8.746		OUTPATIENT SUBSTANCE ABUSE TREATMENT 
8.746.1		DEFINITIONS
Alcohol and/or drug screening means the collection of urine to test for the presence of alcohol and/or drugs.  
Group Therapy means therapeutic substance abuse counseling and treatment services with more than one client.
Individual and Family Therapy means therapeutic substance abuse counseling services with one client per session.  Family therapy shall be directly related to the client’s treatment for substance abuse and/or dependence.  
Social/Ambulatory Detoxification means services provided on a residential basis by a facility licensed by the Alcohol and Drug Abuse Division (ADAD) of the Department of Human Services based on American Society of Addiction Medicine (ASAM) criteria.  
Substance Abuse Assessment means an evaluation designed to determine the level of drug/alcohol abuse or dependence and the comprehensive treatment needs of a client.
Targeted Case Management means medically necessary coordination and planning services provided with or on behalf of a client with a substance abuse diagnosis.  
8.746.2		Client Eligibility
8.746.2.A.	Clients identified as being appropriate for the Substance Abuse Treatment program shall be assessed as having drug/alcohol abuse or dependence.
8.746.3		Provider Requirements
8.746.3.A.	Outpatient substance abuse services shall be provided in an approved facility or by certain licensed health care practitioners with certification in addiction counseling.  
8.746.3.B.	Providers shall be one of the following:
a.	Facilities licensed by ADAD to offer outpatient services.
b.	Licensed physicians who are also:
i)	Certified in Addiction Medicine by the American Society of Addiction Medicine (ASAM), or
ii)	Certified Addiction Counselors (CAC II or CAC III) or Licensed Addiction Counselors (LAC) by Department of Regulatory Agencies (DORA), or
iii)	Certified by the National Association of Alcohol and Drug Abuse Counselors (NAADAC) as an NCAC II or MAC.
iv)	Certified in Addiction Psychiatry by the American Board of Psychiatry and Neurology (ABPN).
c.	Licensed non-physician practitioners are any of the following:
i)	Psychologist, PhD.
ii)	Nurse Practitioner.
iii)	Licensed Clinical Social Worker (LCSW).
iv)	Marriage and Family Therapist.
v)	Licensed Professional Counselor (LPC).
vi)	Licensed Addiction Counselor (LAC).
d.	The above licensed non-physician practitioners shall also be certified addiction counselors with one of the following credentials:
i)	Certified by DORA as a CAC II, CAC III.
ii)	Certified by NAADAC as an NCAC II or MAC.
8.746.4		Covered Services
1.	Outpatient Substance Abuse Treatment services are limited to:
a.	Substance Abuse Assessment, which shall be limited to three sessions per state fiscal year. 
b.	Individual and Family Therapy, which shall be limited to 25 sessions at 15 minutes per unit, up to four units per session per state fiscal year.  
c.	Group Therapy sessions, which shall be up to an including three hours per session and limited to 36 sessions per state fiscal year.
d.	Alcohol/Drug Screening, which shall be limited to 36 specimen collections per state fiscal year.  Substance abuse counseling services shall be provided along with screening to discuss results with client. 
e.	Targeted Case Management, which shall be limited to 36 contacts per state fiscal year.  Services may include service planning, advocacy and linkage to other medical services related to substance abuse diagnosis, monitoring, and care coordination.
f.	Social/Ambulatory Detoxification, which shall be limited to seven days per state fiscal year and includes supervision, observation and support for individuals whose intoxication/withdrawal signs and symptoms are severe enough to require a 24 hour structured program but do not require hospitalization.