5101:3-30-02 Coverage and limitation policies for alcohol and drug addiction treatment services.

(A) The following identifies alcohol and drug addiction treatment services that may be covered by medicaid and the limitation policies applicable to these services.

(1) “Assessment services” are those services defined in rule 3793:2-1-08 of the Administrative Code and provided in accordance with Chapters 3793:2-1 and 3793:2-2 of the Administrative Code.

(2) “Crisis intervention services” are those services defined in rule 3793:2-1-09 of the Administrative Code and provided in accordance with Chapters 3793:2-1 and 3793:2-2 of the Administrative Code.

(3) “Individual counseling services” and “group counseling services” are those services defined in rule 3793:2-1-11 of the Administrative Code and provided in accordance with Chapters 3793:2-1 and 3793:2-2 of the Administrative Code.

(4) “Medical somatic services” are those services defined in rule 3793:2-1-13 of the Administrative Code and provided in accordance with Chapters 3793:2-1 and 3793:2-2 of the Administrative Code.

(5) “Drug screening/urinalysis services” are those services defined in rule 3793:2-1-14 of the Administrative Code and provided in accordance with Chapters 3793:2-1 and 3793:2-2 of the Administrative Code. Notwithstanding the provisions found in Chapters 3793:2-1 and 3793:2-2 of the Administrative Code, a physician must order the drug screening/urinalysis for medicaid to cover the service.

(6) “Methadone administration services” are those services defined in rule 3793:2-1-15 of the Administrative Code and provided in accordance with Chapters 3793:2-1 and 3793:2-2 of the Administrative Code and licensed in accordance with Chapter 3793:2-3 of the Administrative Code.

(7) “Case management services” are those services defined in rule 3793:2-1-16 of the Administrative Code and provided in accordance with Chapters 3793:2-1 and 3793:2-2 of the Administrative Code.

(8) “Intensive outpatient services” are those services defined in rule 3793:2-1-17 of the Administrative Code and provided in accordance with Chapters 3793:2-1 and 3793:2-2 of the Administrative Code.

(9) “Ambulatory medical” or “social detoxification services” are those services defined in paragraph (F) of rule 3793:2-1-10 of the Administrative Code and provided in accordance with Chapters 3793:2-1 and 3793:2-2 of the Administrative Code.

(B) Services meeting the requirements identified in paragraphs (A)(1) to (A)(9) of this rule are covered when recommended by an individual who has one of the following credentials:

(1) Certified chemical dependency counselor three;

(2) Licensed physician;

(3) Licensed psychologist;

(4) Licensed professional clinical counselor with a declared scope of practice of alcohol and drug addiction counseling;

(5) Licensed professional counselor with a declared scope of practice of alcohol and drug addiction counseling;

(6) Licensed independent social worker with a declared scope of practice of alcohol and drug addiction counseling; or

(7) Registered nurse with a declared scope of practice of alcohol and drug addiction nursing.

Eff 7-1-91 (Emer.); 9-30-91

Rule promulgated under: RC Chapter 119.

Rule authorized by: RC 5111.02

Rule amplifies: RC 3793.06, 3793.11, 5111.01, 5111.02