I would recommend setting a guideline regarding the amount of service hour availability for each counselor relating to a maximum number of patient in their "caseload".  For example: can a treatment center, under good faith, report that they are meeting the patient's needs if a counselor or counseling assistant's time and duties does not physically allow for them to provide group and/or individual services to a certain number of clients per week/month at the minimum level.  Guidelines about the number of patient's served per counselor would provide legal support for patient's to recieve the services they have a right to.  Agencies are incentivized to reduce the availability of counselors and setting a guideline to counterbalance this would be in the best interest of the patient's  and the commonwealth. 

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

I support the concept that those receiving MAT should receive counseling by a QSAP.  However, this regulation does not take in account individuals who are receiving MAT that has previously and successfully participated in intensive outpatient treatment and no longer requires face to face counseling every other week for the first year. Neither does this regulation allows for supports that may be met outside of formal treatment such as those provided by faith base, recovery support, NA, AA, etc. that could reduce the need for structured and formal treatments for extended periods of time. I do support the notion that individuals who receive MAT be monitored for the two-year timeframe; however, their level of treatment should be based on the unique aspects/ needs of the individual consumer.