12VAC35-105-970 Counseling sessions

“the provider shall conduct face-to-face counseling sessions (either individual or group) at least every two weeks for the first year of an individual’s treatment and every month in the second year of the individual’s treatment….” This regulation is overly prescriptive and does not embody the recovery and person centered spirit of services that the state has encouraged us to provide.  Many individuals do not require this length and this level of intensity of services.  Some in fact require more intensity than is outlined.  It seems to make sense that every effort is made to match the intensity/frequency of treatment to the actual need of the client, rather than some prescribed rule set by the state.  Additionally, what happens when a client refuses to attend sessions every other week due to child care issues, or work related issues, or they are stable, not using and don’t see the need?  Would the state propose that we then discontinue MAT, almost certainly ensuring relapse?  Furthermore, where is the provision for tele-health to help address some of these barriers?  Agencies will have difficulty maintaining this level of care for up to a year given current staffing capacity.  There is no funding attached to this mandate which causes an undue burden on the provider.  This regulation does nothing to promote additional providers to come into the system, in fact, it causes another layer of burdensome regulation which often result in pushing well meaning, qualified providers out of the system.

12VAC35-105-580 Service description requirements

“The provider shall admit only those individuals whose service needs are consistent with the service description…..” Ideally this would be the case.  However, this doesn’t always occur.  For example, a client may qualify for IOP according to the ASAM, but if that level of care isn’t provided by the CSB and the client has no insurance, it may be that the client receives outpatient services, thus being admitted to a lesser level of care than is identified by need.   Or the client’s ASAM indicates a need for residential services and they are offered such, but the client declines and wants only IOP.  Are we not to provide that level of care?  Again, where is the client choice and person centered treatment?

Leslie Stephen