Designated Service Providers are categorized as either treatment providers or Recovery Residence (housing) providers.
Treatment Providers
- DMHA certified as a CMHC, ASO, ASR, PIP, or OTP agency — can include level IV recovery residences.
- Responsible for the clinical comprehensive assessment, ANSA, diagnosis, and treatment plan.
- As of July 1, 2019, all treatment providers are required to be enrolled as a Medicaid/HIP provider, as well as be credentialed by all 4 Managed Care Entities.
- Required to enter necessary information into DARMHA and WITS.
- Able to build vouchers for their agency and housing providers.
- Capable of making internal referrals within WITS to housing providers — allows housing providers to be paid directly.
Recovery Residence
- Alcohol and drug free living environments, including recovery homes and sober living homes.
- DMHA Certifications type: level II, III, or IV recovery residence.
- Able to accept participants prior to connection to treatment for an assessment.
- Required to communicate with treatment providers and CJP regarding participants.
- May only claim for the daily housing rate as well as a daily per diem unless the agency is certified as a level IV.
Residential
- DMHA certified as a provider of residential care.
- Clinically Managed Low Intensity ASAM 3.1
- 24-hour supportive living environment; at least 5 hours of low intensity treatment per week
- Ability to arrange for and monitor pharmacotherapy for psychiatric medications.
- Withdrawal Management services 2 and lower
- Must offer addiction medications when clinically indicated.
- 10 - 20 hours of clinical addiction services per week
- 75% of services are clinical in addition medical.
- Required to provide protocols for the continuation of addiction medication, including direct operational linkage or access to methadone, buprenorphine, injectable naltrexone providers.
- Clinically Managed High Intensity ASAM 3.5
- 24-hour living environment, more high-intensity treatment
- Minimal risk of severe withdrawal
- Withdrawal Management services 3.2 and lower
- 75% of services are clinical in addition medical.
- Required to provide protocols for the continuation of addiction medication, including direct operational linkage or access to methadone, buprenorphine, injectable naltrexone providers.
- 20 or more hours of clinical addiction services per week
- Each consumer must be staffed and overseen by a medical director at least twice a month.
All Clinically Managed services will require a Prior Authorization for services.