1. (A) Staff Supervision Requirements.

   1. (1) Unlicensed or Not Independently Licensed Staff. All professionals who are unlicensed, who are in a profession without licensure, or who are not independently licensed or certified as a peer supervisor must receive direct and continuous supervision. Direct and continuous supervision may be provided using telehealth technology.
   2. (2) Independently Licensed and Certified Peer Supervisor Staff. All independently licensed professionals and certified peer supervisors must receive supervision in accordance with the relevant licensing requirements and program policy. Supervision may be provided using telehealth technology.
   3. (3) The supervising clinician is primarily responsible for the care of the member. For any care delivered by a professional under supervision, there must be documentation in the clinical chart that the chart was reviewed by the supervising clinician.
   4. (4) All supervision must be documented in files accessible for review by the MassHealth agency. Supervision notes must, at a minimum, contain information regarding frequency of supervision, format of supervision, supervisor’s signature and credentials, and general content of supervision session.

2. (B) Required Qualifications of Certain Professional and Paraprofessional Staff.

   1. (1) Peer Recovery Coaches. Peer recovery coaches must meet the following requirements:

      1. (a) have at least two years of sustained recovery; and
      2. (b) hold, or be actively working to obtain, credentialing as a Certified Addiction Recovery Coach (CARC) through the Massachusetts Board of Substance Abuse Counselor Certification, or alternative licensure or certification process, as directed by EOHHS.

   2. (2) Peer Recovery Coaches for Pregnant and Postpartum Members. Peer recovery coaches for pregnant and postpartum members must meet the following requirements:

      1. (a) have at least two years of sustained recovery;
      2. (b) hold, or be actively working to obtain, credentialing as a Certified Addiction Recovery Coach (CARC) through the Massachusetts Board of Substance Abuse Counselor Certification, or alternative licensure or certification process, as directed by EOHHS; and

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-17

Provider Manual Series (130 CMR 418.000)

Transmittal Letter Date

Substance Use Disorder Treatment

Manual SUD-24 03/28/2025

1. (c) have lived experience as a pregnant or postpartum individual or have completed specialized training in providing peer recovery coaching services to pregnant and postpartum individuals.
2. (3) Recovery Support Navigators. Recovery support navigators must hold a bachelor’s degree in social work, psychology, or a related behavioral health field, or have two years of relevant work experience and/or lived experience with a primary diagnosis of substance use disorder.

3. (4) Recovery Support Navigators for Pregnant or Postpartum Members. Recovery support navigators for pregnant and postpartum members must meet the following requirements:

   1. (a) hold a bachelor’s degree in social work, psychology, or a related behavioral health field, or have two years of relevant work experience and/or lived experience with a primary diagnosis of substance use disorder; and
   2. (b) have lived experience as a pregnant or postpartum individual or have completed specialized training in providing recovery support navigator services to pregnant and postpartum individuals.
4. (5) Certified Alcohol Counselor (CAC) and Certified Alcohol and Drug Addiction Counselor (CADAC). There are three levels of certification: CAC, CADC, CADC II. Each level must have received a “Certification of Alcohol and Drug Counselors” provided by the Massachusetts Board of Substance Abuse Counselor Certification (MBSACC).
5. (6) Licensed Alcohol and Drug Counselor I. A licensed alcohol and drug counselor must be licensed by the Department of Public Health pursuant to 105 CMR 168.00: Licensure of Alcohol and Drug Counselors.

6. (C) Minimum Staffing Composition Requirements for Services. In addition to the requirements set forth in 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs, programs must meet the following staffing requirements to provide each service:

   1. (1) Acute Treatment Services – ASAM Level 3.7 Medically Managed Residential Treatment (ATS). Programs delivering medically monitored intensive inpatient services must designate at a minimum the following staff:

      1. (a) Medical Director. A program must designate one physician who is responsible for the provision of all medical services provided by the program. The Medical Director may provide medical services directly or delegate the provision of direct services to a nurse practitioner or physician assistant working under their supervision. The medical director, or a designated nurse practitioner or physician assistant working under their supervision must be available, either on-site or remotely, for consultation and to facilitate admissions 24 hours per day, seven days per week, including weekends and holidays to ensure the provision of high-quality care. The Medical Director must be available to be onsite during any hours of program operation, as needed.
      2. (b) Clinical Director. A program must designate one individual employed on a full-time basis who is responsible for the adequacy and appropriateness of member care, and oversight of quality management. The Clinical Director must meet the minimum requirements set forth in 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs.
      3. (c) Program Director. A program must designate one individual, employed on a full- time basis, who is responsible for the daily administration and operation of the program.
      4. (d) Nurse Manager. A program must designate one individual, employed on a full-time

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-18

Provider Manual Series (130 CMR 418.000)

Transmittal Letter Date

Substance Use Disorder Treatment

Manual SUD-24 03/28/2025

basis, who is responsible for ensuring on-site nursing coverage 24 hours per day, seven days a week, and provide direct and continuous supervision of nursing staff. (e) Nursing Staff. A program must schedule all daytime shifts with at least one RN-level nurse during day and evening shifts and schedule all overnight shifts with at least one of either an RN-level or licensed practical nurse. (f) Recovery Specialist. A program must schedule at least one recovery specialist for each shift. (g) Counseling Staff. Programs serving members younger than 18 years old must schedule counseling staff to cover a minimum of 12 hours a day, seven days a week. All other programs must provide sufficient staff coverage on all shifts to ensure patient needs are met. (h) Case Manager. Programs serving members younger than 18 years old must designate case management staffing such that there is a minimum of eight hours of case management services provided at least five days a week. All other programs must designate sufficient staff coverage to ensure that patient needs are met. (i) Other Medical Professionals. The program must have available, whether on staff or by contract, at least one OB/GYN to facilitate medically necessary care to pregnant members. (j) Other Clinical Staff. The organization must employ at least one independently licensed clinician, in addition to the Clinical Director, to support additional oversight of clinical adequacy, and appropriateness of member care and quality management of the program.

1. (2) Clinical Stabilization Services – ASAM 3.5 Clinically Managed High-Intensity Residential Services (CSS). Programs delivering clinically managed high-intensity residential services must designate at a minimum the following staff:

   1. (a) Medical Director. A program must designate one physician who is responsible for the provision of all medical services provided by the program. The Medical Director may also provide medical services directly or delegate the provision of direct services to an advanced practice nurse practitioner or physician assistant working under their supervision must be available on-site or remotely for consultation and to facilitate admissions 24 hours per day, seven days per week, including weekends and holidays to ensure the provision of high-quality care. The Medical Director must be available to be onsite during any hours of program operation, as needed.
   2. (b) Clinical Director. A program must designate one individual employed on a full-time basis who is responsible for the adequacy and appropriateness of member care, and oversight of quality management. The Clinical Director must meet the minimum requirements set forth in 105 CMR 164.000 Licensure of Substance Use Disorder Treatment Programs.
   3. (c) Program Director. A program must designate one individual, employed on a full- time basis, who is responsible for the daily administration and operation of the program.
   4. (d) Nursing Staff. The program must ensure that no less than 40 hours of nursing coverage is available on a weekly basis including weekends and holidays.
   5. (e) Counseling Staff. A program must schedule, at a minimum, the full-time equivalent of 2.5 counseling staff members to be present 12 hours a day, seven days a week.
   6. (f) Recovery Specialist. A program must schedule at least one recovery specialist for each shift.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-19

Provider Manual Series (130 CMR 418.000)

Transmittal Letter Date

Substance Use Disorder Treatment

Manual SUD-24 03/28/2025

1. (g) Case Manager. A program must schedule, at a minimum, one case manager or care coordinator on a full-time basis, five days a week.
2. (h) Other Clinical Staff. The organization must employ at least one independently licensed clinician, in addition to the Clinical Director, to support additional oversight of clinical adequacy, and appropriateness of member care and quality management of the program.
3. (3) Individualized Treatment Stabilization Services (ITS) Tiers 1 and 2. Programs delivering individualized treatment services must meet all staffing requirements for both ASAM 3.7
4. (ATS) and ASAM 3.5 (CSS) services pursuant to 130 CMR 418.410 and 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs, and must designate, at minimum, a master’s level clinician to provide individual and group counseling services.
5. (4) Residential Rehabilitation Services (RRS) and Transitional Support Services (TSS) – ASAM Level 3.1 Clinically Managed Low-Intensity Residential Services. Programs delivering residential rehabilitation services or transitional support services must meet all staffing requirements pursuant to 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs. In addition, RRS and TSS programs must designate, at a minimum, a medication specialist.

6. (5) Opioid Treatment Programs (OTPs). Programs delivering OTP services must designate at a minimum the following staff:

   1. (a) Medical Director. A program must designate one physician with documented clinical experience with opioid-dependent, alcohol, and other drug-dependent individuals, or 40 hours of documented continuing education in treating addicted individuals and medications for treatment of addiction, including all FDA-approved medications for treatment of opioid use disorder, who is responsible for the provision of all medical services provided by the program. The Medical Director may provide medical services directly or delegate such direct service provision to an advanced practice registered nurse or physician assistant who has received midlevel waiver approval through Bureau of Substance Addiction Services and SAMHSA and who are working under the supervision of the Medical Director. The Medical Director is responsible for coverage of admission requests during evening and weekend hours.
   2. (b) Clinical Director. A program must designate one individual who is independently licensed as a Licensed Alcohol and Drug Counselor I (LADC I), Licensed Independent Clinical Social Worker (LICSW), Licensed Marriage and Family Therapist (LMFT), Licensed Mental Health Counselor (LMHC), or psychologist. The Clinical Director is responsible for adequacy and appropriateness of member care, and oversight of quality management.
   3. (c) Program Director. A program must designate one individual, employed on a full- time basis, who is responsible for the daily administration and operation of the program.
   4. (d) Nurse Manager. A program must designate a Nurse Manager who is employed by the program to oversee the provision of nursing services and provide direct and continuous supervision of all nursing staff employed by the OTP.
   5. (e) Nursing Staff. A program must ensure nursing coverage for operations, including during evening and weekend hours.
   6. (f) Clinical Staff. The program or the organization must employ at least one additional independently licensed clinician in addition to the Clinical Director., The program must employ sufficient clinicians to ensure individual, group, and family counseling is

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-20

Provider Manual Series (130 CMR 418.000)

Transmittal Letter Date

Substance Use Disorder Treatment

Manual SUD-24 03/28/2025

provided to meet the needs of members seeking the service.

1. (6) Structured Outpatient Addiction Programs (SOAP) – ASAM Level 2.1. Programs delivering structured outpatient addiction program services must designate at a minimum the following staff:

   1. (a) Program Director. A program must designate one individual, employed on a full- time basis, who is responsible for the daily administration and operation of the program.
   2. (b) Clinical Director. A program must designate one individual employed on a full-time basis who meets the minimum requirements set forth in 105 CMR 164.000 Licensure of Substance Use Disorder Treatment Programs. The Clinical Director is responsible for adequacy and appropriateness of member care, and oversight of quality management.
   3. (c) Clinical Staff. A program must employ sufficient clinical staff who meet the minimum requirements set forth in 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs to ensure individual, group, and family counseling, as well as treatment planning, is provided to meet the needs of members seeking the service; and
   4. (d) Case Manager. A program must designate one case manager responsible for helping clients obtain medically necessary services by providing information, referral coordination, discharge planning, and follow-up.
   5. (e) Other Clinical Staff. The organization must employ at least one independently licensed clinician, in addition to the Clinical Director, to support additional oversight of clinical adequacy, and appropriateness of member care and quality management of the program.

2. (7) Enhanced Structured Outpatient Addiction Programs (E-SOAP) – ASAM Level 2.1. Programs delivering E-SOAP services must meet all requirements for SOAP services set forth in 130 CMR 418.409(8) and must designate at a minimum, the following staff:

   1. (a) Case Manager. A program must employ, on a full-time basis, at least one case manager working under the supervision of the clinical director. The case manager is responsible for helping members obtain medically necessary services by providing information, referral coordination, discharge planning, and follow-up. Case managers must ensure individuals are connected to appropriate services, including OB/GYN, pediatrics, family care providers, CSP-HI, housing resources, school resources, and other medical/social services providers or state agencies.
   2. (b) Other Clinical Staff. The organization must employ at least one independently licensed clinician, in addition to the Clinical Director, to support additional oversight of clinical adequacy, and appropriateness of member care and quality management of the program.

   3. (c) Clinical Staff. In addition to the clinical staffing requirements set forth in 130 CMR 418.410, program staff must also ensure that clinicians trained in:

      1. 1. family and adolescent counseling;
      2. 2. services for members experiencing or at risk of experiencing homelessness; and
      3. 3. members who are pregnant are available for members enrolled in this service.
3. (8) Medically Managed Inpatient Treatment – ASAM Level 4.0. Programs delivering these services must ensure that members receive daily medical services provided by a physician or their designee as well as designating a primary nurse for each member. The program must have available, whether on staff or by contract, at least one OB/GYN to facilitate medically necessary care to pregnant members.
4. (9) Substance Use Disorder Outpatient Counseling Services – ASAM Level 1.5 Outpatient

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4 Program Regulations

4-21

Provider Manual Series (130 CMR 418.000)

Transmittal Letter Date

Substance Use Disorder Treatment

Manual SUD-24 03/28/2025

Therapy. Programs delivering these services must designate at a minimum:

1. (a) Clinical Director. A program must designate one individual who is independently licensed as a Licensed Alcohol and Drug Counselor I (LADC I), Licensed Independent Clinical Social Worker (LICSW), Licensed Marriage and Family Therapist (LMFT), Licensed Mental Health Counselor (LMHC), or psychologist. The Clinical Director is responsible for adequacy and appropriateness of member care, and oversight of quality management.
2. (b) Program Director. A program must designate one individual, employed on a full- time basis, who is responsible for the daily administration and operation of the program.
3. (c) Clinical Staff. A program must employ sufficient clinicians to ensure individual, group, and family counseling is provided to meet the needs of members seeking the service.