This service must be provided at a licensed Outpatient Opioid Treatment Program under 10A NCAC 27G .3600.

The individual is eligible for this service when all of the following criteria are met:

• A DSM-5 (or any subsequent editions of this reference material) diagnosis of a severe opioid use disorder is present
• ASAM (American Society for Addiction Medicine) for Opioid Treatment Services (OTS) level of care is met This service may be a part of an aftercare planning process (time limited step down or transitioning) and is required to avoid returning to a higher, more restrictive level of service.

• Service Order Requirement A comprehensive clinical assessment is one mechanism to demonstrate medical necessity for a service and to assess and identify an individual’s needs.
• For state-funded services, a service order is recommended. Providers shall coordinate with the LME-MCO regarding their requirements for service orders.

The individual meets the criteria for discharge if any one of the following applies:

• The individual’s level of functioning has improved with respect to the goals outlined in the service plan, inclusive Disc of a transition plan to step down, or no longer benefits, or has the ability to function at this level of care, 
• ANY of the following apply:
  • The individual has achieved goals,
    discharge to a lower level of care is indicated; or, NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services Mental Health and Substance Abuse Services Date Amended: August 1, 2022 105 State-Funded Enhanced MH/SA Services – August 1, 2022
  • The individual is not making progress, or is regressing and all realistic treatment options with this modality have been exhausted.

A physician’s order is required for medication to be administered.

The individual is eligible to continue this service if the desired outcome or level of functioning has not been restored, improved or sustained over the time frame outlined in the individual’s service plan or the individual continues to be at risk for relapse based on history or the tenuous nature of the functional gains;

OR, The individual meets any of the specifications listed in the ASAM criteria for Dimension 5 Relapse, Continued Use or Continued Problem Potential for Opioid Treatment Services.

August 1, 2022, The individual is not making progress, or is regressing and all realistic treatment options with this modality have been exhausted.

NOTE: Any denial, reduction, suspension, or termination of service requires notification to the individual, legally responsible person, or both about the individual’s appeal rights pursuant to G.S. 143B-147(a)(9) and Rules 10A NCAC 27I .0601-.0609.

Service Maintenance Criteria If the individual is functioning effectively with this service and discharge would otherwise be indicated, Opioid Treatment should be maintained when it can be reasonably anticipated that regression is likely to occur if the service is withdrawn.

The decision should be based on ANY ONE of the following:

• History of regression in the absence of Opioid Treatment is documented in the individual’s record.
• Service Maintenance Criteria If the individual is functioning effectively with this service and discharge would otherwise be indicated, Opioid Treatment should be maintained when it can be reasonably anticipated that regression is likely to occur if the service is withdrawn.
• Presence of a DSM-5 (or any subsequent editions of this reference material) diagnosis that would necessitate a disability management approach, in the event that there is epidemiological sound expectations that symptoms will persist and that ongoing treatment interventions are needed to sustain functional gains.
• Service Maintenance Criteria If the individual is functioning effectively with this service and discharge would otherwise be indicated, Opioid Treatment should be maintained when it can be reasonably anticipated that regression is likely to occur if the service is withdrawn.

• This service may only be provided by a registered nurse, licensed practical nurse, pharmacist, or physician.
• Documentation Requirements A Medication Administration Record (MAR) shall be utilized to document each administration or dispensing of methadone.
• In addition, a modified service note shall be written at least weekly, or per date of service if the individual receives the service less frequently than weekly.