(1) In order to be reimbursed for outpatient services, an individual outpatient treatment provider must be state approved and be a licensed addiction counselor.
(2) In order to become state approved, the licensed addiction counselor (LAC) must complete and submit the designated application to the department.
(3) If the application and supporting documentation do not meet the application requirements, the department will notify the applicant in writing identifying the incomplete or missing information within 30 days of receipt of the application.
(a) The applicant has 30 days from the date of notification to respond in writing to the content of the notice.
(b) If a response is not received within 30 days, the department will deny approval and will notify the applicant in writing of the denial.
(4) If the application and supporting documentation meet the application requirements, the department shall issue provisional approval. Provisional approval is granted to provide time to comply with standards. Within 90 days of granting provisional approval, the department shall inspect the provider either on-site or remotely.
(5) The provider must submit the requested documentation to the department or allow the department access to the provider's premises for inspection.
(6) Within 20 days of the inspection, the department shall issue final approval or deny the application and shall send written notification of full approval or denial to the applicant.
(7) The department will reimburse a state approved outpatient treatment provider for American Society of Addiction Medicine (ASAM) level of care 1.0, Outpatient Services, using appropriate Common Procedural Terminology (CPT) codes.
(8) The department will annually inspect the provider, on-site or remotely, to ensure the provider continues to meet requirements of this rule.
(9) Approved providers must follow the ASAM Criteria in the provision of services and adhere to requirements outlined in the BHDD Medicaid Services Provider Manual.