ANNEX A2
INITIATIVE-SPECIFIC ANNEX As
Initial the boxes below to identify the Initiatives your agency wants to participate in. Agencies must meet eligibility and application requirements to qualify for Initiative participation.
Fee-for-Service Initiatives / InitialDrug Court Network
Driving Under The Influence (DUII)
Driving Under The Influence (DUII) - Vivitrol Sub-network
Mutual Agreement Program Department of Corrections (MAP DOC)
Mutual Agreement Program State Parole Board (MAP SPB)
Medication Assisted Treatment Initiative (MATI)
South Jersey Initiative (SJI)
Screening, Brief Intervention & Referral to Treatment (SBIRT)
I understand and agree to deliver services under these initiatives according to the contract Document Annex A2. I have reviewed these contract requirements with our agency staff and affirm that our agency policies and procedures support adherence to these requirements. I understand that our agency will be monitored by DMHAS for adherence to these contract requirements.
Agency Name: ______
Federal ID: ______
Signature Date
Print Name Title
DRUG COURT NETWORK
Drug Court Program Summary
Piloted in 1996 and implemented statewide in 2004, the mission of the Drug Courts (DC) is to stop the abuse of alcohol and other drugs and related criminal activities. Drug Court programs are rigorous, requiring intensive supervision based on frequent drug testing and court appearances, along with tightly structured regimens of treatment and recovery services. This level of supervision permits the program to actively support the recovery process and react swiftly to impose appropriate therapeutic sanctions or to reinstate criminal proceedings when participants cannot comply with the program. Approval to provide services to DC participants is predicated on an agency's ability and agreement to adhere to the following:
Participating providers agree to cooperate with the monitoring requirements of DMHAS, the Administrative Office of the Courts (AOC) and the vicinages of the New Jersey Superior Court Drug Court Personnel, which includes site visits, on-site review of case files, billing/fiscal records and interviews of staff and clients to insure compliance with Drug Court procedures.
Contract Specific Requirements
In addition to the General Service Requirements stated in the Division of Mental Health and Addiction Services (DMHAS) Standard FFS Network Annex A, the Drug Court contractee shall comply with the following Drug Court specific requirements:
1. No paid or volunteer staff involved in the criminal justice system has authority over or access to any Drug Court client’s confidential information including, but not limited to, clinical reports, records and information disclosed in individual, group, family sessions or community meetings.
2. DMHAS and the referring Drug Court shall be notified in writing of clients’ program admission denials which includes referrals to a more suitable level of care.
3. All Drug Court primary counselors shall adhere to the Division of Consumer Affairs, State Board of Marriage and Family Therapy Examiners Alcohol and Drug Counselor Committee regulations regarding the practice of alcohol and drug counseling including the requirements for counselor interns.
4. All non-clinical staff who has contact with Drug Court clients shall receive an orientation on Drug Court mandates.
5. Staff attendance is required at court staffing sessions and client court appearances.
6. The contractee shall complete monthly Drug Court reports for residential programs and weekly Drug Court reports for non-residential programs in accordance with vicinage specific requirements.
7. The contractee shall notify the referring Drug Court and DMHAS regarding client nonadherence to treatment and Drug Court program requirements within 2 hours of any relevant incident. If a client absconds, it must be reported immediately.
8. Discharge planning shall begin at admission and include client’s probation officer so that housing and continued care needs can be addressed throughout the course of treatment.
9. The Contractee shall include agency name, contact number and e-mail on all correspondence sent to the referring Drug Court and to DMHAS.
DRIVING UNDER THE INFLUENCE INITIATIVE (DUII)
Driving Under the Influence Initiative Program Summary
Implemented in November 2005, the Driving Under the Influence initiative (DUII) supports treatment services for individuals convicted of Driving Under the Influence and who meet financial and program eligibility as set by the Division of Mental Health and Addiction Services.
Contract Specific Requirements
In addition to the General Service Requirements stated in the Division of Mental Health and Addiction Services (DMHAS) Standard FFS Network Annex A, the DUII Contractee shall comply with the following DUII requirements:
1. Affiliation and network requirements:
a. All treatment contractees shall be affiliated through the Affiliation Agreement Process as defined in New Jersey Administrative Code 10:162-5 et seq. , New Jersey Statute 39:4-50 (NJ Statutes annotated version as per State Law Library).
i. Outpatient Contractees shall be affiliated with the referring County Intoxicated Driver Resource Center (IDRC).
ii. All DMHAS licensed residential programs will be affiliated with the DMHAS Intoxicated Driving Program (IDP).
b. All Affiliated Contractees shall comply with N.J.A.C. 10:162-5 et seq.
2. Initiative eligibility guidelines:
a. Clients shall have a DUI conviction on or after October 17, 2005.
b. Clients shall be a resident of New Jersey.
c. The following documents shall be reviewed in the assessment process and retained in the client’s chart:
i. Proof of the client’s New Jersey residency.
ii. A copy of the client’s Court Conviction Document confirming a DUI conviction on or after October 17, 2005.
3. DUII Treatment Requirements: The treatment contractee agrees to schedule the client for an intake within 30 days after the client’s contact with the contractee. If the client cannot be scheduled within 30 days, client will be directed back to the referring IDRC in order that another treatment referral may be obtained for the client. DUII clients should not be placed on a waiting list before treatment can commence.
4. Urine Drug Screens: The treatment contractee shall ensure that all clients will be randomly screened for alcohol and other drug use.
5. Reporting for IDRC Clients: The treatment contractee shall utilize the NJSAMS ASI and LOCI and all other reporting requirements of the NJSAMS IDRC reporting module in accordance with N.J.A.C. 10:162-6
6. Clients not referred directly from the IDRC/IDP should be directed to contact the appropriate IDRC for a referral. The treatment provider may also contact the appropriate IDRC to referral through NJSAMS.
7. The contractee contracted shall meet agency criteria to participate in the co-occurring network and have demonstrated readiness to provide integrated care for dually diagnosed client by December 31, 2012
Driving Under the Influence (DUII) –
Vivitrol Sub-network
The implementation of the Vivitrol Pilot on July 1, 2011, offers an adjunct component to treatment for alcohol and/or opioid dependence for clients seeking treatment and support services through the Driving Under the Influence Initiative (DUII).
The purpose of this pilot is to determine the impact of Vivitrol as an enhancement to the current episode of treatment available to DUI offenders on: (1) increased abstinence; (2) decreased legal involvement and (3) the engagement of the client into long term, sustained recovery. Positive outcomes would also support public health and safety, and result in cost savings to the State of New Jersey in acute care treatment costs and incarceration costs.
Client treatment will be funded through the DUII and medical and data collection will be funded through the Vivitrol Pilot Network.
In addition to the General Service Requirements state in the DMHAS Standard FFS Network Annex A, and the DUII contract requirements, the Vivitrol Pilot Network contractee shall comply with the following Vivitrol Pilot requirements:
Participant Initiative Eligibility Guidelines:
1. Approved for treatment funding through the DUII
2. Age 21 years or older
3. Meet diagnosis for alcohol dependence and/or opioid dependence
4. Meet ASAM criteria for any outpatient level of care
5. Medically approved by a physician.
CONTRACT SPECIFIC REQUIREMENTS:
Staffing:
The prescription and administration of the medication will be conducted by the appropriate medical personnel (either a Medical Director, Nurse Practitioner, Physician Assistant, Registered Nurse).
All counseling services must be provided in accordance with DMHAS and DCA regulation.
Specific documentation Requirements:
In addition to the client treatment and medical charts, the following must be documented:
1. Client education and consent regarding the use of Vivitrol
2. Client consent to participate in the Vivitrol Pilot
3. UDS results
4. Results of medical tests (LFT)
5. Progress note for each visit including visits in which medication is administered
6. Surveys
Client Education, Recruitment and Consent:
Agencies will ensure, and comply with, client choice and consent to participate in this pilot project. Staff shall provide eligible participants with the appropriate education regarding the medication, as well as guidelines for participation in the project.
A client information packet that is specific to injectable naltrexone pharmacology and developed by agency medical personnel shall be provided to the client by their counselor and verbally reviewed with the client. The information packet shall include the benefits and the risks of the medication and of being a participant in the pilot. The client consent form for both medication and pilot participation shall be reviewed and signed. This consent will be documented in the client file and a copy will be provided to the DMHAS.
Outpatient agencies receiving clients from residential programs shall conduct an individual session to complete new client consent forms for both medication and pilot participation for client review and signature.
Residential agencies shall provide up to one half hour care coordination to the appropriate Vivitrol Pilot Network outpatient program to ensure a seamless transition in service and medication follow up.
Induction:
Residential Agencies agree to provide induction as part of discharge planning. Induction at the Short-Term Residential care will be administered at any time within the 28 day experience. Induction at Long-Term Residential will be administered within 28 days prior to discharge. Clients will be referred to outpatient services for follow up injections.
Induction at Halfway Houses can be administered upon completion of the orientation/black-out period while client is engaged in outpatient services.
The Outpatient Agency agrees to provide induction upon client consent at any time during the treatment episode at any level of outpatient treatment.
Agency shall conduct Liver Functioning Test (LFT) as per medical need identified by physician. Up to three LFT can be requested.
Medical universal precautions shall be utilized by all personnel to ensure safety.
Continuing Service Requirements:
Vivitrol is an enhancement to treatment services and therefore medication administration shall include a comprehensive management program that includes counseling. All clients shall be maintained in the appropriate level of substance abuse treatment as determined by the LOCI.
If client meets criteria for treatment completion and elects to continue to receive Vivitrol for the full six months, the agency shall ensure a twice monthly individual session with the clinician. Each session will be a minimum of one hour and will be face to face with a licensed or certified clinician.
Agency Pilot Participation:
Agency agrees to participate in all mandatory trainings regarding the Vivitrol Pilot Network. Agency agrees to mandatory staff participation on monthly “Vivitrol Pilot” team conference calls.
Reporting:
Agency shall utilize the DMHAS survey tools to capture and report the outcome measures. These instruments will be administered to the client every month for six months in an individual face to face session and entered into NJSAMS. Agency shall conduct a follow up survey six months after the last injection. Agency shall provide $25 (non-cash) incentive to client for participation in follow up survey. Follow up survey may be conducted as a face to face interview or a phone interview. An exit interview shall be provided to all clients upon leaving the pilot.
Discharge Criteria:
The length of service in the Vivitrol Pilot varies with the severity of the patient’s illness and his/her response to the pilot program. Average length of service is 3-6 months of medication with a one-time follow up survey six-months after the last injection. If client chooses to leave the study at any point, the medication will no longer be funded by this initiative. However, client treatment will continue to be funded by the DUII as long as funds are available.
Service Authorization Period (initial and subsequent):
Each client is eligible for one time service authorization period for a maximum of five injections over a six month period.
MUTUAL AGREEMENT PROGRAM –
DEPARTMENT OF CORRECTIONS (MAP DOC)
Mutual Agreement Program Department of Corrections Program Summary
The Mutual Agreement Program (MAP) was implemented in 1984 as a cooperative effort between the New Jersey State Parole Board (SPB), Department of Corrections (DOC) and the Department of Human Services, Division of Mental Health and Addiction Services (DHS DMHAS). The goal of the MAP program is to afford the opportunity of private chemical abuse treatment as a special condition of parole for the NJDOC inmates who otherwise might not achieve parole status.
MAP DOC agencies are privately licensed residential substance abuse treatment programs located throughout the state of New Jersey. These facilities provide a highly structured environment, which introduces intensive therapy for behavioral and psychological problems related to addiction.
Contract Specific Requirements
In addition to the General Service Requirements stated in the Division of Mental Health and Addiction Services (DMHAS) Standard FFS Network Annex A, the Mutual Agreement Program Department of Corrections (MAP DOC) network contractee shall comply with the following MAP DOC requirements:
1. No paid or volunteer staff actively involved in the criminal justice system can have authority over or access to any MAP DOC client’s confidential information including but not limited to, clinical reports, records and information disclosed in individual, group and family sessions or community meetings.
2. Contractee shall identify and maintain at least one staff person to coordinate MAP DOC services. This staff person shall act as a liaison with the DOC and DMHAS’ MAP Coordinator regarding all MAP DOC issues and concerns.
3. In addition to DMHAS Licensure Standards regarding Reportable Events, MAP DOC network contractee shall ensure that their facility’s policy and procedures manual include and adhere to the following:
a. The manner by which immediate notification is made to DOC of any incidents which require a parolee be discharged from the program and returned to the jurisdiction of the Department of Corrections. Such incidents might include an inmate absconding or any disciplinary action that requires the inmate be removed from the program, and should include how written notification will be provided to the DOC as well as including a copy of the incident report and discharge summary, as applicable.