Substance
Abuse
Family
Evaluation
Preferred Practice Standards
Key Contact Information 5
Welcome to Project SAFE 6
History 6
Program Overview 6
Project S.A.F.E Covered Services 7
Evaluation 8
Adolescent Evaluation: 9
Comprehensive Evaluation: 9
Individual Therapy 10
Group Therapy 10
Family Therapy 10
Intensive Outpatient Therapy (IOP) 10
Partial Hospitalization Program (PHP) 10
Urine Drug Screens 11
Hair Testing 11
Treatment Levels of Care 11
Service Limitations and Exclusions 12
Level of Care Guide (Table I) 13
Level I: (SA I.1 & SA I.1) Outpatient 13
Level of Care Guide (Table II) 14
Level II: (SA II.1 & MH II.1) Intensive Outpatient (IOP) 14
Level of Care Guide (Table III) 15
Level II: SAII.5 & MH II.5 Partial Hospital & SA Day/Evening 15
Referral and Authorization Process 16
Service Authorization and Referral Process for Covered Services 17
Referral and Authorization Process (CHART) 23
Type of Service/Level of Care 23
Information Needed From DCF 23
Information Need from the Provider 23
Information needed or provided by ABH 23
Authorization Requirements 23
Reimbursement Protocol 24
Provider Credentialing 25
Reimbursement 25
Reimbursement for Evaluation 26
DCF Responsibilities 26
Provider Responsibilities 26
ABH Project S.A.F.E. Will 26
Reimbursement for Treatment 27
DCF Responsibilities 27
Provider Responsibilities 27
ABH Project S.A.F.E. Will 28
Reimbursement for IOP or PHP Levels of Care 29
DCF Responsibilities 29
Provider Responsibilities 29
ABH Project S.A.F.E. Will 29
Reimbursement for Hair Testing 30
DCF Responsibilities 30
Provider Responsibilities 30
ABH Project S.A.F.E. Will 30
Reimbursement for Random Urine Drug Screens Only 31
DCF Responsibilities 31
Provider Responsibilities 31
ABH Project S.A.F.E. Will 31
Requests for Court Cost Reimbursement 33
DCF Responsibilities 33
Provider Responsibilities 33
ABH Project S.A.F.E. Will 33
Special Exceptions 34
Six Tab Web Base Claim System 36
Complaints, Grievances, and Appeals 38
Appendix A 42
CLIENT REFERRAL FORM (page 1) 42
CLIENT REFERRAL FORM (page 2) 43
Appendix B 44
CLIENT REPORT FORM 44
PROJECT SAFE 44
Appendix C 45
Needs Assessment Form 45
Appendix D 46
TANF ELIGIBILITY SCREENING FORM 46
Appendix E: Outpatient Treatment Request Downloading Procedure 47
Outpatient Treatment Request Downloading Procedure (page 2) 48
Outpatient Treatment Request Downloading Procedure (page 3) 49
Appendix G 51
Special Exception 51
FAQ for Project SAFE Special Exceptions 52
(Formerly Regional Administrator’s Approval) 52
Appendix H: 54
Screen Shot of Web-Based Claims System 54
Key Contact Information
Advanced Behavioral Health
213 Court Street
Middletown, CT 06457
Referral Hotline:…………………………1-800-272-0097
Main Number:……………………………1-860-638-5309
Billing Department……………………….1-860-704-6144
Fax:………………………………………..1-860-638-5302
Advanced Behavioral Health Website:
https://www.abhct.com/
Online access to information and materials, such as newsletters, alert memos, and forms.
Department of Children and Families Website:
http://www.state.ct.us/dcf/
Online access to a wide variety of information related to the Department of Children and Families such as newsletters, other publications, and forms.
Department of Mental Health and Addiction Services Website:
http://www.dmhas.state.ct.us/
Online access to a wide variety of information related to the Department of Mental Health and Addiction Services such as newsletters, publications, and forms.
Welcome to Project SAFE
Welcome to the Advanced Behavioral Health (ABH) Project S.A.F.E. Provider network. As a member of the Project S.A.F.E. Provider network you have joined a group of highly respected behavioral health professionals. We recognize that you share our commitment to improve the quality of life for clients by providing a continuum of high quality accessible behavioral health care services.
This Preferred Practice Standards handbook has been developed to inform you of standard practice of participants in the ABH Project S.A.F.E. network The handbook begins with an introduction, states policies and procedures for referral, authorization, claims submission, and the complaints, grievances, and appeal process. Finally, the necessary forms are included, along with a glossary and index for your convenience. Services provided for ABH Project S.A.F.E. clients must be consistent with the practices encompassed in this handbook Should you have any questions, please contact ABH Project S.A.F.E. at:
1-800-272-0097
History
The Department of Children and Families (DCF) initiated Project S.A.F.E. (Substance Abuse Family Evaluation) in 1995 as a way to connect its child protection system with the adult substance abuse treatment system. DCF contracted with ABH to coordinate central intake and priority access to drug screening, evaluation, and ambulatory treatment for substance abusing primary caregivers of children receiving protective services. DCF began collaborating with the Department of Mental Health and Addiction Services (DMHAS) in October 1999 to identify and address more effectively substance abuse issues and to coordinate and blend state, federal, and private resources to meet the needs of these populations.
Program Overview
Project S.A.F.E. is a program, jointly funded by DCF and DMHAS, designed to provide priority access to substance abuse evaluation and outpatient treatment services. Clients are eligible for Project S.A.F.E. services if they meet the following criteria:
· Parents or Primary Caregiver involved in child Protective Services
· The completed DCF Substance Abuse Screen has identified that substance use/abuse may be effecting the ability to parent effectively and substance abuse treatment or further evaluation is needed;
· A Referral has been made by DCF Social Worker prior to any treatment and \or evaluation service
Funding for Project S.A.F.E. services is provided by DCF and DMHAS, and administered by ABH. This funding system is designed as a payer of last resort. The term ‘payer of last resort’ indicates that the Project S.A.F.E. funds are used to reimburse providers on a fee-for-service basis when there is no other source of reimbursement available.
Project S.A.F.E. Covered Services
There are a variety of services that are reimbursed under Project S.A.F.E.’s payer of last resort system. In the following section, we will outline identify and define all services covered by Project SAFE.
Project S.A.F.E Covered Services
There are eight basic treatment services that are reimbursable within Project S.A.F.E.
· Evaluation
· Individual Therapy (SA I.1)
· Group Therapy (SA I.1)
· Family Therapy (SA I.1)
· Intensive Outpatient Therapy (IOP) (SA II.1)
· Partial Hospitalization Program (PHP) (SA II.5)
· Urine Drug Screens
· Hair Testing
The following section contains a description of these services.
Evaluation
Clients are referred for a Project S.A.F.E evaluation because the DCF Social Worker has completed the DCF substance abuse screen (DCF form 2110) and found reason to believe that the individual’s ability to parent effectively is impaired as a result of his/her use. The evaluation is conducted by an approved Project S.A.F.E Provider and consists of a bio-psycho-social assessment focusing on the following areas:
· Demographic Information
· Family composition and history
· Substance abuse history
· Trauma history
· Medical history and current medical status
· DSM IV TR Diagnostic formulation
· Drug screen results
· Summary and recommendations
Each evaluation should contain a written narrative in the aforementioned areas.
Once the evaluation is completed by the provider, the results of the evaluation should be verbally communicated to the DCF Social Worker within twenty-four (24) hours (one business day) of its completion. A written clinical summary will be forwarded to both the Social Worker and the DCF Substance Abuse Specialist within five (5) business days of the evaluation.
In specific cases there are two different evaluation subtypes that may be completed. They are an adolescent evaluation or a comprehensive evaluation.
Adolescent Evaluation:
Project S.A.F.E. also has capacity to conduct adolescent specific evaluations. The Project S.A.F.E. Adolescent Evaluation Project was initiated in (the then )Region IV to provide Substance Abuse Evaluations to adolescents who are suspected of substance abuse, but do not meet the basic Project S.A.F.E. criteria. DCF Region IV Social Workers who believe that an adolescent would benefit from a Project S.A.F.E. evaluation should complete the following forms prior to contacting the North Central Region ARG:
· Adolescent Screening Form
· Project SAFE Referral Form
These two forms are then reviewed by the ARG, and approved if clinically appropriate. Once approved, the ARG or designee will call the ABH Intake Coordinator at 1-800-272-0097, and make the referral.
Comprehensive Evaluation:
The Comprehensive Evaluation Pilot Project began in March 2002, with the following objectives:
· To develop and standardize a comprehensive bio-psycho-social evaluation for Project S.A.F.E. clients;
· To collect comprehensive information about the clients served by Project S.A.F.E.;
· To provide a process for efficient and effective distribution of substance abuse evaluation results.
There are ten (10) providers that are participating in the Comprehensive Evaluation Pilot Project. The referral process for this pilot project is as follows:
1. Make an evaluation referral by calling the 1-800 Project S.A.F.E line
2. Once referred, the provider utilizing a specifically designed Bio-Psycho-social Evaluation that has been standardized will evaluate the client.
3. The form itself is used to collect data and should be completed entirely by the evaluating clinician.
4. Once it is completely filled out, the form is faxed to ABH within thirty (30) days of the date of service for processing.
5. ABH enters all of the information into a database, and then distributes a data processed form to the following:
· Referring DCF Social Worker;
· Treatment Provider;
· Regional Substance Abuse Specialist (if requested).
Individual Therapy
Individual therapy consists of one to one therapy in duration of up to one hour, with a frequency of no more than once weekly and no less than once per month. Treatment focuses on reducing symptoms, improving function, maintaining abstinence and relapse prevention.
Group Therapy
Group therapy consists of therapy in duration up to one and a half hours, with a frequency of once weekly. Treatment focuses on reducing symptoms, providing psycho-education, improving functioning, relapse prevention and maintenance of abstinence. Groups should be limited to no more than twelve (12) clients per group session.
Family Therapy
Family therapy consists of therapy sessions with a client and one or more individual(s) identified by the client as family, with duration of up to one hour, a frequency of no more than once weekly. Treatment focuses on building and maintaining supports for recovery, repairing relationships, reducing symptoms, providing psycho-education and maintenance of abstinence.
Intensive Outpatient Therapy (IOP)
A non-residential service provided in a general hospital, private freestanding psychiatric hospital, state operated facility or in a facility licensed by the Department of Public Health as a “Psychiatric Outpatient Clinic for Adults”. IOP services provides each client with three to four (3-4) hours per day, three to five (3-5) days per week of clinically intensive programming based on an individualized treatment plan. Treatment focuses on reducing symptoms, improving functioning, maintaining community connection and relapse prevention. As a client is preparing for discharge, titration of IOP may occur, decreasing the frequency to less than three (3) times per week. IOP must include one therapy session per day, inclusive of (at least) one individual therapy session per week. Random drug screens can be completed on the same day that a patient attends and are reimbursed separately.
Partial Hospitalization Program (PHP)
A non-residential service provided in a general hospital, private freestanding psychiatric hospital, state operated facility or by a provider that is a non-profit entity that involves ambulatory intensive psychiatric and/or substance abuse treatment services. PHP services are designed to serve individuals with significant impairment resulting from substance abuse as well as co-occurring psychiatric disorders. These services target adults who have recently been discharged from inpatient facilities, or whose admission to inpatient care may be prevented by treatment in PHP program. PHP consists of therapeutic programming of a minimum of four (4) hours per day, at least four (4) days per week, based on a comprehensive and coordinated individualized treatment plan involving the use of multiple concurrent treatment services and modalities. Treatment focuses on reducing symptoms, improving functioning, maintaining community connection, and relapse prevention. As a client is preparing for discharge, titration of PHP may occur, decreasing the frequency to less than four (4) times per week. PHP must include one therapy session per day, inclusive of (at least) one individual therapy session per week. Random drug screens can be completed on the same day that a patient attends and are reimbursed separately.
Urine Drug Screens
Urine drug screens are used to determine the recent use/abuse of substances. Random urine drug screens are defined as two (2) urine drug screens per week for a period of six (6) weeks. Random screens should not occur on the same day and time each week. In order for the screens to be random, the client may be contacted by the treatment provider and asked to come in within the next twenty- four (24) hours for a drug screen, provided it is not on a day when treatment services are provided. Random drug screens can also be requested for a client who is not in active treatment under the following circumstances:
· In response to a court ordered request or;
· Has had an evaluation within the past six (6) months.
Hair Testing
Hair testing is utilized to determine a three-month history of substance use/abuse history prior to the hair test. Careful collection of samples by authorized treatment providers following collection guidelines is necessary to ensure effective use of hair testing. Positive hair test results can be further analyzed to determine if the client’s use/abuse of substances occurred within 30/60/90 days prior to collection. This multi-sectional testing can be performed on a positive sample per request of the referring DCF Social Worker. A hair test may be requested for some of the following reasons:
· Family reunification planning is expected to occur in the immediate future.
· DCF or provider staff has reason to believe that client has attempted to alter the urine drug screens or failed to keep scheduled appointments.
· Central or Area Office has concerns about a particular high risk or high profile case.
· DCF staff identifies cases in which domestic violence is connected with substance abuse.
· The Court requires documentation of historical drug use during a 30/60/90 day period
· DCF staff identifies abuse/neglect cases in which the primary caregivers are said to be in recovery from substance abuse.