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Substance Use Treatment Services (SUTS) Policies and Procedures

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42 CFR 438 Medicaid/Medi-Cal Managed Care Policies- SUTS
Substance Use Treatment Services (SUTS) Beneficiary Refund Policy
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Financial Reporting Requirements
Substance Use Treatment Services (SUTS) Beneficiary Refund Policy
It is the Behavioral Health Services Department (BHSD) policy to ensure clients are aware of a refund policy at the time of admission. The beneficiary is made aware of the refund process at admission. A signed acknowledgement will serve as acknowledgement of the refund process.
SUTS Executive Level Salary Limitation Policy
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Financial Reporting Requirements
SUTS Executive Level Salary Limitation Policy
It is the Behavioral Health Services Department (BHSD) policy to ensure that no part of any federal funds shall be used to pay for the salary and wages of an individual at a rate in excess of Level I of the OPM’s Executive Schedule.
Substance Abuse and Prevention Block Grant (SABG) Expenditures Tracking
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Financial Reporting Requirements
Substance Abuse and Prevention Block Grant (SABG) Expenditures Tracking
It is the Behavioral Health Services Department (BHSD) policy to ensure: 1. Tracking of obligations and expenditures, including but not limited to those spent on primary prevention, and services to pregnant women and women with dependent children.
Electronic Signatures in EHR Systems for County and Contractors
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Documentation Requirements
Electronic Signatures in EHR Systems for County and Contractors
DHCS approves the use of electronic signatures in electronically signed records as equivalent to a manual signature affixed by hand for financial, program, and medical records audit or program review purposes. This approval extends to all electronically signed records requiring signature under the California Code of Regulations, Title 9, Division
Methadone Treatment
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Scope of Services
Methadone Treatment
It is BHSD policy for Medication Assisted Treatment (MAT) Programs to ensure that all medication dispensed meets the basis for effectiveness and safety for narcotic treatment program(s). The safety and effectiveness of all MAT medications will be based on California Society of Addiction Medicine (CSAM). The monitoring mechanism shall be under the supervision of a person licensed to prescribe or dispense prescription drugs.
Residential Placement and Authorization
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Quality Improvement System
Residential Placement and Authorization
The Behavioral Health Services Department (BHSD) Substance Use Treatment Services (SUTS) Managed Care Plan (MCP) manages residential capacity and placements for beneficiaries in Santa Clara County in accordance with State and Federal requirements. All referrals to residential programs must meet the eligibility for medical necessity, based on the DSM 5 criteria for a substance use disorder, ASAM (American Society for Addiction Medicine) level of care (LOC) criteria, and be authorized by the BHSD SUTS MCP.
Medical Director Roles, Responsibility, Code of Conduct Requirements
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Plan Administration and Organization
Medical Director Roles, Responsibility, Code of Conduct Requirements
Behavioral Health Services Department (BHSD) and its Substance Use Treatment Services (SUTS) Contractors must have a written (1) Code and Conduct and (2) Roles and Responsibilities for their Medical Directors that comply with the requirements outlined below. The Roles and Responsibilities and Code of Conduct for the BHSD SUTS and the SUTS Contractor’s Medical Director (1) shall be clearly documented, signed and dated by a provider representative and the Medical Director and (2) must be submitted to BHSD SUTS administration for review, approval, and sign off.
Minimum Quality Drug Treatment Standards for Substance Use Prevention and Treatment for Block Grants (SABG)
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Utilization Management Program
Minimum Quality Drug Treatment Standards for Substance Use Prevention and Treatment for Block Grants (SABG)
Behavioral Health Services Department (BHSD) will implement and adhere to the Minimum Quality Drug Treatment Standards for Substance Abuse Prevention and Treatment Block Grants (SABG), including those Personnel Policies (e.g., personnel files, job descriptions, volunteers/interns, codes of conduct) and Program Management Policies (e.g., admission/readmission, treatment).
Pre-Requisite Training
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Program Integrity
Pre-Requisite Training
It is BHSD policy that all internal and external substance use care professionals have completed pre-requisite training prior to providing substance use treatment services. In addition, all staff and contract providers must conduct the mandatory annual training in accordance with DHCS requirements.
SUTS Provider Network Selection and Retention
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Provider Network
SUTS Provider Network Selection and Retention
To ensure that county and contracted providers understand and adhere to all of the required elements of the provider selection and retention process in accordance with county, state and federal regulations.
SUTS Beneficiary Request for 2nd Opinion
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Beneficiary Rights
SUTS Beneficiary Request for 2nd Opinion
Per 42 CFR 438.206 (b) (3), at the request of a beneficiary, Behavioral Health Services Department (BHSD) shall provide for a second opinion by a licensed professional of the healing arts (LPHA) either employed by or contracted with BHSD, when BHSD or one of its providers determine that the medical necessity criteria as described in 42 CFR 438.210 have not been met [specifically, criteria from the Diagnostic Statistical Manual Version 5 (DSM 5) and American Society of Addiction Medicine (ASAM)
Last updated: 9/27/2019 9:36 AM