Service Category Standards of Care
Substance-abuse Treatment Services — Outpatient
Originated Revised Ratified
August 2001 August 2001 March 2003 April 2003 January 2006 February 2006 August 2009 October 2009 October 1997 March 2010 November 2015 March 2010 1. Service Definition
Substance abuse services- outpatient is the provision of medical or other treatment and/or
counseling to address substance abuse problems (i.e., alcohol and/or legal and illegal drugs) in an outpatient setting by a physician or under the supervision of a physician, or by other qualified personnel. Services may include use of funds to expand HIV-specific capacity of programs if timely access to treatment and counseling is not otherwise provided.
Services are limited to the following: (1) pre-treatment/ recovery readiness programs; (2) harm reduction; (3) mental health counseling to reduce depression, anxiety and other disorders associated with substance abuse; (4) outpatient drug-free treatment and counseling, (5) opiate assisted therapy; (6) neuro-psychiatric pharmaceuticals; (7) relapse prevention and (8) limited acupuncture services with a written referral from the client’s primary health care provider, provided by a certified or licensed practitioners wherever State certification or licensure exists. Services provided must include a treatment plan that calls only for allowable activities and includes (1) the quantity, frequency, and modality of treatment provided; (2) the date treatment begins and ends; (3) regular monitoring and assessment on client progress; and (4) the signature of the individual providing the service and or the supervisor as applicable (HRSA, 2013).
2. Service Standards of Care
Substance-abuse treatment for persons with HIV disease should reflect competence and experience in evaluation, formulation and diagnosis as well as in evidence-based therapeutics, using contemporary practice guidelines where available. Agencies eligible for Ryan White Title I funding must be compliant with the current COMAR 10.47.01.03 regulations. The standards apply for outpatient programs.
2.1. Baseline Evaluation
2.1.1. Eligibility for all applicable funding resources must be assessed before Ryan White Title I funds can be used.
2.1.2. Documentation that demonstrates that the client was not eligible for any other funding resource to pay for services must be maintained in every client record.
2.1.3. Eligibility must be documented to ensure that the client’s income is within the Ryan White guidelines for the uninsured and underinsured.
2.1.4. For those with insurance without substance-abuse coverage, documentation must show that the client:
22.214.171.124. Is HIV positive.
126.96.36.199. Has had a medical or health-status report within the past six months. 2.1.5. For clients without any insurance, documentation must show that the client:
188.8.131.52. Is HIV positive.
184.108.40.206. Has documentation that shows a medical or health status report within the last six months.
220.127.116.11. Lives within the EMA.
2.1.6. A statement of eligibility can be completed by the referring agency for each client. 2.2. Treatment and Evaluation — COMAR 10.47.01.04
2.2.1. The following components of treatment and evaluation must be standard practice with all clients and should be reflected in the record documentation:
18.104.22.168. An initial evaluation must be conducted before the beginning of any treatment. 22.214.171.124. Clinical staff knowledgeable about the full spectrum of alcohol and drug
126.96.36.199. Clinical staff should be working in a substance-abuse program certified and/or licensed by the Maryland Office of Health Care Quality or hold current
certification/licensure recognized by the Maryland Alcohol and Drug Abuse Administration for practice in Maryland (COMAR 10.47.01.06).
188.8.131.52. The intake and assessment must meet the clinical requirements as outlined in COMAR 10.47.01.02, 10.47.02.03, 10.47.01.04, 10.47.02.04 and 10.47.02.05. 2.3. Further or Continued Services
Follow-up visits should adhere to the following protocols.
2.3.2. COMAR 10.47.02.00 et seq., for outpatient services requirements for monitoring on-going services.
3. Administrative Standards of Care
This section describes the agency’s minimum administrative requirements. Agencies and individuals may exceed these standards. It is the responsibility of the agency receiving funds to ensure that it is complying with the most current COMAR regulations.
3.1. Licensing, Knowledge, Skills and Experience
Providers shall document the following in terms of licensing, knowledge and experience.
3.1.1. Refer to COMAR 10.47.01.06 (Staff Requirements) for minimum qualifications for staff providing services.
3.1.2. Staff providing services must have both knowledge and experience in working with HIV-positive individuals as well as meeting the licensure or certification requirements.
3.1.3. The agency must encourage and allow continuing education and professional development opportunities to be pursued on an annual basis.
3.1.4. The agency is responsible for ensuring that each staff person attends training and educational opportunities related to HIV/AIDS and pertinent related topics.
3.1.5. The agency is required to maintain documentation of staff attendance at continuing-education and professional-development opportunities for both HIV/AIDS topics and substance-abuse treatment topics or best practices.
3.2. Client Rights and Confidentiality
Providers shall document the following in terms of clients’ rights and confidentiality. 3.2.1. Refer to COMAR 10.47.01.07 (Patient Rights and Grievance Procedures) and
3.2.2. The agency must maintain documentation that copies of policies have been given to clients seeking services.
3.2.3. The agency shall have a consumer advisory board and maintain documentation of its meetings.
3.2.4. If a waiting list exists, the agency shall show evidence of a plan to attempt to communicate regularly with those clients on the list regarding waiting-list status.
3.2.5. The agency must have: written criteria for services; a fee structure; an intake process; and discharge, transfer and closing procedures. It must document that clients are informed of these.
3.4. Agency Responsibilities Not applicable.
3.5. Quality Assurance
Providers should have a written quality-assurance activity that identifies areas for improvement and the subsequent actions taken. The agency must show:
3.5.1. An overall mechanism or quality-assurance plan designed to monitor both appropriateness and effectiveness of all services provided.
3.5.2. Documentation of care plan reviews, both peer and supervisory. 3.5.3. Documentation of utilization review.
3.5.4. Documentation of the most recent site visit by the administrative agency.
3.5.5. Documentation of action plans that address corrective actions and/or improvement in outcomes based on best practices.
3.5.6. Documentation of periodic data and narrative reports to the administrative agency. 3.5.7. A process to solicit information about satisfaction with services at least annually.
3.5.8. Assurance that it meets the service category standards and/or any applicable professional or federal practice standards.
6. References and Further Reading