Part VII. Addition Medicine Service Requirements
Article 1
Medically Managed Intensive Inpatient Level of Care 4.0
12VAC35-105-1430. Medically managed intensive inpatient Level of care 4.0 staff criteria.
A medically managed intensive inpatient program shall meet the following staff requirements:
1. Have a team of appropriately trained and credentialed professionals who provide medical management by physicians 24 hours a day, primary nursing care and observation 24 hours a day, and professional counseling services 16 hours a day;
2. Have an interdisciplinary team of appropriately credentialed clinical staff, which may include addiction-credentialed physicians, nurse practitioners, physician assistants, nurses, counselors, psychologists, and social workers, who assess and treat individuals with severe substance use disorders or addicted individuals with concomitant acute biomedical, emotional, or behavioral disorders;
3. Have staff who are knowledgeable about the biopsychosocial dimensions of addiction as well as biomedical, emotional, behavioral, and cognitive disorders;
4. Have facility-approved addiction counselors or licensed, certified, or registered addiction clinicians who administer planned interventions according to the assessed needs of the individual; and
5. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1440. Medically managed intensive inpatient Level of care 4.0 program criteria.
A medically managed intensive inpatient program shall meet the following programmatic requirements. The program shall:
1. Deliver services in a 24-hour medically managed, acute care setting and shall be available to all individuals within that setting;
2. Provide cognitive, behavioral, motivational, pharmacologic, and other therapies provided on an individual or group basis, depending on the individual's needs;
3. Provide, for the individual who has a severe biomedical disorder, physical health interventions to supplement addiction treatment;
4. Provide, for the individual who has stable psychiatric symptoms, individualized treatment activities designed to monitor the individual's mental health;
5. Provide planned clinical interventions that are designed to enhance the individual's understanding and acceptance of his addiction illness;
6. Provide family and caregiver treatment services as deemed appropriate by a licensed professional and included in an assessment and treatment plan;
7. Provide health education services;
8. Make medication assisted treatment (MAT) available for all individuals admitted to the service. MAT may be provided by facility staff or coordinated through alternative resources; and
9. Comply with 12VAC35-105-1055 through 12VAC35-105-1130.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1450. Medically managed intensive inpatient Level of care 4.0 admission criteria.
Before a medically managed intensive inpatient program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:
1. Meet diagnostic criteria for a substance use disorder or substance induced disorder as defined by the DSM; and
2. Meet the admission criteria of Level 4.0 of ASAM, including the specific criteria for adult and adolescent populations.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1460. Medically managed intensive inpatient Level of care 4.0 discharge criteria.
Before a medically managed intensive inpatient program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:
1. Achieved the goals of the treatment services and no longer require ASAM 4.0 level of care;
2. Been unable to achieve the goals of the individual's treatment but could achieve the individual's goals with a different type of treatment; or
3. Achieved the individual's original treatment goals but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
Article 2
Medically Monitored Intensive Inpatient Services Level of Care 3.7
12VAC35-105-1470. Medically managed intensive inpatient Level of care 4.0 co-occurring enhanced programs.
A. Medically managed intensive inpatient co-occurring enhanced programs shall be staffed by appropriately credentialed mental health professionals who assess and treat the individual's co-occurring mental disorders. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
B. Medically managed intensive inpatient co-occurring enhanced programs shall offer individualized treatment activities designed to stabilize the individual's active psychiatric symptoms, including medication evaluation and management.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1480. Medically monitored intensive inpatient services Level of care 3.7 staff criteria.
A medically monitored intensive inpatient treatment program shall meet the following staff requirements. The program shall:
1. Have a licensed physician to oversee the treatment process and ensure quality of care. A physician, a licensed nurse practitioner, or a licensed physician assistant shall be available 24 hours a day in person or by telephone. A physician, a licensed nurse practitioner, or a licensed physician assistant shall assess the individual in person within 24 hours of admission;
2. Offer 24-hour nursing care and conduct a nursing assessment on admission. The level of nursing care must be appropriate to the severity of needs of individuals admitted to the service;
3. Have interdisciplinary staff, which may include physicians, nurses, addiction counselors, and behavioral health specialists who are able to assess and treat the individual and obtain and interpret information regarding the individual's psychiatric and substance use or addictive disorders;
4. Offer daily onsite counseling and clinical services. Clinical staff shall be knowledgeable about the biological and psychosocial dimensions of addiction and other behavioral health disorders with specialized training in behavior management techniques and evidence-based practices;
5. Have staff able to provide a planned regimen of 24-hour professionally directed evaluation, care, and treatment services;
6. Make MAT available for all individuals with opioid use disorder or alcohol use disorder. MAT may be provided by facility staff or coordinated through alternative resources; and
7. Ensure all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1490. Medically monitored intensive inpatient services Level of care 3.7 program criteria.
A medically monitored intensive inpatient treatment program shall meet the following programmatic requirements. The program shall:
1. Be made available to all individuals within the inpatient setting;
2. Provide a combination of individual and group therapy as deemed appropriate by a credentialed addiction treatment professional and included in an assessment and treatment plan. Such therapy shall be adapted to the individual's level of comprehension;
3. Make available medical and nursing services onsite to provide ongoing assessment and care of addiction needs;
4. Provide direct affiliations with other easily accessible levels of care or close coordination through referral to more or less intensive levels of care and other services;
5. Provide family and caregiver treatment services as deemed appropriate by a credentialed addiction treatment professional and included in an assessment and treatment plan;
6. Provide educational and informational programming adapted to individual needs. The educational and informational programming shall include materials designed to enhance the individual's understanding of addiction and may include peer recovery support services as appropriate;
7. Utilize random drug screening to monitor drug use and reinforce treatment gains;
8. Regularly monitor the individual's adherence in taking any prescribed medications; and
9. Comply with 12VAC35-105-1055 through 12VAC35-105-1130.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1500. Medically monitored intensive inpatient Level of care 3.7 admission criteria.
Before a medically monitored intensive inpatient program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:
1. Meet diagnostic criteria for a moderate or severe substance use or addictive disorder; and
2. Meet the admission criteria of Level 3.7 of ASAM, including the specific criteria for adult and adolescent populations.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1510. Medically monitored intensive inpatient Level of care 3.7 discharge criteria.
A. Before a medically monitored intensive inpatient program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:
1. Achieved the goals of the treatment services and no longer require ASAM 3.7 level of care;
2. Been unable to achieve the goals of the individual's treatment but could achieve the individual's goals with a different type of treatment; or
3. Achieved the individual's original treatment goals but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.
B. Discharge planning shall occur for individuals and include realistic plans for the continuity of MAT services as indicated.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1520. Medically monitored intensive inpatient Level of care 3.7 co-occurring enhanced programs.
A. Medically monitored intensive inpatient co-occurring enhanced programs shall offer psychiatric services, medication evaluation, and laboratory services as indicated by the needs of individuals admitted to the service. A psychiatrist shall assess the individual by telephone within four hours of admission and in person with 24 hours following admission. A credentialed addiction treatment professional shall conduct a behavioral health-focused assessment at the time of admission. A registered nurse shall monitor the individual's progress and administer or monitor the individual's self-administration of psychotropic medications.
B. Medically monitored intensive inpatient co-occurring enhanced programs shall be staffed by addiction psychiatrists and appropriately credentialed behavioral health professionals who are able to assess and treat co-occurring psychiatric disorders and who have specialized training in behavior management techniques and evidence based practices. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
C. Medically monitored intensive inpatient co-occurring enhanced programs shall offer planned clinical activities designed to promote stabilization of the individual's behavioral health needs and psychiatric symptoms and to promote such stabilization, including medication education and management and motivational and engagement strategies.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
Article 3
Clinically Managed High-Intensity Residential Services Level of Care 3.5
12VAC35-105-1530. Clinically managed high-intensity residential services Level of care 3.5 staff criteria.
A clinically managed high-intensity residential care program shall meet the following staff requirements. The program shall:
1. Offer telephone or in-person consultation with a physician, a licensed nurse practitioner, or a licensed physician assistant in case of emergency related to an individual's substance use disorder 24 hours a day seven days a week;
2. Offer onsite 24-hour-a-day clinical staffing by credentialed addiction treatment professionals in addition to other allied health professionals, such as peer recovery specialists, who work in an interdisciplinary team;
3. Have clinical staff knowledgeable about the biological and psychosocial dimensions of substance use and mental health disorders and their treatment. Staff shall be able to identify the signs and symptoms of acute psychiatric conditions. Staff shall have specialized training in behavior management techniques; and
4. Ensure that all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1540. Clinically managed high-intensity residential services Level of care 3.5 program criteria.
A clinically managed high-intensity residential care program shall meet the following programmatic requirements. The program shall:
1. Provide daily clinical services, including a range of cognitive, behavioral, and other therapies in individual or group therapy; programming; and psychoeducation as deemed appropriate by a credentialed addiction treatment professional and included in an assessment and treatment plan;
2. Provide counseling and clinical interventions to teach an individual the skills needed for daily productive activity, prosocial behavior, and reintegration into family and community;
3. Provide motivational enhancement and engagement strategies appropriate to an individual's stage of readiness to change and level of comprehension;
4. Have direct affiliations with other easily accessible levels of care or provide coordination through referral to more or less intensive levels of care and other services;
5. Provide family and caregiver treatment services as deemed appropriate by a credentialed addiction treatment professional and included in an assessment and treatment plan;
6. Provide educational, vocational, and informational programming adaptive to individual needs;
7. Utilize random drug screening to monitor progress and reinforce treatment gains as appropriate to an individual treatment plan;
8. Ensure and document that the length of an individual's stay shall be determined by the individual's condition and functioning;
9. Make a substance use treatment program available for all individuals; and
10. Make MAT available for all individuals with opioid use disorder or alcohol use disorder. Medication assisted treatment may be provided by facility staff, or coordinated through alternative resources.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1550. Clinically managed high-intensity residential services Level of care 3.5 admission criteria.
A. The individuals served by a clinically managed high-intensity residential care program are individuals who are not sufficiently stable to benefit from outpatient treatment regardless of intensity of service.
B. Before a clinically managed high-intensity residential service program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:
1. Meet diagnostic criteria for a substance use disorder or addictive disorder of moderate to high severity as defined by the DSM; and
2. Meet the admission criteria of Level 3.5 of ASAM.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1560. Clinically managed high-intensity residential services Level of care 3.5 discharge criteria.
Before a clinically managed high-intensity residential service program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:
1. Achieved the goals of the treatment services and no longer require ASAM 3.5 level of care;
2. Been unable to achieve the goals of the individual's treatment but could achieve the individual's goals with a different type of treatment; or
3. Achieved the individual's original treatment goals but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1570. Clinically managed high-intensity residential services Level of care 3.5 co-occurring enhanced programs.
A. Clinically managed high-intensity residential services co-occurring enhanced programs shall offer psychiatric services, medication evaluation, and laboratory services. Such services shall be available by telephone within eight hours and onsite or closely coordinated offsite within 24 hours.
B. Clinically managed high-intensity residential services co-occurring enhanced programs shall be staffed by appropriately credentialed mental health professionals, including addiction psychiatrists who are able to assess and treat co-occurring mental disorders and who have specialized training in behavior management techniques. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
C. Clinically managed high-intensity residential services co-occurring enhanced programs shall offer planned clinical activities designed to stabilize the individual's mental health problems and psychiatric symptoms and to maintain such stabilization, including medication education and management and motivational and engagement strategies. Goals of therapy shall apply to both the individual's substance use disorder and any co-occurring mental disorder.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
Article 4
Clinically Managed Population-Specific High Intensity Residential Services Level of Care 3.3
12VAC35-105-1580. Clinically managed population-specific high-intensity residential services Level of care 3.3 staff criteria.
A clinically managed, population-specific, high-intensity residential services program shall meet the following staff requirements. The program shall:
1. Offer telephone or in-person consultation with a physician, a licensed nurse practitioner, or a physician assistant in case of emergency related to an individual's substance use disorder 24 hours a day, seven days a week;
2. Have allied health professional staff onsite 24 hours a day. At least one clinician with competence in the treatment of substance use disorder shall be available onsite or by telephone 24 hours a day;
3. Have clinical staff knowledgeable about the biological and psychosocial dimensions of substance use and mental health disorders and their treatment and able to identify the signs and symptoms of acute psychiatric conditions. Staff shall have specialized training in behavior management techniques; and
4. Ensure all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1590. Clinically managed population-specific high-intensity residential services Level of care 3.3 program criteria.
A clinically managed, population-specific, high-intensity residential services program shall meet the following programmatic requirements. The program shall:
1. Provide daily clinical services that shall include a range of cognitive, behavioral, and other therapies administered on an individual and group basis, medication education and management, educational groups, and occupational or recreation activities as deemed appropriate by a credentialed addiction treatment professional and included in an assessment and treatment plan;
2. Provide daily professional addiction and mental health treatment services that may include relapse prevention, exploring interpersonal choices, peer recovery support, and development of a social network;
3. Provide services to improve the individual's ability to structure and organize the tasks of daily living and recovery. Such services shall accommodate the cognitive limitations within this population;
4. Make available medical, psychiatric, psychological, and laboratory and toxicology services through consultation or referral as indicated by the individual's condition;
5. Provide case management, including ongoing transition and continuing care planning;
6. Provide motivational interventions appropriate to the individual's stage of readiness to change and designed to address the individual's functional limitations;
7. Have direct affiliations with other easily accessible levels of care or coordinate through referral to more or less intensive levels of care and other services;
8. Provide family and caregiver treatment services as deemed appropriate by an assessment and treatment plan;
9. Utilize random drug screening to monitor progress and reinforce treatment gains;
10. Regularly monitor the individual's adherence to taking prescribed medications;
11. Make the substance use treatment program available to all individuals served by the residential care service; and
12. Make MAT available for all individuals with opioid use disorder or alcohol use disorder. Medication assisted treatment may be provided by facility staff or coordinated through alternative resources.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1600. Clinically managed population-specific high-intensity residential services Level of care 3.3 admission criteria.
Before a clinically managed, population-specific, high-intensity residential service program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:
1. Meet diagnostic criteria for a moderate or severe substance use or addictive disorder as defined by the DSM; and
2. Meet the admission criteria of Level 3.3 of ASAM.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1610. Clinically managed population-specific high-intensity residential services Level of care 3.3 discharge criteria.
A. Before a clinically managed, population-specific, high-intensity residential service program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:
1. Achieved the goals of the treatment services and no longer require ASAM 3.3 level of care;
2. Been unable to achieve the goals of the individual's treatment but could achieve the individual's goals with a different type of treatment; or
3. Achieved the individual's original treatment goals but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.
B. Discharge planning shall occur for individuals and include realistic plans for the continuity of MAT services as indicated.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1620. Clinically managed population-specific high-intensity residential services Level of care 3.3 co-occurring enhanced programs.
A. Clinically managed population-specific high-intensity residential services co-occurring enhanced programs shall offer psychiatric services, medication evaluation, and laboratory services. Such services shall be available by telephone within eight hours and onsite or closely coordinated offsite within 24 hours, as appropriate to the severity and urgency of the individual's mental condition.
B. Clinically managed population-specific high-intensity residential services co-occurring enhanced programs shall be staffed by appropriately credentialed psychiatrists and licensed mental health professionals who are able to assess and treat co-occurring mental disorders and who have specialized training in behavior management techniques. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
C. Clinically managed population-specific high-intensity residential services co-occurring enhanced programs shall offer planned clinical activities designed to stabilize the individual's mental health problems and psychiatric symptoms and to maintain such stabilization, including medication education and management and motivational and engagement strategies. Goals of therapy shall apply to both the substance use disorder and any co-occurring mental health disorder.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
Article 5
Clinically Managed Low-Intensity Residential Services Level of Care 3.1
12VAC35-105-1630. Clinically managed low-intensity residential services Level of care 3.1 staff criteria.
A clinically managed low-intensity residential services program shall meet the following staff requirements. The program shall:
1. Offer telephone or in-person consultation with a physician in case of emergency related to an individual's substance use disorder, available 24 hours a day, seven days a week. The program shall also provide allied health professional staff onsite 24 hours a day;
2. Have clinical staff who are knowledgeable about the biological and psychosocial dimensions of substance use disorder and their treatment and are able to identify the signs and symptoms of acute psychiatric conditions;
3. Have a team comprised of appropriately trained and credentialed medical, addiction, and mental health professionals; and
4. Ensure all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1640. Clinically managed low-intensity residential services Level of care 3.1 program criteria.
A clinically managed low-intensity residential services program shall meet the following programmatic requirements. The program shall:
1. Offer a minimum of five hours a week of professionally directed treatment in addition to other treatment services offered to individuals, such as partial hospitalization or intensive outpatient treatment the focus of which is stabilizing the individual's substance use disorder. Services shall be designed to improve the individual's ability to structure and organize the tasks of daily living and recovery;
2. Ensure collaboration with care providers to develop an individual treatment plan for each individual with time-specific goals and objectives;
3. Provide counseling and clinical monitoring to support successful initial involvement in regular, productive daily activity;
4. Provide case management services;
5. Provide motivational interventions appropriate to the individual's stage of readiness to change and level of comprehension;
6. Have direct affiliations with other easily accessible levels of care or coordinate through referral to more or less intensive levels of care and other services;
7. Include the ability to arrange for needed procedures as appropriate to the severity and urgency of the individual's condition;
8. Provide family and caregiver treatment and peer recovery support services as deemed appropriate by a licensed professional and included in an assessment and treatment plan;
9. Provide addiction pharmacotherapy and the ability to arrange for pharmacotherapy for psychiatric medications;
10. Utilize random drug screening to monitor progress and reinforce treatment gains;
11. Make a substance abuse treatment program available to all individuals; and
12. Make MAT available for all individuals with opioid use disorder and alcohol use disorder. Medication assisted treatment may be provided by facility staff or coordinated through alternative resources.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1650. Clinically managed low-intensity residential services Level of care 3.1 admission criteria.
Before a clinically managed low-intensity residential service program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:
1. Meet diagnostic criteria for a moderate or severe substance use or addictive disorder as defined by the DSM; and
2. Meet the admission criteria of Level 3.1 of ASAM.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1660. Clinically managed low-intensity residential services Level of care 3.1 discharge criteria.
Before a clinically managed low-intensity residential services program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:
1. Achieved the goals of the treatment services and no longer require ASAM 3.1 level of care;
2. Been unable to achieve the goals of the individual's treatment but could achieve the individual's goals with a different type of treatment; or
3. Achieved the individual's original treatment goals but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1670. Clinically managed low-intensity residential services Level of care 3.1 co-occurring enhanced programs.
A. Clinically managed low-intensity residential services co-occurring enhanced programs shall offer psychiatric services, including medication evaluation and laboratory services. Such services shall be provided onsite or closely coordinated offsite, as appropriate to the severity and urgency of the individual's mental condition.
B. Clinically managed low-intensity residential services co-occurring enhanced programs shall be staffed by appropriately credentialed licensed mental health professionals who are able to assess and treat co-occurring disorders with the capacity to involve addiction-trained psychiatrists. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
C. Clinically managed low-intensity residential services co-occurring enhanced programs shall offer planned clinical activities that are designed to stabilize the individual's mental health problems and psychiatric symptoms and to maintain such stabilization, including medication education and management and motivational and engagement strategies. Goals of therapy shall apply to both the substance use disorder and any co-occurring mental disorder.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
Article 6
Partial Hospitalization Level of Care 2.5
12VAC35-105-1680. Substance abuse partial hospitalization services Level of care 2.5 staff criteria.
A substance abuse partial hospitalization program shall meet the following staff requirements. The program shall:
1. Have an interdisciplinary team of addiction treatment professionals, which may include counselors, psychologists, social workers, and addiction-credentialed physicians. Physicians treating individuals in this level shall have specialty training or experience in addiction medicine;
2. Have staff able to obtain and interpret information regarding the individual's biopsychosocial needs;
3. Have staff trained to understand the signs and symptoms of mental disorders and to understand and be able to explain the uses of psychotropic medications and their interactions with substance-related disorders; and
4. Ensure all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1690. Substance abuse partial hospitalization services Level of care 2.5 program criteria.
A substance abuse partial hospitalization program shall meet the following programmatic requirements. The program shall:
1. Offer no fewer than 20 hours of skilled treatment services per week in a structured program. Services may include individual and group counseling, medication management, family therapy, peer recovery support services, educational groups, or occupational and recreational therapy;
2. Provide a combination of individual and group therapy as deemed appropriate by a licensed professional and included in an assessment and treatment plan;
3. Provide medical and nursing services as deemed appropriate by a licensed professional and included in an assessment and treatment plan;
4. Provide motivational enhancement and engagement strategies appropriate to an individual's stage of readiness to change and level of comprehension;
5. Have direct affiliations with other easily accessible levels of care or coordinate through referral to more or less intensive levels of care and other services;
6. Provide family and caregiver treatment services as deemed appropriate by a licensed professional and included in an assessment and treatment plan;
7. Provide educational and informational programming adaptable to individual needs;
8. Ensure and document that the length of service shall be determined by the individual's condition and functioning;
9. Make emergency services available by telephone 24 hours a day, seven days a week when the program is not in session; and
10. Make MAT available for all individuals with opioid use disorder or alcohol use disorder. MAT may be provided by facility staff or coordinated through alternative resources.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1700. Substance abuse partial hospitalization Level of care 2.5 admission criteria.
Before a substance abuse partial hospitalization program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:
1. Meet diagnostic criteria for a substance use disorder or addictive disorder as defined by the DSM; and
2. Meet the admission criteria of Level 2.5 of ASAM, including the specific criteria for adult and adolescent populations.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1710. Substance abuse partial hospitalization Level of care 2.5 discharge criteria.
Before a substance abuse partial hospitalization program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:
1. Achieved the goals of the treatment services and no longer require ASAM 2.5 level of care;
2. Been unable to achieve the goals of the individual's treatment but could achieve the individual's goals with a different type of treatment; or
3. Achieved the individual's original treatment goals but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1720. Substance abuse partial hospitalization Level of care 2.5 co-occurring enhanced programs.
A. Substance abuse partial hospitalization co-occurring enhanced programs shall offer psychiatric services appropriate to the individual's mental health condition. Such services shall be available by telephone and onsite or closely coordinated offsite, within a shorter time than in a co-occurring capable program.
B. Substance abuse partial hospitalization co-occurring enhanced programs shall be staffed by appropriately credentialed mental health professionals who assess and treat co-occurring mental disorders. Intensive case management shall be delivered by cross-trained, interdisciplinary staff through mobile outreach and shall involve engagement-oriented addiction treatment and psychiatric programming. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
C. Substance abuse partial hospitalization co-occurring enhanced programs shall offer intensive case management, assertive community treatment, medication management, and psychotherapy.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
Article 7
Intensive Outpatient Services Level of Care 2.1
12VAC35-105-1730. Substance abuse intensive outpatient services Level of care 2.1 staff criteria.
A substance abuse intensive outpatient services program shall meet the following staff requirements. The program shall:
1. Be staffed by interdisciplinary team of appropriately credentialed addiction treatment professionals, which may include counselors, psychologists, social workers, and addiction-credentialed physicians. Physicians shall have specialty training or experience in addiction medicine or addiction psychiatry;
2. Have program staff that are able to obtain and interpret information regarding the individual's biopsychosocial needs;
3. Have program staff trained to understand the signs and symptoms of mental disorders and to understand and be able to explain the uses of psychotropic medications and their interactions with substance use and other addictive disorders; and
4. Ensure all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1740. Substance abuse intensive outpatient services Level of care 2.1 program criteria.
A substance abuse intensive outpatient services program shall meet the following programmatic requirements. The program shall:
1. Offer a minimum of three service hours per service day to achieve no fewer than nine hours and no more than 19 hours of programming per week in a structured environment;
2. Ensure psychiatric and other medical consultation shall be available within 24 hours by telephone and within 72 hours in person;
3. Offer consultation in case of emergency related to an individual's substance use disorder by telephone 24 hours a day, seven days a week when the treatment program is not in session;
4. Provide a combination of individual and group therapy as deemed appropriate by a licensed professional and included in an assessment and treatment plan;
5. Have direct affiliations with other easily accessible levels of care or coordinate through referral to more or less intensive levels of care and other services;
6. Provide family and caregiver treatment and peer recovery support services as deemed appropriate by a licensed professional and included in an assessment and treatment plan;
7. Provide education and informational programming adaptable to individual needs and developmental status;
8. Ensure and document that the length of service shall be determined by the individual's condition and functioning; and
9. Make MAT available for all individuals with opioid use disorder and alcohol use disorder. MAT may be provided by facility staff or coordinated through alternative resources.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1750. Substance abuse intensive outpatient services Level of care 2.1 admission criteria.
Before a substance abuse intensive outpatient services program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:
1. Meet diagnostic criteria for a substance use disorder or addictive disorder as defined by the DSM; and
2. Meet the admission criteria of Level 2.1 of ASAM, including the specific criteria for adult and adolescent populations.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1760. Substance abuse intensive outpatient services Level of care 2.1 discharge criteria.
Before a substance abuse intensive outpatient services program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:
1. Achieved the goals of the treatment services and no longer require ASAM 2.1 level of care;
2. Been unable to achieve the goals of the individual's treatment but could achieve the individual's goals with a different type of treatment; or
3. Achieved the individual's original treatment goals but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1770. Substance abuse intensive outpatient services Level of care 2.1 co-occurring enhanced programs.
A. Substance abuse intensive outpatient services co-occurring enhanced programs shall offer psychiatric services appropriate to the individual's mental health condition. Such services shall be available by telephone and onsite or closely coordinated offsite, within a shorter time than in a co-occurring capable program.
B. Substance abuse intensive outpatient services co-occurring enhanced programs shall be staffed by appropriately credential mental health professionals who assess and treat co-occurring mental disorders. Capacity to consult with an addiction psychiatrist shall be available. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
C. Substance abuse intensive outpatient services co-occurring enhanced programs shall offer intensive case management, assertive community treatment, medication management, and psychotherapy.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
Article 8
Substance Abuse Outpatient Services Level of Care 1.0
12VAC35-105-1780. Substance abuse outpatient services Level of care 1.0 staff criteria.
Substance abuse outpatient services programs shall meet the following staff requirements. The program shall:
1. Have appropriately credentialed or licensed treatment professionals who assess and treat substance-related mental and addictive disorders;
2. Have program staff who are capable of monitoring stabilized mental health problems and recognizing any instability of individuals with co-occurring mental health conditions;
3. Provide medication management services by a licensed independent practitioner with prescribing authority; and
4. Ensure all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1790. Substance abuse outpatient services Level of care 1.0 program criteria.
Substance abuse outpatient services programs shall meet the following programmatic requirements. The program shall:
1. Offer no more than nine hours of programming a week;
2. Ensure emergency services shall be available by telephone 24 hours a day, seven days a week;
3. Provide individual or group counseling, motivational enhancement, family therapy, educational groups, occupational and recreational therapy, psychotherapy, addiction, and pharmacotherapy as indicated by each individual's needs;
4. For individuals with mental illness, ensure the use of psychotropic medication, mental health treatment and that the individual's relationship to substance abuse disorders shall be addressed as the need arises;
5. Provide medical, psychiatric, psychological, laboratory, and toxicology services onsite or through consultation or referral. Medical and psychiatric consultation shall be available within 24 hours by telephone, or if in person, within a timeframe appropriate to the severity and urgency of the consultation requested;
6. Have direct affiliations with other easily accessible levels of care or coordinate through referral to more or less intensive levels of care and other services; and
7. Ensure through documentation that the duration of treatment varies with the severity of the individual's illness and response to treatment.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1800. Substance abuse outpatient services Level of care 1.0 admission criteria.
Before a substance abuse outpatient services program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:
1. Meet diagnostic criteria for a substance use disorder or addictive disorder as defined by the DSM; and
2. Meet the admission criteria of Level 1.0 of ASAM, including the specific criteria for adult and adolescent populations.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1810. Substance abuse outpatient services Level of care 1.0 discharge criteria.
Before a substance abuse outpatient services program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:
1. Achieved the goals of the treatment services and no longer require ASAM 1.0 level of care;
2. Been unable to achieve the goals of the individual's treatment but could achieve the individual's goals with a different type of treatment; or
3. Achieved the individual's original treatment goals but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-105-1820. Substance abuse outpatient services Level of care 1.0 co-occurring enhanced programs.
A. Substance abuse outpatient services co-occurring enhanced programs shall offer ongoing intensive case management for highly crisis-prone individuals with co-occurring disorders.
B. Substance abuse outpatient services co-occurring enhanced programs shall include credentialed mental health trained personnel who are able to assess, monitor, and manage the types of severe and chronic mental disorders seen in a level 1 setting as well as other psychiatric disorders that are mildly unstable. Staff shall be knowledgeable about management of co-occurring mental and substance-related disorders, including assessment of the individual's stage of readiness to change and engagement of individuals who have co-occurring mental disorders. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.
C. Substance abuse outpatient services co-occurring enhanced programs shall offer therapies to actively address, monitor, and manage psychotropic medication, mental health treatment, and interaction with substance-related and addictive disorders.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
Article 9
Mobile Medication-Assisted Treatment Services
12VAC35-105-1821. Application for operation of a mobile medication-assisted treatment program.
Each mobile medication-assisted treatment program shall operate as a component of a licensed MAT location and shall be listed on the provider's license addendum.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 41, Issue 5, eff. December 5, 2024; Errata, 41:6 VA.R. 756 November 4, 2024.
12VAC35-105-1822. Physical security controls; mobile MAT programs; storage areas.
A. For any conveyance operated as a mobile MAT program, a safe must be installed and used to store narcotic drugs in Schedules II through V for the purpose of maintenance or detoxification treatment, when not located at the provider's U.S. Drug Enforcement Administration (DEA) registered location. The safe shall:
1. Have the following specifications or the equivalent: 30 man-minutes against surreptitious entry, 10 man-minutes against forced entry, 20 man-hours against lock manipulation, and 20 man-hours against radiological techniques;
2. If it weighs less than 750 pounds, be bolted or cemented to the floor or wall in such a way that it cannot be readily removed; and
3. Be equipped with an alarm system that, upon attempted unauthorized entry, shall transmit a signal directly to a central protection company or a local or state police agency that has a legal duty to respond or a 24-hour control station operated by the DEA registrant.
B. The controlled substance storage areas shall be accessible only to an absolute minimum number of specifically authorized employees. When it is necessary for employee maintenance personnel, nonemployee maintenance personnel, business guests, or visitors to be present in or pass through controlled substance storage areas, the registrant shall provide for adequate observation of the area by an employee specifically authorized in writing.
C. The storage area for controlled substances in a mobile MAT program shall not be accessible from outside of the vehicle.
D. Personnel transporting the controlled substances on behalf of the mobile MAT program are required to retain control over all controlled substances when transferring the controlled substances between the DEA registered location and the conveyance, while en route to and from the dispensing locations, and when dispensing at the dispensing location. At all other times during transportation, all controlled substances shall be properly secured in the safe.
E. Upon completion of the operation of the mobile MAT program on a given day, the conveyance shall be immediately returned to the DEA registered location, and all controlled substances shall be removed from the conveyance and secured within the DEA registered location. After the conveyance has returned to the DEA registered location and the controlled substances have been removed, the conveyance may be parked until its next use at the DEA registered location or in any secure, fenced-in area once the local DEA office has been notified of the location of the secure, fenced-in area.
F. All mobile MAT programs shall establish a standard written operating procedure to ensure, if the mobile MAT program becomes inoperable, that all controlled substances on the inoperable conveyance are accounted for, removed from the inoperable conveyance, and secured at the DEA registered location.
G. With regard to the requirement within subsection E of this section, a mobile MAT program may apply to the DEA for an exception to this requirement. The application for such an exception must be submitted to the DEA in accordance with 21 CFR 1307.03. If the DEA grants an exception, the provider shall be permitted to operate in accordance with that exception. The provider shall maintain a record of the exception at the DEA registered location and in the mobile MAT program conveyance.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 41, Issue 5, eff. December 5, 2024; Errata, 41:6 VA.R. 756 November 4, 2024.
12VAC35-105-1824. Other security controls for mobile MATs.
A. Individuals enrolled in a mobile MAT program shall wait in an area that is physically separated from the narcotic storage and dispensing area by a physical entrance, such as a door or other entryway. Individuals served must wait outside of a mobile MAT program component if that conveyance does not have seating or a reception area that is separated from the narcotic storage and dispensing area. This requirement shall be enforced by the provider and all provider employees.
B. All mobile MAT programs shall comply with standards established by the U.S. Secretary of Health and Human Services respecting the quantities of narcotic drugs that may be provided to persons enrolled in a mobile MAT program for unsupervised use.
C. Provider personnel who are authorized to dispense controlled substances for narcotic treatment shall ensure proper security measures and patient dosage. The mobile MAT program shall comply with U.S. Drug Enforcement Administration (DEA) security requirements.
D. Any controlled substances being transported for disposal from the dispensing location of a mobile MAT program shall be secured and disposed of in compliance with 21 CFR Part 1317 and all other applicable federal, state, tribal, and local laws and regulations.
E. A conveyance used as part of a mobile MAT program may only be supplied with narcotic drugs by the DEA registered MAT that operates the conveyance. No persons permitted to dispense controlled substances to a mobile MAT shall:
1. Receive controlled substances from other mobile MAT programs or any other entity;
2. Deliver controlled substances to other mobile MAT programs or any other entity; or
3. Conduct reverse distribution of controlled substances on a mobile MAT program.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 41, Issue 5, eff. December 5, 2024; Errata, 41:6 VA.R. 756 November 4, 2024.
12VAC35-105-1826. Records for mobile MATs.
A. A provider of a mobile MAT program shall maintain records with the following information for each narcotic controlled substance:
1. Name of substance;
2. Strength of substance;
3. Dosage form;
4. Date dispensed;
5. Adequate identification of individuals served;
6. Amount consumed;
7. Amount and dosage form taken home by individuals served; and
8. Dispenser's initials.
B. The records required by subsection A of this section shall be maintained in a dispensing log at the U.S. Drug Enforcement Administration (DEA) registered site of the mobile MAT program and shall be maintained in compliance with 21 CFR 1304.22 without reference to 21 CFR 1304.03.
C. As an alternative to maintaining a paper dispensing log, a mobile MAT program may also use an automated or computerized data processing system for the storage and retrieval of program dispensing records if the following conditions are met:
1. The automated system maintains the information required in subsection A of this section;
2. The automated system has the capability of producing a hard copy printout of the program's dispensing records;
3. The mobile MAT program prints a hard copy of each day's dispensing log, which is then initialed appropriately by each person who dispensed medication to individuals served;
4. The automated system is approved by DEA;
5. The mobile MAT program maintains an offsite back-up of all computer-generated program information; and
6. The automated system is capable of producing accurate summary reports for both the DEA registered site of the mobile MAT program and any mobile MAT program for any timeframe selected by department personnel during an investigation. If these summary reports are maintained in hard copy form, they must be kept in a systematically organized file located at the DEA registered site of the mobile MAT program.
D. The provider shall retain all records for a minimum of six years following the last patient encounter in accordance with § 54.1-2910.4 of the Code of Virginia.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 41, Issue 5, eff. December 5, 2024; Errata, 41:6 VA.R. 756 November 4, 2024.
12VAC35-105-1828. Physical plant exemption for mobile MATs.
Mobile MAT program locations are exempt from physical plant requirements located within 12VAC35-105-260 through 12VAC35-105-380.
Statutory Authority
§§ 37.2-302 and 37.2-400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 41, Issue 5, eff. December 5, 2024; Errata, 41:6 VA.R. 756 November 4, 2024.