Substance Abuse Services (Residential)
Service Standard
Substance Abuse Services (Residential) Service Standard print version
Subcategories | Service Units |
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Substance Abuse Services (Residential) - Detox | Per day |
Substance Abuse Services (Residential) - Treatment | Per day |
Health Resources and Services Administration (HRSA) Description:
Substance Abuse Services (residential) (SA-R) activities are those provided for the treatment of drug or alcohol use disorders in a residential setting to include screening, assessment, diagnosis, and treatment of substance use disorder.
Program Guidance:
Substance Abuse Services (residential) is permitted only when the client has received a written referral from the clinical provider as part of a substance use disorder treatment program funded under the HRSA Ryan White HIV/AIDS Program (RWHAP). Acupuncture therapy may be an allowable cost under this service category only when it is included in a documented plan as part of a substance use disorder treatment program funded under the HRSA RWHAP.
Limitations:
HRSA RWHAP funds may not be used for inpatient detoxification in a hospital setting unless the detoxification facility has a separate license.
Services:
Activities provided under the SA-R service category include:
- Pretreatment/recovery readiness programs
- Harm reduction
- Behavioral health counseling associated with substance use disorder
- Medication-assisted therapy
- Neuro-psychiatric pharmaceuticals
- Relapse prevention
- Detoxification, if offered in a separate licensed residential setting (including a separately-licensed detoxification facility within the walls of an inpatient medical or psychiatric hospital)
Services must be provided in accordance with the Texas Health and Safety Code, Title 6, Subtitle B, Chapter 464, and the Texas Administrative Code (TAC), Title 25, Part 1, Chapter 448 for Substance Abuse Standards of Care.
Universal Standards:
Service providers for Substance Abuse Services - Residential must follow HRSA/DSHS Universal Standards 1-46 and 189-203.
Service Standards and Measures:
The following standards and measures are guides to improving healthcare outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program.
Standard | Measure |
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Initial Screening: Each client must be screened for SA-R services based using the Texas Department of Insurance criteria per the TAC standards for substance abuse services. The screening process should collect all information necessary to determine the type of services required to meet the client’s needs. To be eligible for admission to a treatment program, an individual must meet the current Diagnostic and Statistical Manual (DSM) criteria for substance use or dependence (or substance withdrawal or intoxication in the case of a detoxification program). |
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Comprehensive Psychosocial Assessment: All clients must receive a comprehensive psychosocial assessment conducted by a licensed substance use disorder counselor. The comprehensive assessment should be completed and signed within 3 days of admission, and a copy of the completed assessment should be offered and provided to the client. If emergent needs prevent the assessment from being completed within 3 days, this must be documented in the client’s record. The comprehensive assessment should include:
During the initial assessment, clients should be assessed for care coordination needs and referrals should be made to case management or other support programs as appropriate. A valid and reliable assessment tool such as the Substance Abuse and Mental Illness Symptoms Screener (SAMISS) and Addiction Severity Index (ASI) should be used to evaluate substance use. The Mini Mental State Examination (MMSE) or other validated tool may be used for cognitive assessment. Residential clients must have a health assessment conducted by a licensed health professional within 96 hours of admission per 25 TAC Section 488.803. |
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Treatment Plan: A treatment plan should be completed and filed in the client record within 5 days of admission. Treatment planning should be a collaborative process through which the provider and client develop desired treatment outcomes and identify the strategies for achieving them. Providers should discuss all available treatment options with the client and incorporate the client’s wishes regarding the treatment course and modality. The treatment plan should include:
The treatment plan should be evaluated on a regular basis and revised as needed to reflect the ongoing reassessment of the client’s issues, needs, and response to treatment. At a minimum, treatment plans must be reviewed and updated midway through the projected duration of treatment and no less frequently than monthly. |
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Progress Notes: Services will be provided according to the individual's treatment plan and documented in the client's record. Progress notes must be completed for every professional counseling session and should include:
For detox program clients, notes should include:
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Referrals: Agencies must make appropriate referrals for clients with medical or support needs. For clients accessing detox programs, referrals should be made to outpatient and/or residential substance use programs for continuity of care. |
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Discharge Planning: Discharge planning should be conducted collaboratively with all clients and completed before the client’s scheduled discharge. A written discharge plan must be developed to address ongoing client needs and continuity of services, and should include:
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Discharge Summary: A discharge summary must be completed for each client within 30 days of discharge and should include:
The facility must contact each client no sooner than 60 days and no later than 90 days after discharge from the residential program and document the client’s current status or the reason contact was unsuccessful. Note: Staff should not inactivate clients in Take Charge Texas (TCT) at the time of case closure or graduation, unless the case is being closed due to a deceased client. |
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References
Division of Metropolitan HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part A Recipients. Health Resources and Services Administration, June 2022.
Division of State HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part B Recipients. Health Resources and Services Administration, June 2022.
Ryan White HIV/AIDS Program. Policy Notice 16-02: Eligible Individuals & Allowable Uses of Funds. Health Resources & Services Administration, October 2018.
Texas Administrative Code, Title 25, Part 1, Chapter 448.