1. (a) The department will approve a community behavioral health services provider that meets the requirements of this section to provide clinically managed low-intensity, medium-intensity, or high-intensity residential substance use disorder treatment services.

2. (b) All residential substance use disorder treatment services must include, at admission and during the course of active treatment as needed,

   1. (1) a substance use intake assessment conducted in accordance with 7 AAC 135.110(c), or an integrated mental health and substance use intake assessment conducted in accordance with 7 AAC 135.110(d); if the assessment conducted under this paragraph is an integrated mental health and substance use intake assessment, and of the individuals listed in (f)(6), (g)(5), or (h)(5) of this section, only a physician, a physician assistant, an advanced practice registered nurse, or a mental health professional clinician may provide that assessment; and

   2. (2) development and maintenance of an individualized treatment plan that includes measurable short-term goals and objectives as needed in the areas of

      1. (A) case management;
      2. (B) addiction treatment;
      3. (C) health care;
      4. (D) mental health;
      5. (E) social services;
      6. (F) vocational services; and
      7. (G) housing services.

3. (c) Residential substance use disorder treatment services may be administered to an individual or a group, or on a family basis, but must include the following component services:

   1. (1) life skills development designed to restore or improve the recipient's overall functioning relative to the recipient's substance use disorder;
   2. (2) counseling to promote successful initial involvement in regular productive daily activity, including going to work or school, and successful reintegration into family living;
   3. (3) motivational and engagement strategies appropriate to the recipient's treatment plan;
   4. (4) medication administration services; of the individuals listed in (f)(6), (g)(5), or (h)(5) of this section, only a physician, a physician assistant, an advanced practice registered nurse, a registered nurse supervised by a physician or advanced practice registered nurse, or a licensed practical nurse supervised by a physician or advanced practice registered nurse may provide medication administration services;
   5. (5) referrals to other agencies, as needed;
   6. (6) discharge or transfer planning;
   7. (7) repealed 6/30/2021;
   8. (8) crisis or relapse prevention planning;
   9. (9) management of a recipient's chronic disease, if medically necessary and clinically appropriate;
   10. (10) urinalysis and breathalyzer testing to reinforce treatment gains as appropriate to the treatment plan;
   11. (11) development of a social network that is supportive to recovery;
   12. (12) services provided to the recipient's family and significant other to support recovery and prevention;
   13. (13) didactic motivational interventions to assist the recipient in understanding the relationship between substance use disorder and attendant life issues;
   14. (14) development of coping skills in the recovery environment.

4. (d) All residential substance use disorder treatment services must be medically necessary, clinically appropriate, and provided in accordance with

   1. (1) the ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, adopted by reference in 7 AAC 70.910; and

   2. (2) one or more of the following:

      1. (A) the Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 70.910;
      2. (B) the International Classification of Diseases, adopted by reference in 7 AAC 70.910.
5. (e) In addition to being delivered during regular business hours, all residential substance use disorder treatment services must be delivered as needed during evening hours and on weekends.

6. (f) Clinically managed low-intensity residential substance use disorder treatment services must

   1. (1) be delivered as a residential service on the premises of a community behavioral health services provider;
   2. (2) include five or more hours of clinical and therapeutic rehabilitative services per week;
   3. (3) be delivered in a structured recovery environment, staffed 24 hours a day, that provides sufficient stability to prevent or minimize the potential for recipient relapse or level of substance use that creates problems for the recipient;
   4. (4) include the availability of telephonic or in-person consultation with a physician, a physician assistant, an advanced practice registered nurse, or the emergency medical staff of a general acute care hospital 24 hours a day, seven days per week;
   5. (5) be provided with the appropriate medical, psychiatric, and psychological services on-site or closely coordinated off-site as determined by the severity and urgency of the recipient's condition;

   6. (6) be provided directly to a recipient by any of the following individuals, working within the scope of the individual's practice:

      1. (A) a substance use disorder counselor;
      2. (B) a behavioral health clinical associate;
      3. (C) a mental health professional clinician;

      4. (D) an individual with an active license under AS 08 to practice as

         1. (i) a physician;
         2. (ii) a physician assistant;
         3. (iii) an advanced practice registered nurse;
         4. (iv) a registered nurse supervised by a physician or advanced practice registered nurse; or
         5. (v) a licensed practical nurse supervised by a physician or advanced practice registered nurse; and
   7. (7) include access to nursing care and observation of the recipient as needed.

7. (g) Clinically managed medium-intensity residential substance use disorder treatment services must

   1. (1) be delivered as a residential service on the premises of a community behavioral health services provider;
   2. (2) include 20 or more hours of clinical and therapeutic rehabilitative services per week;

   3. (3) include the availability of consultation with a physician, a physician assistant, an advanced practice registered nurse, or the emergency medical staff of a general acute care hospital 24 hours a day, seven days per week, including

      1. (A) telephonic consultation available no later than eight hours after the provider's request for consultation;
      2. (B) in-person consultation available no later than 24 hours after the provider's request for consultation;
   4. (4) be provided with the appropriate medical, psychiatric, and psychological services on-site or closely coordinated off-site as determined by the severity and urgency of the recipient's condition;

   5. (5) be available 24 hours per day, must be provided on-site, and must be provided directly to a recipient by any of the following individuals, working within the scope of the individual's practice:

      1. (A) a substance use disorder counselor;
      2. (B) a behavioral health clinical associate;
      3. (C) a mental health professional clinician;

      4. (D) an individual with an active license under AS 08 to practice as

         1. (i) a physician;
         2. (ii) a physician assistant;
         3. (iii) an advanced practice registered nurse;
         4. (iv) a registered nurse supervised by a physician or advanced practice registered nurse; or
         5. (v) a licensed practical nurse supervised by a physician or advanced practice registered nurse; and
   6. (6) include access to nursing care and observation of the recipient as needed.

8. (h) Clinically managed high-intensity residential substance use disorder treatment services must

   1. (1) be delivered as a long-term residential inpatient service on the premises of a community behavioral health services provider;
   2. (2) include 20 or more hours of clinical and therapeutic rehabilitative services per week;

   3. (3) include the availability of consultation with a physician, a physician assistant, an advanced practice registered nurse, or the emergency medical staff of a general acute care hospital 24 hours a day, seven days per week, including

      1. (A) telephonic consultation available no later than eight hours after the provider's request for consultation;
      2. (B) in-person consultation available no later than 24 hours after the provider's request for consultation;
   4. (4) be provided with the appropriate medical, psychiatric, and psychological services on-site or closely coordinated off-site as determined by the severity and urgency of the recipient's condition;

   5. (5) be available 24 hours per day, must be provided on-site, and must be provided directly to a recipient by any of the following individuals, working within the scope of the individual's practice:

      1. (A) a substance use disorder counselor;
      2. (B) a behavioral health clinical associate;
      3. (C) a mental health professional clinician;

      4. (D) an individual with an active license under AS 08 to practice as

         1. (i) a physician;
         2. (ii) a physician assistant;
         3. (iii) an advanced practice registered nurse;
         4. (iv) a registered nurse supervised by a physician or advanced practice registered nurse; or
         5. (v) a licensed practical nurse supervised by a physician or advanced practice registered nurse; and
   6. (6) include access to nursing care and observation of the recipient as needed.
9. (i) In this section, "telephonic" means two-way vocal communication by telephone or voice over internet protocol technologies.

(Eff. 10/1/2011, Register 199; am 6/16/2016, Register 218; am 4/24/2020, Register 234; am 6/30/2021, Register 238)

Authority: AS 47.05.010, AS 47.30.477, AS 47.30.570, AS 47.30.470, AS 47.30.530, AS 47.37.140, AS 47.30.475, AS 47.30.540