Part VI. Special Programs
12VAC35-46-1120. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 25, Issue 21, eff. August 6, 2009; repealed, Virginia Register Volume 41, Issue 18, eff. June 19, 2025.
12VAC35-46-1130. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 25, Issue 21, eff. August 6, 2009; repealed, Virginia Register Volume 41, Issue 18, eff. June 19, 2025.
12VAC35-46-1140. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 25, Issue 21, eff. August 6, 2009; repealed, Virginia Register Volume 41, Issue 18, eff. June 19, 2025.
12VAC35-46-1150. (Reserved).
Statutory Authority
§§ 37.2-302 and 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1160. Clinically managed, medium-intensity residential services Level of care 3.5 staff criteria.
A clinically managed, medium-intensity residential care program shall meet the following staff requirements. The program shall:
1. Ensure the availability of emergency consultation with a licensed physician by telephone or in person 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 24 hours a day;
2. Provide licensed clinicians who are able to obtain and interpret information regarding the signs and symptoms of intoxication and withdrawal, as well as the appropriate monitoring and treatment of those conditions and how to facilitate entry into ongoing care;
3. Provide appropriately trained staff who are competent to implement physician-approved protocols for the child's or adolescent's observation, supervision, and treatment, including over the counter medications for symptomatic relief, determination for the appropriate level of care, and facilitation of the child's or adolescent's transition to continuing care;
4. Provide staff training that shall include at a minimum the requirements within 12VAC35-46-310, and all staff administering over the counter medications shall complete the training program approved by the Board of Nursing and required by subsection L of § 54.1-3408 of the Code of Virginia;
5. Provide access, as needed, to medical evaluation and consultation, which shall be available 24 hours a day to monitor the safety and outcome of withdrawal management in this setting, in accordance with the provider's written criteria for admission and discharge as required by 12VAC35-46-640 and 12VAC35-46-765; and
6. 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 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1170. Clinically managed, medium-intensity residential services Level of care 3.5 program criteria.
A clinically managed, medium-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 licensed professional and included in an assessment and treatment plan;
2. Provide counseling and clinical interventions to teach a child or adolescent the skills needed for daily productive activity, prosocial behavior, and reintegration into family and community;
3. Provide motivational enhancement and engagement strategies appropriate to the child's or adolescent's stage of readiness to change and level of comprehension;
4. 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;
5. Provide family and caregiver treatment services as deemed appropriate by a licensed 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 stay is determined by the child's or adolescent's condition and functioning;
9. Make medication assisted treatment (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;
10. Provide educational services in accordance with state law to maintain the educational and intellectual development of the child or adolescent while they are admitted to the service. When indicated, additional educational opportunities shall be provided to remedy deficits in the educational level of children or adolescents who have fallen behind because of their involvement with alcohol and other drugs;
11. Ensure that all children and adolescents served by the residential service have access to the substance use treatment program; and
12. Provide daily clinical services to assess and address the child's or adolescent's withdrawal status and service needs. This may include nursing or medical monitoring, use of medications to alleviate symptoms, or individual or group therapy or programming specific to withdrawal and withdrawal support.
Statutory Authority
§§ 37.2-302 and 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1180. Clinically managed, medium-intensity residential services Level of care 3.5 admission criteria.
A. A clinically managed, medium-intensity residential care program provides treatment for children who have impaired functioning across a broad range of psychosocial domains, including disruptive behaviors, delinquency and juvenile justice involvement, educational difficulties, family conflicts and chaotic home situations, developmental immaturity, and psychological problems.
B. Before a clinically managed, medium-intensity residential service program may admit a child or adolescent, the child or adolescent 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 child or adolescent 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, including the specific criteria for adolescent populations.
Statutory Authority
§§ 37.2-302 and 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1190. Clinically managed, medium-intensity residential services Level of care 3.5 discharge criteria.
Before a clinically managed, medium-intensity residential service program may discharge or transfer a child or adolescent, the child or adolescent 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 children or adolescents 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 child's or adolescent's treatment but could achieve the child's or adolescent's goals with a different type of treatment; or
3. Achieved the child's or adolescent'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 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1200. Clinically managed, medium-intensity residential services Level of care 3.5 co-occurring enhanced programs.
A. Clinically managed, medium-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, medium-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, medium-intensity residential services co-occurring enhanced programs shall offer planned clinical activities designed to stabilize the child's or adolescent'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 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1210. 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 and emergency services, available 24 hours a day, seven days a week by the clinically managed, low-intensity residential services provider. The program shall also provide allied health professional staff present onsite 24 hours a day;
2. Have clinical staff, with the credentials described in subdivision 3 of this section, 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;
4. Have staff that shall be knowledgeable about child or adolescent development and experienced in engaging and working with children or adolescents; and
5. 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 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1220. 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 planned clinical program activities that are professionally directed, in addition to other treatment services offered to children or adolescents[]. Services shall be designed to stabilize the child's or adolescent's substance use disorder, improve the child's or adolescent's ability to structure, and organize the tasks of daily living and recovery;
2. Collaborate with care providers to develop an individual treatment plan for each child or adolescent 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 child's or adolescent's stage of readiness to change and level of comprehension;
6. Maintain direct affiliations with other easily accessible levels of care or coordinate through referral to more or less intensive levels of care and other services. Include the ability to arrange for needed procedures as appropriate to the severity and urgency of the child's or adolescent's condition;
7. 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;
8. Provide addiction pharmacotherapy and the ability to arrange for pharmacotherapy for psychiatric medications;
9. Utilize random drug screening to monitor progress and reinforce treatment gains;
10. Ensure that all children and adolescents served by the residential service have access to the substance use treatment program; and
11. Make MAT available for all children or adolescents 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 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1230. Clinically managed, low-intensity residential services Level of care 3.1 admission criteria.
Before a clinically managed, low-intensity residential service program may admit a child or adolescent, the child or adolescent 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 child or adolescent 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 3.1 of ASAM, including the specific criteria of adolescent populations.
Statutory Authority
§§ 37.2-302 and 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1240. Clinically managed, low-intensity residential services Level of care 3.1 discharge criteria.
Before a clinically managed, low-intensity residential service program may discharge or transfer a child or adolescent, the child or adolescent 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 children or adolescents 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 child's or adolescent's treatment but could achieve the child's or adolescent's goals with a different type of treatment; or
3. Achieved the child's or adolescent'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 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1250. 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 appropriate 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 child's or adolescent's mental condition.
B. Clinically managed, low-intensity residential services co-occurring enhanced programs shall be staffed by appropriately credentialed mental health professionals who are able to assess and treat co-occurring disorders with the capacity to involve addiction-trained psychiatrists.
C. Clinically managed, low-intensity residential services co-occurring enhanced programs shall offer planned clinical activities that are designed to stabilize the child's or adolescent'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 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 39, Issue 11, eff. February 17, 2023.
12VAC35-46-1260. Qualified residential treatment programs.
A. A qualified residential treatment program (QRTP) shall have a trauma-informed treatment model that is designed to address the needs, including clinical needs as appropriate, of children with serious emotional or behavioral disorders or disturbances and, with respect to a child, is able to implement the treatment identified for the child.
B. In addition to the staffing requirements within Part II (12VAC35-46-170 et seq.) through Part VI (12VAC35-46-1120 et seq.) of this chapter, a QRTP shall have registered or licensed nursing staff and other licensed clinical staff who:
1. Provide care within the scope of their practice as defined by state law;
2. Are on-site according to the treatment model referred to in subsection A of this section; and
3. Are available 24 hours a day and seven days a week.
The QRTP is not required to acquire nursing or other clinical staff solely through means of a direct employer to employee relationship.
C. To the extent appropriate and in accordance with the child's best interests, the QRTP shall facilitate participation of family members in the child's treatment program.
D. The QRTP shall facilitate outreach to the family members of the child, including siblings, document how the outreach is made, including contact information, and maintain contact information for any known biological family and fictive kin of the child. Documentation of outreach to family members and contact information of family members shall be placed within the child's record at the QRTP.
E. The QRTP shall document how family members are integrated into the treatment process for the child, including after discharge, and how sibling connections are maintained. Documentation of family member integration shall be placed within the child's record at the QRTP.
F. The QRTP shall provide or ensure discharge planning and family-based aftercare support for at least six months following discharge.
G. The QRTP shall be licensed in accordance with 42 USC § 471(a)(10) and accredited by any of the following independent nonprofit organizations:
1. The Commission on Accreditation of Rehabilitation Facilities (CARF);
2. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO);
3. The Council on Accreditation (COA); or
4. Any other independent, nonprofit accrediting organization approved by the U.S. Secretary of Health and Human Services.
Statutory Authority
§§ 37.2-203 and 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 40, Issue 6, eff. December 7, 2023.
12VAC35-46-1270. Additional requirements for QRTP placements for children within the custody of local social service boards.
A. The qualified residential treatment program (QRTP) shall coordinate with the local departments of social services, the child's biological family members, relative and fictive kin of the child, and, as appropriate, professionals who are a resource to the family of the child, such as teachers, clergy, or medical or mental health providers who have treated the child.
B. All documents related to a child's need for placement shall be placed within the child's record at the qualified residential treatment program, including the assessment determination of the qualified individual, as defined in 42 USC § 675a(c)(1)(D)(i), and the written documentation of the approval or disapproval of the placement in a qualified residential treatment program by a court or administrative body.
C. This section shall not apply to direct parental placements of children into the QRTP that are made outside of the social services system.
Statutory Authority
§§ 37.2-203 and 37.2-408 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 40, Issue 6, eff. December 7, 2023.