Inter-Tribal Council of Michigan

Anishnaabek Healing Circle

Access to Recovery (ATR IV)

Service Rates

11/13/14

Important things to Remember:

·  Voucher/Service Code limits are set for the entire length of the ATR program. Requests for exceptions will be managed authorized ATR Exceptions Coordinator at the local Tribal Access Center.Requests for exceptions may be considered if the access center is meeting their established quarterly client target goal and the access center has funds available in their cap.

·  Exceptions, reauthorizations of vouchers and/or service codes that exceed the set amounts, must be justified and authorized prior to the client receiving the service. To request an exception, please send a request to the authorized ATR Exceptions Coordinator at the local Tribal Access Center for review and written approval. Include the client ID, the amount of the request and a justification for the exception. Only the ATR Exceptions Coordinator at the local Tribal Access Center will have access to the VMS to make changes.

·  The Tribal Access Centers will be responsible for managing their average cost per client and staying within their caps set by the performance-based resource allocation plan. Each access center must establish a written process for reviewing and prioritizing client needs at the local level.

·  ITC will be monitoring exceptions and providing technical assistance in how to best manage local vouchers and ATR resources.

·  Residential, transitional living, and detox voucher will still require approval from ITC and exceptions to these vouchers will also require ITC approval. Please send a request to Connie Deplonty with a copy to Cora Gravelle for these voucher or service code exceptions. Include the client ID, the amount of the request and a justification for the exception.

·  Never bill any direct client care such as transportation under an hourly rate code. Direct client expenses charged to hourly service rates will not be authorized for payment.

ATR IV Vouchers and Voucher Limits

Client GPRA Follow-up Voucher / (Maximum Initial Voucher Value =$120 ) (Auto Generated Voucher =$120 no expiration date) (Maximum for three years $120)
Client GPRA Discharge Voucher / (Maximum Initial Voucher Value =$10 ) (Maximum for three years $20)
Access Center Voucher / (Maximum Initial Value = $420 ) (Auto Generated Voucher = $420) (Maximum for three years $420)
Motivational Development and Readiness Voucher / Voucher (Maximum Initial Value = $480) (Maximum for three years $1,000)
Care Coordination Voucher / (Maximum Initial Value = $800) (Phase I Voucher =$200) (Maximum for three years $2,400)
Brief Intervention Voucher / (Maximum Initial Value = $180) (Maximum for three years $180)
Outpatient Voucher / (Maximum Initial Value = $1,100 ) (Maximum for three years $2,200)
Intensive Outpatient Voucher / Voucher (Maximum Initial Value = $1,200) (Maximum for three years $2,400)
Residential Treatment Voucher / (Maximum Value = 30 days) ($8,250 maximum)
Sub-acute Detox Voucher / (Maximum Value =3 days ) ($975 Maximum)
Medical Services Voucher / (Maximum Initial Value = $300) (Maximum for three years $600)
Medically Assisted Treatment Voucher / (Vivitrol)(Maximum Initial Value = $2120) (Maximum for four
Years = $4240) Pilot Sites Only
Medically Assisted Treatment Voucher / (Suboxone)(Maximum Initial Value = $2152) (Maximum three years $4304) Pilot Sites Only
Transitional Living Facilities Voucher / (Maximum Value =30 days ) (Maximum value =$2250)
Employment & Education Voucher / (Maximum Initial Value = $800) (Maximum for three years $800)
Peer Support & Relapse Prevention Voucher / (Maximum Initial Value = $800) (Phase I Voucher Limit=$240) (Maximum for three years $2400)
Family & Parenting Support Voucher / (Maximum Initial Value = $400) (Maximum for three years $400)
Legal Support Voucher / (Maximum Initial Value = $200 ) (Maximum for three years $200)
Health & Global Wellness Voucher / (Maximum Initial Value =$200) (Maximum for three years $800)
Spiritual Support/Cultural Support Voucher / (Maximum Initial Value = $800) (Maximum for three years $2,400)
Mental Health Services/Co-Occurring Voucher / (Maximum Initial Value =$1,600) (Maximum for three years $1,600)
Transportation Voucher / (Maximum Initial Value =$150) (Maximum for three years $300)
Digital Story-Telling Voucher / (Maximum Initial Value =$1,200) (Maximum for three years $1,200) Client must be stable, in sustained recovery, with pre-approval.
GPRA Intake – Follow-up - Discharge
Voucher/Service Code / Unit Cost / Unit Definition and Maximum
2013 = GPRA Intake / $60 / GPRA Intake Complete and sent to ITC. (GPRA intake is completed and billed by access center unless the screening is completed by the call in center then it is completed and billed by the treatment provider.) (up to $120 or two GPRA intakes total in a three year period)
2015 = GPRA Follow-up / $60 / GPRA Follow-Up Complete and sent to ITC. (Two in a three year period)
2018= GPRA Follow-up (no client interview) / $10 / GPRA Follow-up completed without client interview (Two in a three year period)
2021 GPRA Follow-up Data Management / $10 / (Use only if GPRA Data Management functions are separated from the data collection.) (Two in a three year period)
2022 GPRA Follow-up Interview Tier 2 Tracker / $50 / (Use only if GPRA Data Management functions are separated from the data collection.) (Two in a three year period)
2023 GPRA Follow-up Interview Completed Out of the Window / $10 / GPRA Follow-up completed after out of window date and sent to ITC (Two in a three year period)
2024 = Incentive 30 day GPRA Follow-up / $60 / GPRA Follow-up completed in the 30 day window
2014 = GPRA Discharge / $10 / GPRA Discharge Complete and sent to ITC. (up to $20 or two discharges total in a three year period)
2017= GPRA Discharge (no client interview) / $10 / GRPA Discharge completed without client interview
Intake – Screening – Assessment – Treatment and Recovery Support Plans
Voucher/Service Code / Unit Cost / Unit Definition and Maximum
2016= ATR Intake Interview / $30 / Intake into ATR (Access Center interview, determination of eligibility & choice of provider)
2010 = Screening / $10 / Screen Complete
2011 = Clinical Assessment / $20 / .25hr/Maximum, 1.5 hrs. /$120. (6 units = 1.5 hour)
2012 = Recovery Support Assessment / $20 / .25hr/Maximum, .5 hrs. /$40. (2 units = .5 hour)
2060 = Clinical Treatment Plan / $20 / .25 hr/ Maximum, 1.5 hrs. /$120 (6 units = 1.5 hours) Written plan completed and/or update completed. (Treatment plan updates may be charged to Case Management 3040.)
2061= Recovery Management Plan / $20 / .25 hr/Maximum, .5 hrs/$40 (2 units = .5 hour) Written plan completed and/or update completed. (Recovery support plan updates may be charged to Recovery Support Care Coordination 5060)
Motivational Development and Readiness
Voucher/Service Code / Unit Cost / Unit Definition and Maximum
6010 = Substance Abuse Education Group (Per Person) / $15 / .25 hr (4 units = 1 hour) or $60 per hour. Must be directly related to treatment or recovery support plan. (32 units or 8 hours max)
6038 = Motivational Development Activities / $10 / .25 hr (4 units = 1 hour) (20 units or 5 hours max)
Care Coordination
Voucher/Service Code / Unit Cost / Unit Definition and Maximum
3040 = Individual Services Coordination (Case Management) / $15 / .25 hr (4 units =1 hour) Must be directly related to treatment or recovery support plan. (40 units or 10 hours max)
3042= Report and Record Keeping / $ 5 / .25 hr (4 units =1 hour) (32 units or 8 hours max)
2131= Crisis Intervention / $20 / .25 hr (4 units =1 hour)
2132 = Discharge Planning from Clinical Treatment / $60 / Discharge Plan Completed ($60 limit) Clinical Only
5060 = Other After Care Services / $15 / .25 hr (4 units =1 hour) (12 units or 3 hours max)
Must be directly related to treatment or recovery support plan.
5010 = Continuing Care / $15 / .25 hr (4 units =1 hour) (20 units or 5 hours max)
Must be directly related to treatment or recovery support plan.
7040 = Information And Referral / $15 / .25 hr (4 units =1 hour) (20 units or 5 hours max)
Must be directly related to treatment or recovery support plan.
Brief Intervention Voucher
Voucher/Service Code / Unit Cost / Unit Definition and Maximum
2020 = Brief Intervention / $15 / .25 hr (4 units =1 hour) (12 units or 3 hours max) Appropriate for persons meeting ASAM –criteria for Early Intervention not appropriate for recovery support clients.
Clinical Services
Voucher/Service Code / Unit Cost / Unit Definition and Maximum
2070 = Individual Counseling / $20 / .25 hr (4 units =1 hour) (40 units or 10 hours max)
2080 = Group Counseling/Per Person / $10 / .25 hr (4 units =1 hour) (40 units or 10 hours max)
2090 = Family/Marriage Counseling / $20 / .25hr (4 units =1 hour) (20 units or 5 hours max)
2091 = Family Therapy w/o Client / $20 / .25hr (4 units =1 hour) (20 units or 5 hours max)
2092 = Family Therapy w/ Client / $20 / .25hr (4 units =1 hour) (20 units or 5 hours max)
2120 = HIV/AIDS Counseling / $15 / .25hr (4 units =1 hour) (20 units or 5 hours max)
2130 = Other Clinical Services / $15 / .25hr (4 units =1 hour)
2100 = Co-Occurring Treatment/Recovery Services / $20 / .25hr(4 units/hour) (40 units or 10 hours max)
2101= Psychological Testing / $ 1 / Testing Completed ($1 increments, $800 maximum) (Bill the actual rate for provider up to $800)
2102 = Psychiatric Evaluation and Follow-up / $ 1 / Psychiatric Evaluation and Follow-up ($1 increments, $800 maximum) (Bill the actual rate for provider up to $800)
2104 = Other Co-Occurring Treatment / $20 / .25hr (4 units/hour) (20 units or 5 hours max)
Residential Treatment (Maximum Value 30 Days)
Voucher/Service Code / Unit Cost / Unit Definition and Maximum
2145 = Residential Treatment Saginaw Chippewa Tribe / $186 / Billed by the day up to 30 days
2136 = Residential Treatment Adult Great Lake Recovery / $100 / Billed by the day up to 30 days
2137 = Residential Treatment - Adolescent Great Lake Recovery Centers / $185 / Billed by the day up to 30 days
2138 = Residential Treatment – Adult & Adolescent Keystone / $275 / Billed by the day up to 30 days
2146=Residential Treatment- Phoenix House Inc / $85 / Billed by the day up to 30 days
2147=Residential Treatment: Addiction Treatment Services / $211 / Billed by the day up to 30 days
2158=Recovery High: Charlovoix County Probate/Family Court / $105 / Billed by the day up to 30 days
2139= Residential Treatment Women’s & Children Great Lakes Recovery Centers / $150 / Billed by the day up to 30 days
2143 = Residential Treatment – Adult New Day Treatment Center / $250 / Billed by the day up to 30 days
2149=Residential Treatment : Harbor Hall / $110 / Billed by the day up to 30 days
2155 = Residential: Muskegon River Youth Home / $142 / Billed by the day up to 30 days
2156=Secure Detention: Muskegon River Youth Home / $176 / Billed by the day up to 30 days
2157=Sexual Offender TX: Muskegon River Youth Home / $198 / Billed by the day up to 30 days
2165= Residential: Salvation Army / $150 / Billed by the day up to 30 days
Sub-acute Detox
Voucher/Service Code / Unit Cost / Unit Definition and Maximum
2161 = Keystone Sub-acute Detox / $250 / Billed by the day up to 3 days
2141 = Residential Treatment – Adult; Sub-Acute Detox Harbor Hall / $234 / Billed by the day up to 4 days
2144 = Sub-Acute Detox Great Lakes Recovery / $225 / Billed by the day up to 4 days
2148=Sub Acute Detox: Addiction Treatment Services / $325 / Billed by the day up to 5 days
2164= Sub Acute Detox: Salvation Army Harbor Light / $175 / Billed by the day up to 5 days
Medical Services
Voucher/Service Code / Unit Cost / Unit Definition and Maximum
4010 = Medical Care / $ 1 / Enter actual amount in units of $1. ($200 max)
Must be directly related to treatment or recovery support plan.
4020 = Alcohol/Drug Testing / $ 1 / Enter actual amount in units of $1. ($150 max)
Must be directly related to treatment or recovery support plan.
4030 = HIV/AIDS Medical Support & Testing / $ 1 / Enter actual amount in units of $1. ($100 max)
Must be directly related to treatment or recovery support plan.
Medically Assisted Treatment
Voucher/Service Code / Unit Cost / Unit Definition and Maximum
4011 = Vivitrol Injection / $1 / Enter actual amount in units of $1. ($2120 max)
One injection per month @ $530. Up to 4 injections per client. This code is only available to ATR providers approved for Medically Assisted Treatment with Vivitrol. ATR Pilot: must have pre-approval from ATR/ITC.
Must be directly related to treatment or recovery support plan.
4012 = Suboxone Prescription / $1 / Enter actual amount in units of $1. ($2152 max)
Maximum cost per prescription $269 for 14 days. Up to 8 refills per voucher. This code is only available to ATR providers approved for Medically Assisted Treatment with Suboxone. ATR Pilot: must have pre-approval from ATR/ITC. Must be directly related to treatment or recovery support plan.