level requirements for this level ofcare.These services must be staffed 24-hours-perday, seven-days-per-week by a licensedphysician or by the designated representativeof a licensed physician.Not less than 20hours per week ofcore services(services(Assessment; Episodeof Care Planaddressingtreatment, recovery,discharge andtransition acrossepisode);coordination andreferral; medicalevaluation andlinkage to services;connection to nextprovider and medicalservices; preparationfor next step.CurrentlyAvailableNot less than 20hours per week of lifeskills and self-careservices.13 P a g e
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsAvailability4 – Medically Managed Intensive Inpatient Organized service delivered in anacute care inpatient setting. It is forpatients whose acute biomedical,emotional, behavioral and cognitiveproblems are so severe that theyrequire primary medical and nursingcare.A hospital providing medically managedintensive inpatient services is accredited andlicensed and staffed 24/7 to provide licensednursing and physician services to patientsrequiring access to a range of servicesincluding ancillary such as laboratory, x-ray,nutrition services) and specialty physicianservices.Service provided asmedically indicatedand throughestablished medicalprotocols.CurrentlyAvailableThe staff are licensed and credentialed bythe hospital and meet the accreditationstandards related to practice within theirlicensures.Level 1-WM – Ambulatory Withdrawal Management without Extended On-site Monitoring (Outpatient Withdrawal tended mbulatory sub-acute detoxificationwithout extended on-site monitoringfor patients expected to demonstratemild withdrawal with daily or lessthan daily outpatient supervision.Supervised monitoring of withdrawaloccurs by personnel trained in SUDand withdrawal management duringidentified hours.Services must have arrangements foraccess to licensed medical personnelas needed.Provider agency licensed and accredited assubstance abuse treatment program.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Providers assessed by the state or itsdesignee and confirmed to meet ASAMprogram level requirements for this level ofcare.Initial length-of-stayauthorizations maybe for up to threedays, with additionaldays authorized ifthere is clinicalevidence thatdetoxification is notsuccessful orcomplete andauthorizationrequirementscontinue to be met.CurrentlyAvailable14 P a g e
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionProvider / Practitioner QualificationsLimitsAvailabilityLevel 2-WM – Ambulatory Withdrawal Management with Extended On-site Monitoring (Outpatient Withdrawal ded mbulatory sub-acute detoxificationwith extended on-site monitoring forpatients expected to demonstratemoderate withdrawal with all daywithdrawal management andsupport and supervision.Services must have arrangements foraccess to licensed medical personnelas needed.Patient has a supportive family orliving situation at night.Provider agency licensed and accredited assubstance abuse treatment program.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Ambulatory detoxification services must bemonitored by appropriately credentialed andlicensed nurses.Providers assessed by the state or itsdesignee and confirmed to meet ASAMprogram level requirements for this level ofcare.Initial length-of-stayauthorizations maybe for up to threedays, with additionaldays authorized ifthere is clinicalevidence thatdetoxification is notsuccessful orcomplete andauthorizationrequirementscontinue to be met.CurrentlyAvailableInitial length-of-stayauthorizations maybe for up to threedays, with additionaldays authorized ifthere is clinicalevidence thatdetoxification is notsuccessful orcomplete andauthorizationCurrentlyAvailableLevel 3.2-WM – Clinically Managed Residential Withdrawal Management (Residential Withdrawal cation management andmonitoring of services to clientdetermined to need moderatewithdrawal, and 24-hour support tocomplete withdrawal supervision andincrease likelihood of continuingtreatment or recovery. Thisresidential setting for detoxificationemphasizes peer and social supportfor persons who warrant 24-hoursupport.Provider agency licensed and accredited assubstance abuse treatment program.Licensure as a sub-acute detoxificationprogram is required.Clinical service provided by Substance AbuseTreatment Specialist (SATS) or SubstanceAbuse Treatment Practitioner (SATP) whenworking under the supervision of a SATS.Providers assessed by the state or itsdesignee and confirmed to meet ASAM15 P a g e
Michigan 1115 OUD/SUD Waiver Implementation PlanASAMLevel ofCareService TitleService DescriptionSub-acute detoxification providessupervised care to manage theeffects of withdrawal from alcoholand/or other drugs as part of aplanned sequence of addictiontreatment. Detoxification is limited tostabilization of the medical effects ofwithdrawal and referral to ongoingtreatment and/or support services.Services must have arrangements foraccess to licensed medical personnelas needed.Provider / Practitioner QualificationsLimitsprogram level requirements for this level ofcare.requirementscontinue to be met.Provider agency licensed and accredited assubstance abuse treatment program.Initial length-of-stayauthorizations maybe for up to threedays, with additionaldays authorized ifthere is clinicalevidence thatdetoxification is notsuccessful orcomplete andauthorizationrequirementscontinue to be met.AvailabilityLevel 3.7 WM – Medically Monitored Inpatient Withdrawal agementServices are inclusive of structuredsupervision within the 24-hour /7 daya week program, provided byavailable trained counselors who
training program. Services provided as medically necessary. Currently Available Didactics and education Services that are designed or intended to teach information about addiction and/or recovery skills. Provider agency licensed and accredited as substance abuse treatment program. State approval for ASAM level of care.
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