9100.1 The purpose of this chapter is to establish requirements governing Medicaid reimbursement for Adult Substance Abuse Rehabilitative Services (ASARS).9100.2 ASARS shall be available to reduce and ameliorate Substance Use Disorder (SUD) which includes both substance abuse and substance dependence.9100.3 The Department of Health, Addiction Prevention and Recovery Administration (APRA) shall be responsible for determining each adult Medicaid beneficiary's eligibility for treatment under the ASARS program pursuant to the requirements set forth in Chapter 23 of Title 29 DCMR.9100.4 Adult Medicaid beneficiaries may present for treatment under the ASARS Program through either of the following:- (a) A beneficiary may self-elect ASARS treatment;

- (b) A legally authorized representative may select treatment under ASARS on behalf of an eligible Medicaid beneficiary; or

- (c) The beneficiary has a legal obligation to seek medically necessary substance abuse treatment services.9100.5 Medicaid reimbursement for ASARS treatment shall not be available for the following:- (a) Treatment for inmates in public institutions, as defined in 42 C.F.R. § 435.1010;

- (b) Services provided in nursing facilities, intermediate care facilities for persons with intellectual disabilities, and institutions for mental diseases, as defined in section 1919(a) of the Social Security Act and 42 C.F.R. §§ 440.150 and 435.1010 ;

- (c) Room, board, and transportation costs;

- (d) Services delivered as a component of human subjects research or clinical trials;

- (e) Educational, vocational, and job training services;

- (f) Services rendered by parents or other family members;

- (g) Legal services;

(h) Strictly social or recreational services;

(i) Services covered elsewhere in the District's State Plan, including habilitative and mental health rehabilitative services; and

(j) Services which are not medically necessary.

9100.6 All services that require prior authorization shall be requested through the beneficiary's Clinical Care Coordinator, assigned pursuant to § 9104.1.

9100.7 ASARS treatment shall be rendered only when the beneficiary is present.

9100.8 The following services are available for Medicaid reimbursement under the ASARS program:

(a) Assessment and Diagnostic Services as described in § 9103;

(b) Clinical Care Coordination as described in § 9104;

(c) Crisis Intervention as described in § 9105;

(d) Medically Managed Intensive Inpatient Detoxification as described in § 9106;

(e) Substance Abuse Counseling as described in § 9107;

(f) Medication Management as described in § 9108; and

(g) Medication Assisted Treatment as described in § 9109.

SOURCE: Final Rulemaking published at 59 DCR 11144 (September 28, 2012).