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

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

(1) "Assessment " is the service defined in rule 3793:2-1-08 of the Administrative Code and provided by an eligible provider as defined in this chapter.

(2) "Crisis intervention " is the service defined in rule 3793:2-1-08 of the Administrative Code and provided by an eligible provider as defined in this chapter.

(3) "Individual counseling " and "group counseling " are those services defined in rule 3793:2-1-08 of the Administrative Code and provided by an eligible provider as defined in this chapter.

(4) "Medical somatic " is the service defined in rule 3793:2-1-08 of the Administrative Code and provided by an eligible provider as defined in this chapter.

(5) "Laboratory urinalysis" is the service defined in rule 3793:2-1-08 of the Administrative Code and provided by an eligible provider as defined in this chapter. 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) "Opioid agonist administration" is the service defined in rule 3793:2-1-08 of the Administrative Code and provided by an eligible provider as defined in this chapter.

(7) "Case management " is the service defined in rule 3793:2-1-08 of the Administrative Code and provided by an eligible provider as defined in this chapter.

(8) "Intensive outpatient " is the service defined in rule 3793:2-1-08 of the Administrative Code and provided by an eligible provider as defined in this chapter.

(9) "Ambulatory detoxification" is the service defined in rule 3793:2-1-08 of the Administrative Code and provided by an eligible provider as defined in this chapter.

(B) Alcohol and other drug treatment services must be recommended by a professional who is qualified to sign an individualized treatment plan in accordance with rule 3793:2-1-06 of the Administrative Code.

(C) Alcohol and other drug treatment services must be performed by a professional who is qualified to perform the specific service. The identification of professionals qualified to perform each specific service is set forth in rule 3793:2-1-08 of the Administrative Code.

(D) The medications listed in appendix A to this rule are covered by the department when rendered and billed by an eligible provider as described in rule 5101: 3-30-01 of the Administrative Code. The medication must be administered by a qualified provider acting within the provider's professional scope of practice.

Replaces: 5101:3-30-02

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Effective: 10/01/2012
R.C. 119.032 review dates: 10/01/2017
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 3793.06 , 3793.11 , 5111.01 , 5111.02
Prior Effective Dates: 7/1/91 (Emer.), 9/30/91