Substance Abuse Service Units

Transcription

1 Substance Abuse Service Units There are four subsections under Substance Abuse Service Units: 1) Unit of Service Definition (UOS) 2) Unduplicated Clients Served (UDC) 3) Unit of Service Calculation 4) Unit of Service Cost A response for each of these items is required for each contract exhibit. Each program modality will utilize the standard definitions of a service unit described below. All SUBSTANCE ABUSE contractors must use these definitions in calculating service units. Residential Service Unit Definition The unit of service for all residential programs (including residential detoxification described below) is a 24-hr bed day. One unit of service equals a participant occupation of a bed for a 24-hr period. Programs are expected to provide a minimum of 20 hours of alcohol and other drug services per week. Choose an occupancy rate between 90% to 100% for your unit of service calculation. For clarification, the days on which a client is admitted to a program or discharged from a program will not be full 24-hr bed days. By convention, the day of admission will be counted toward units of service and entered into BIS. The day of discharge will not be counted toward units of service and not entered into BIS. If a client completes the intake process and then leaves without spending the night, the episode may be opened and closed the same day with only one unit of service entered. The discharge code is #7, assessment only, no treatment provided. Detoxification Service Descriptions Levels of Detoxification Services Each program shall establish policies and procedures to identify participants who are in need medical services beyond the capacity of the program and to refer or transfer such participants to more appropriate levels of service. All referrals to another level of service shall be documented in participant s file. The level of detoxification service is contingent upon the severity of use, characteristics of the substance used, current physical health status of the participant, current level of functioning of the participant and the availability of support services. Detoxification services shall be provided or the participant referred to another level of service in accordance with the criteria for the following levels of detoxification services: Substance Abuse Service Units Section Page 1 of 24

2 a. Nonresidential Detoxification Nonresidential detoxification services are appropriate for participants who are assessed as being at minimal risk of severe withdrawal syndrome outside the program setting, are free of severe physical and psychiatric complications and would safely respond to several hours of monitoring, medication and treatment. b. Nonresidential Detoxification With Extended On-Site Monitoring Nonresidential detoxification with extended on-site monitoring services are appropriate for participants who are assessed as being at moderate risk of severe withdrawal syndrome outside the program setting, are free of severe physical and psychiatric complications and would safely respond to several hours each day of monitoring, medication, and treatment. Appropriately credentialed and licensed individuals (such as licensed vocational nurses, licensed psychiatric technicians, registered nurses, licensed practical nurses, nurse practitioners, physician s assistants, or physicians) shall monitor participants over a period of several hours each day. c. Monitored Residential Detoxification Monitored residential detoxification services are appropriate for participants assessed as not requiring medication for the management of withdrawal, but require this level of service to complete detoxification and enter into continued treatment or self-help recovery because of inadequate home supervision or support structure. This level is characterized by its emphasis on peer and social support. d. Medically-Managed Residential Detoxification Medically-managed residential detoxification services are appropriate for participants whose level of physiological dependence upon alcohol and/or other drug requires prescribed medication for the management of withdrawal, but whose withdrawal signs and symptoms do not require the full resources of a medically-monitored inpatient detoxification facility. Medications for the management of withdrawal shall only be provided under the direction of a licensed physician or other person authorized to prescribed drugs, pursuant to Section 4036, Chapter 9, Division 2 of the Business and Professions Code. No participant shall be given medication unless a physician or his/her licensed medical staff has personally examined the participant. e. Medically-Monitored Inpatient Detoxification Medically-monitored inpatient detoxification services are required for participants whose withdrawal signs and symptoms are sufficiently severe to require primary medical and nursing care services. These services are provided in an acute care hospital setting under the direction of a licensed physician and delivered by medical and nursing professionals. Substance Abuse Service Units Section Page 2 of 24

3 Outpatient Service Unit Definition The unit of service for outpatient programs (including outpatient detox. and aftercare, but excluding methadone maintenance and methadone detoxification) is defined as one face-to-face contact per day of at least 30 minutes duration to include one or more of the following: assessment, treatment planning, individual and group counseling, education, family collateral counseling, aftercare, crisis intervention, and case management. Except in well documented crisis situations, only one contact per day is reimbursable. This per day contact is all inclusive of the services provided by the program and must be a face-to-face contact of at least 30 minutes duration to be considered for reimbursement. Please note that the time away from the client used for development of assessments, treatment plans, collateral information is not included in this calculation. However, these costs are recovered when unit cost (total program cost/number of units) is calculated. State certification standards require a minimum of two (2) contacts per month. Intensive Outpatient Service Unit Definition The intensive outpatient modality has been officially added to the substance abuse services system of care to recognize programs whose frequency and intensity of services are more than those defined in the outpatient service unit, but less than those defined by the day treatment service unit. One unit of intensive outpatient service is defined as one face-to-face contact per day of at least 50 minutes minimum duration to include one or more of the following: assessment, treatment planning, individual and group counseling, education, family collateral counseling, crisis intervention, case management, medication monitoring, aftercare, or related service activities such as acupuncture. The modality requires a schedule of five (5) hours or more weekly for each client with participation of at least four (4) attendance days per month. Day Treatment Service Unit Definition The unit of service for all programs that fall under this modality is a treatment day. This treatment day contact is all inclusive of the services provided by the program. One unit of day treatment service is defined as one face-to-face contact per day of at least 3 hours minimum duration to include one or more of the following: assessment, treatment planning, individual and group counseling, education, family collateral counseling, crisis intervention, case management, medication monitoring, aftercare, or related service activities such as acupuncture. The modality requires a schedule of at least three (3) hours per day, at least three (3) days per week for each client. Please also indicate the minimum hours per day and minimum days per week of required attendance for each participant. CBHS Substance Abuse and State certification standards require a minimum of nine (9) hours of services per week, three (3) hours per day, three (3) days per week. Prevention Service Unit Definition Prevention consists of a comprehensive framework of organized, planned and concrete strategies and activities aimed not only at preventing substance use and abuse but also at promoting healthful behaviors, decisions and environments among individuals, families and communities. Substance Abuse Service Units Section Page 3 of 24

4 A comprehensive program may include services provided in a variety of settings for both the general population and targeted at-risk sub-populations. CBHS needs to define its services in terms used also by the State and Federal governments. Before proceeding, determine the exact nature of your program s prevention activities. As in previous years, this information will be used on your annual Prevention Activities Data System (PADS) report prepared for primary prevention programs. Following this section on pages is a listing of prevention service descriptions used by State and Federal officials. Please identify whether the strategy is considered primary or secondary followed by the service code name(s) that best describe(s) your prevention services. Use these descriptors in determining Substance Abuse Services modality for Section 3, calculating units of service in Section 4, and in describing the goals and objectives and strategies used to accomplish these in Section 6: Methodology. It is advisable to choose reasonably. Select strategies in which your program can develop focused expertise. One unit of prevention is defined as one face-to-face contact per day of at least five (5) minutes duration for an individual and thirty (30) minutes duration for a group between a member of the target population and a staff person for the purpose of information, risk reduction, education and referral. The exception to this definition is for telephone hotline services specifically contracted as such. For those programs, the unit of service is defined as either a face-to-face or telephone contact between a member of the target population and a staff person for the purpose of information dissemination. To clarify, there is no maximum duration for a prevention activity occurring on the same day. For example, a group of 4 hours duration with 16 participants doing prevention strategy xyz yields 16 units of service, the same number as if the group were 60 minutes in duration. However, if on the same day with the same participants, the activity changes substantially to strategy abc, then a second set of units can be generated. Caution must be exercised in employing this option. Selection of strategies must be part of the planned overall curriculum in place and documented at the beginning of the contract year. Changing activities frequently at mid-year for the purpose of gaining more units of service will not be permitted. Prevention Service Descriptions Primary Prevention - These strategies count toward the 20 percent primary prevention requirement of DADP funding 12 Information Dissemination [Federal Definition] This strategy provides awareness and knowledge of the nature and extent of alcohol, tobacco and drug use, abuse and addiction and their effects on individuals, families and communities. It also provides knowledge and awareness of available prevention programs and services. Information dissemination is characterized by one-way communication from the source to the audience, with limited contact between the two. Examples of activities conducted and methods used for this strategy include (but are not limited to) the following: Substance Abuse Service Units Section Page 4 of 24

5 a. Clearinghouse/information resource center(s) b. Resource directories c. Media campaigns d. Brochures e. Radio/TV public service announcements f. Speaking engagements g. Health fairs/health promotion h. Information lines 13 Education [Federal Definition] This strategy involves two-way communication and is distinguished from the Information Dissemination strategy by the fact that interaction between the educator/facilitator and the participants is the basis of its activities. Activities under this strategy aim to affect critical life and social skills, including decision-making, refusal skills, critical analysis (e.g., of media messages) and systematic judgment abilities. Examples of activities conducted and methods used for this strategy include (but are not limited to) the following: a. Classroom and/or small group sessions (all ages); b. Parenting and family management classes; c. Peer leader/helper programs; d. Education programs for youth groups; and e. Children of substance abusers groups. 14 Alternatives [Federal Definition] This strategy provides for the participation of target populations in activities that exclude alcohol, tobacco and other drug use. The assumption is that constructive and healthy activities offset the attraction to, or otherwise meet the needs usually filled by, alcohol, tobacco and other drug and would, therefore, minimize or obviate resorting to the latter. Examples of activities conducted and methods used for this strategy include (but are not limited to) the following: a. Drug free dance and parties; b. Youth/adult leadership activities; c. Community drop-in services; and d. Community service activities. 15 Problem Identification and Referral [Federal Definition] This strategy aims at identification of those who have indulged in illegal/ageinappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of illicit drugs in order to assess if their behavior can be reversed through education. It should be noted, however, that this strategy does not include any activity designed to determine if a person is in need of treatment. Examples of activities conducted and methods used for this strategy include (but are not limited to) the following: a. Employee assistance programs; b. Student assistance programs; and c. Driving while under the influence/driving while intoxicated education programs. Substance Abuse Service Units Section Page 5 of 24

6 16 Community-Based Process [Federal Definition] This strategy aims to enhance the ability of the community to more effectively provide prevention and treatment services for alcohol, tobacco and drug abuse disorders. Activities in this strategy include organizing, planning, enhancing efficiency and effectiveness of services implementation, inter-agency collaboration, coalition building and networking. Examples of activities conducted and methods used for this strategy include (but are not limited to) the following: a. Community and volunteer training, e.g. neighborhood action training, training of key people in the system, staff officials training; b. Systematic planning; c. Accessing services and funding; and d. Community team-building. 17 Environmental [Federal Definition] This strategy establishes or changes written and unwritten community standards, codes and attitudes, thereby influencing incidence and prevalence of the abuse of alcohol, tobacco, and other drugs used in the general population. This strategy can be divided into two subcategories to permit distinction between activities which center on legal and regulatory initiatives and those which relate to the service and action-oriented initiatives. Examples of activities conducted and methods used for this strategy shall include, but not be limited to, the following: a. Promoting the establishment and review of alcohol, tobacco and drug use policies in schools; b. Technical assistance to communities to maximize local enforcement procedures governing availability and distribution of alcohol, tobacco and other drug use; c. Modifying alcohol and tobacco advertising practices; and d. Product pricing strategies. Secondary Prevention These strategies do not count toward the 20 percent primary prevention requirement of DADP funding 18 Early Intervention This strategy is designed to come between a substance use and his or her actions in order to modify behavior. It includes a wide spectrum of activities ranging from user education to formal intervention and referral to appropriate treatment/recovery services. Substance Abuse Service Units Section Page 6 of 24

7 19 Outreach and Intervention This service code is defined as activities for the purpose of encouraging those individuals in need of treatment such treatment. 20 Intravenous Drug User (IDU or IVDU) Activities for the purpose of encouraging those individuals in need of treatment to undergo such treatment. 21 Referrals, Screening, and Intake Activities involved in the assessment of a client s needs regarding treatment to ensure the most appropriate treatment. This may include the completion of record-keeping documents. 24 California Mentor Initiative (CMI) The CMI is designed to enhance and expand mentor service programs across the state. For the purposes of CMI, mentoring is defined as a relationship over a prolonged period of time between two or more people where older, wiser, more experienced individuals provide constant, as needed support, guidance, and concrete help to the younger at-risk persons as they go through life. An at risk youth is an individual under 19 years of age whose environment increases his/her chance of becoming a teen parent, school dropout, gang member, or user of alcohol or drugs. Targeted children and youth must not be normally served by the State or local educational agencies or must be in need of special services or additional resources. [Title IX, Section 4114(b) or the Safe and Drug Free Schools and Communities {SDFSC) Act] Funding under the CMI is restricted to five percent administrative costs, primary prevention, and secondary prevention services. [Title IX, Section 4114(a)(3) of the SDFSC Act] Program Code 12 shall be used to support mentoring services for youth which are in need of treatment under Secondary Prevention (code 24 only) and Support Services (codes only). Units of services are staff hours. Mentor hours are displayed in the field titled Description [ADP Bulletin #99-02, January 14, 1999]. Program Code 13 shall be used to support mentoring services for children and youth who are not in need of treatment under service codes 11 through 17. Units of services Substance Abuse Service Units Section Page 7 of 24

8 are staff hours. Mentor hours are displayed in the field titled Description. [ADP Bulletin #99-02, January 14, 1999] Ancillary Service Unit Definition Like prevention, ancillary services consist of a comprehensive framework of organized, planned and concrete strategies and activities. Unlike prevention, these services more often have a medical intervention or a health coordination nature. As stated previously, CBHS needs to define its services in terms used also by the State and Federal governments. Before proceeding, determine the exact nature of your program's ancillary strategies. Following the section listing Prevention Strategies is a listing of Ancillary Service descriptions used by State and Federal officials. Please identify the strategy number followed by the service code name(s) that best describe(s) your ancillary services. Use these descriptors in determining Substance Abuse Services modality for Section 3, calculating units of service in Section 4, and in describing the goals and objectives and strategies used to accomplish these in Section 6: Methodology. It is advisable to choose reasonably. Select strategies in which your program can develop focused expertise. Historically, CBHS/CSAS has not funded all the ancillary options. To date, ancillary services have been only Perinatal Outreach, HIV Early Intervention Services, Tuberculosis (TB) Services, and stand alone Case Management. One unit of ancillary service is defined as one face-to-face contact per day of at least five (5) minutes duration for an individual and thirty (30) minutes duration for a group between a member of the target population and a staff person for the purpose of information, risk reduction, education, referral, testing and case management. Ancillary Service Unit Descriptions 22 Perinatal Outreach Perinatal Outreach is an element of service that identifies and encourages eligible pregnant and parenting women in need of treatment services to take advantages of these services. Outreach may also to educate the professional community on perinatal services so that they become referral sources for potential clients. [Perinatal Services Network Guidelines Fall 1995] 63 Cooperative Projects This code allows for funding of special projects that have been approved by the Department prior to funding. [ADP Letter #96-21 dated April 12, 1996] Cooperative Projects are those which the Department and a County conjointly utilize strategies and activities to expand or enhance alcohol and drug services. Substance Abuse Service Units Section Page 8 of 24

9 64 Vocational Rehabilitation Services which provide for gaining and maintaining job skills which will allow for productive employment. Vocational rehabilitation includes vocational testing, counseling, guidance, job training, job placement, and other relevant activities designed to improve the alcoholic person s ability to become economically self-supporting. [Alcohol Services Reporting System Manual] 65 HIV Early Intervention Services Those activities involved in the prevention and delay of the progression of HIV by encouraging HIV counseling, testing, assessment of the progression of the disease and the provision of prophylactic and anti-viral prescription drugs. 66 Tuberculosis (TB) Services These services provide counseling and testing regarding tuberculosis offered to individuals either seeking treatment for substance abuse. 67 Interim Services (within 48 hours) Interim services are those services offered to injecting drug users or pregnant women seeking substance abuse treatment who cannot be admitted to a program due to capacity limitations. 68 Case Management Case Management services are activities involved in the integrating and coordinating of all necessary services to ensure successful treatment and recovery. Services may include outreach, intake, assessment, individual services plans, monitoring and evaluation of progress, and community resource referrals. Note: Programs that receive perinatal funds must provide or arrange for case management services. [Perinatal Services Network Guidelines Fall 1995] 69 Primary Medical Care (Perinatal Only) This is an element required in SAPT Block Grant funded perinatal programs. The program must provide or arrange for this service, which does not include specialist care or hospitalization for pregnant women and women with dependent children who are receiving substance abuse services. If the care is not covered by a third party provider, SAPT Block Grant funds may be used as the payment of last resort. This service must include referrals for prenatal care. [Perinatal Services Network Guidelines Fall 1995] Substance Abuse Service Units Section Page 9 of 24

10 70 Pediatric Medical Care (Perinatal Only) This is an element required in SAPT Block Grant funded perinatal programs. The program must provide or arrange for this service, which does not include specialist care or hospitalization for the children of women who are receiving substance abuse services. If the care is not covered by a third party provider, SAPT Block Grant funds may be used as the payment of last resort. This service must include immunizations. 71 Transportation (Parolee Services Only) This service is the provision of or arrangement for the transportation of a client to and from treatment services. Narcotic Treatment Program Service Unit Definition Narcotic Treatment Programs (NTP) are commonly called methadone maintenance programs, methadone detoxification programs, or LAAM maintenance programs in San Francisco. The unit of service definitions for NTPs are based on California Code of Regulations (CCR) Title 9, Narcotic Treatment Protocols, and Title 22, Medi-Cal Protocols. One unit of service for a Narcotic Treatment Program is defined as either one dose of methadone or LAAM (either for clinic consumption or take-home) or one 10 minute period of face-to-face individual or group counseling to include assessment, treatment planning, collateral counseling to family and friends, medication review, and crisis intervention. Groups must be 4-10 members in size. For Medi-Cal reimbursement, the standards for service delivery specify daily dosing and five units of counseling per month in maintenance programs. Driving Under the Influence Service Unit Definition DUI programs are established by California Health and Safety Codes and are regulated by California Code of Regulations (CCR), Title 9. One unit of service for a DUI Program is defined as one hour of education, one hour of group counseling, or 15 minutes of individual counseling in a program licensed as meeting State DADP standards. CBHS needs to measure client capacity in several ways. Unduplicated clients corresponds to slots measured annually. For each contract exhibit please indicate as exactly as possible the number of unduplicated clients that will be seen annually. Unduplicated clients are those individuals who receive at least one treatment service during the fiscal year. For residential programs, UDC can be calculated by multiplying the number of daily slots available by the number of treatment cycles that can be offered during the fiscal year. For outpatient programs, the UDC calculation equals number of weekly slots available multiplied by number of treatment cycles offered annually. Residential Service UDC Required formula to be used in renewal application for typical residential programs. Documentation consists of data entry into BIS. Substance Abuse Service Units Section Page 10 of 24

11 # of slots (program s daily bed capacity) x # treatment cycles offered annually = UDC Example 1: Definite treatment cycle A treatment cycle of 90 days (1/4 year) can be offered four times annually. Show this calculation. 20 clients (program s capacity) x 4 treatment cycles annually = 80 UDC annually Example 2: Indefinite treatment cycle A treatment program offers a treatment cycle of 45 days but permits clients to extend to 90 days. The average length of stay for all clients is 63 days (1/6 year). 30 clients x 6 cycles annually = 180 UDC annually Required formula to be used in renewal application for residential detoxification programs with high recidivism rates. If the typical client returns an average of 3 times during the year, then only 1/3 of the client treatment episodes are unique. The remainder are repeat client episodes for the year. This applies to 5 programs. # of slots x # of treatment cycles offered annually x recidivism factor = UDC Example 3: A 12-bed residential detox program offers detox for 3-21 days with the typical client staying 7 days (1/52 of a year). From prior years it is known that most clients re-enter about three times during the year. 12 clients x 52 cycles annually x.33 recidivism factor = 206 UDC Outpatient Service UDC Required formula to be used in renewal application. Documentation consists of data entry into BIS. Example 1: Definite treatment cycle A treatment cycle of 6 months (1/2 year) can be offered two times annually. Show this calculation. 50 clients (program s weekly capacity) x 2 treatment cycles annually = 100 UDC annually Example 2: Indefinite treatment cycle A treatment program offers a treatment cycle of 6 months but several clients do not engage and drop out early while others extend to one year. The average length of stay for all clients is 103 days (0.28 year). 50 clients x 3.57 cycles annually(1.00/0.28 = 3.57) = 178 UDC annually Intensive Outpatient Service UDC Substance Abuse Service Units Section Page 11 of 24

12 Required formula to be used in renewal application. Documentation consists of data entry into BIS. Examples: See Outpatient UDC Day Treatment Service UDC Required formula to be used in renewal application. Documentation consists of data entry into BIS. Examples: See Outpatient UDC Prevention Service UDC Before completing the UDC calculation, begin by estimating the number of times each participant will be seen during the year. Participants of each prevention strategy will be counted separately from other prevention strategies. It is acceptable that across different strategies there will be duplication of clients. Use of strategies not described below requires the approval of CBHS Progam Staff. Required formula to be used in renewal application: Example 1: Information Dissemination (12): A program sets up a booth in a Health Fair three times annually, all in diverse locations. At each fair 200 pieces of promotional information are handed out. It is assumed that the fairs attendees are unique. Staff also go to four Parent Teacher meetings giving a brief presentation, staying afterwards for questions, and passing out information to 35 parents each time. In these cases the UDC calculations and the UOS calculations will be the same. Documentation consists of a log of date, time duration, staff present, # of materials distributed, general description of target population. 200 attendees x 3 health fairs annually = 600 UDC 35 parents x 4 meetings annually = 140 UDC total = 540 UDC for Information Dissemination Example 2: Education (13) Classroom education is given in five classrooms with an average enrollment of 28 students. The 15 week curriculum is given once per year for each classroom. Documentation consists of a log of date, time duration, subject matter covered, number of students present each time, teachers signature, general description of target population. 140 students (28 x 5) x 1 cycle annually = 140 UDC Example 3: Alternatives (14) Recreational activities that act as alternatives to hanging out in high risk environments are provided three times weekly at a youth center. Neighborhood youth may drop-in as they Substance Abuse Service Units Section Page 12 of 24

13 choose, but they are encouraged to join ongoing activities. Approximately 18 youth are present each of the three days. Each youth comes an average of twice weekly for approximately 6 months of the year. Documentation consists of daily sign-in logs for the activity or one sign-in for the center with a check box for the activity which will be attended. 18 youth x 3 sessions weekly x 50 weeks annually = 2700 maximum possible each youth attends 2 sessions weekly x 25 weeks annually = / 50 = 54 UDC Example 4: Problem Identification and Referral (15) An after school program conducts periodic (quarterly) rap sessions to find out if drug experimentation is occurring among the youth. Another staff person enters club scene frequented by young adults to find out if they are using designer drugs. Neither staff person is doing on-site education or counseling. The target population is seen only once each year. Documentation consists of a log of date, time duration, number of participants present each time, teachers signature, general description of target population. 15 (average # of youth/young adults present) x 4 sessions annually (if quarterly) = 60 UDC Example 5: Early Intervention (18) A trained staff person meets with selected individuals of a drop-in center to engage them and facilitate their making some change in their life circumstances. One FTE staff person can see about 5 individuals daily for each of that person s 230 working days annually (52 weeks minus 6 wks vacation/sick/holiday=46 wks x 5 days weekly). Although client attendance is sporadic, each individual may be seen about once every couple of months. Documentation consists of data entry into BIS. 5 participants x 230 days annually = 1150 maximum possible each person attends 6 sessions annually = / 6 = 192 UDC Example 6: Outreach and Intervention (19) A trained Community Health Outreach Worker (CHOW) goes out into the community and talks with people about problems in their lives, provides resource material for where they might seek help, and encourages them to follow-through with seeking help. Documentation consists of a log of date, time duration, number of participants seen each time, staff signature, general description of each participant. Follow the example of Early Intervention above. Example 7: Intravenous Drug User (Strategy 20): Substance Abuse Service Units Section Page 13 of 24

14 A staff person anticipates that most participants will be seen 1-3 times. Follow example for Early Intervention above. Example 8: Referrals, Screening, and Intake (21) A staff person anticipates that most participants will be seen once only. Follow example for Early Intervention above. Ancillary Service UDC Before completing the UDC calculation, begin by estimating the number of times each participant will be seen during the year. Participants of each prevention strategy will be counted separately from other prevention strategies. It is acceptable that across different strategies there will be duplication of clients. Use of strategies not described below requires the approval of CBHS Progam Staff. Required formula to be used in renewal application. Documentation consists of data entry into BIS or its approved alternative database. Example 5: HIV Early Intervention (65), Tuberculosis Services (66), Case Management (68), Acupuncture, or Perinatal Outreach (22) A trained staff person meets with selected individuals in a service center to engage them and facilitate their making some change in their life circumstances. One FTE staff person can see about 5 individuals daily for each of that person s 230 working days annually (52 weeks minus 6 wks vacation/sick/holiday=46 wks x 5 days weekly). Although client attendance is sporadic, each individual may be seen about 4 times over a period of months. Documentation consists of data entry into BIS when clients can be identified by name or a log of date, time duration, number of participants seen each time, staff signature, general description of each participant when participants can not be identified by name. 5 participants x 230 days annually = 1150 maximum possible each person attends 4 sessions annually = / 4 = 288 UDC Narcotic Treatment Program Service UDC Required formulas to be used in renewal application. Documentation consists of data entry into BIS. Maintenance formula # of slots (program s daily capacity) x # treatment cycles offered annually = UDC Maintenance A methadone maintenance program provides a continuous treatment cycle of greater than one year, but a few clients drop out each year. The average length of stay for all clients is 340 day (0.93 year). Substance Abuse Service Units Section Page 14 of 24

15 250 clients x 1.08 cycles annually(1.00/0.93 = 1.08) = 270 UDC annually Detoxification formula # of slots x # of treatment cycles offered annually x recidivism factor = UDC Detoxification A 30-slot methadone detox program offers detox for 21 days with the typical client staying 14 days (0.04 of a year). From prior years it is known that most clients re-enter about three times during the year. 30 clients x 25 cycles annually x.33 recidivism factor = 248 UDC Driving Under the Influence Service UDC Required formula to be used in renewal application. Documentation consists of data entry into BIS or its approved alternative database. Example 1: Definite treatment cycle A treatment cycle of 1 year is offered annually. Show this calculation. 100 clients (program s weekly capacity) x 1 treatment cycle annually = 100 UDC annually Example 2: Mid-year turnover in a definite treatment cycle A treatment cycle of 18 months (1 1/2 years) is offered. As groups end, new ones will begin. Show this calculation. 25 clients (average group size) x 6 groups annually x 1 treatment cycle annually per group = 150 UDC annually When completing this section, use only the formula indicated for the appropriate service modality and show this calculation on your renewal application in this section. Residential Service UOS Calculation Required formula to be used in renewal application: # CBHS funded beds x 365 days x occupancy rate no less than 90% = total units Note: All formulas used for calculating units of service and costs per unit of service rates for residential programs shall be based on whole beds. There will be no partial beds. 20 funded beds x 365days x 0.92 = 6,716 total units Substance Abuse Service Units Section Page 15 of 24

16 Note 2: Programs funded by SACPA, the Substance Abuse and Crime Prevention Act of 2000, are not permitted to have an occupancy rate below 100% in their formulas. Outpatient Service UOS Calculation Required formula to be used in Renewal application: # contracted slots x # of contacts per week x 50 weeks = units of service * Note: All formulas used for calculating units of service and costs per unit of service rates for non-residential programs shall be based on 50 weeks of service per year in order to account for anticipated closure for holidays. Formulas shall be based on whole slots. There will be no partial slots. 40 slots x 3 weekly meetings x 50 weeks = 6,000 total units Intensive Outpatient Service UOS Calculation Required formula to be used in Renewal application: # of contracted slots x # of contacts per week x 50 weeks per year = total units of service * Note: All formulas used for calculating units of service and costs per unit of service rates for non-residential programs shall be based on 50 weeks of service per year in order to account for anticipated closure for holidays. Formulas shall be based on whole slots. There will be no partial slots. 20 slots x 3 weekly meetings x 50 weeks per year = 3,000 total units Day Treatment Service UOS Calculation Required formula to be used in Renewal application: # of slots available daily x # of days per week program is open x 50 weeks per year x a utilization rate no less than 90% = total units of service * Note: All formulas used for calculating units of service and costs per unit of service rates for non-residential programs shall be based on 50 weeks of service per year in order to account for anticipated closure for holidays. Formulas shall be based on whole slots. There will be no partial slots. Substance Abuse Service Units Section Page 16 of 24

17 25 slots x 5 weekly meetings x 50 weeks per year x.90 = 5,625 total units Prevention Service UOS Calculation Required formulas to be used in the Renewal application: Note services may be conducted in group settings or individually. Group: # of participants per activity x # of activities per year = units of service Individual: # of contacts per week x 50 weeks per year = units service Note: If your program offers more than one type of prevention service, you must provide a separate formula and calculation for each category of prevention strategy. List the different calculations according to each unique type of service provided, then sum all to give total units of service. Your unit cost will be based on this aggregate total. Under no circumstances will there be separate costs attached to each service type within the same exhibit. The list of prevention strategies paired with the number of units of service for each and the grand total of units paired with the single overall unit cost must also be transferred to the Exhibit B, DPH #1A page. Formulas shall be based on whole participants. There will be no partial participants. A Primary Prevention program for youth uses (13) Education and (14) Alternatives as strategies and does its work in group settings. (13) Education: 50 youth x 12 sessions per year (classroom curriculum) = 600 units (13) Education: 12 parents x 2 sessions per year (2-hr workshop) = 24 units Education sub-total = 624 (14) Alternatives: 150 youth x 6 parties per year (clean & sober dance) = 900 units Grand Total Units = 1,524 A Secondary Prevention program does (20) Outreach to IDUs and (19) Outreach and Intervention to crack users. (20) IDU: 50 IDUs contacts per week x 50 weeks per year = 2,500 units (19) Outreach and Intervention: 75 crack users contacts x 50 weeks per year = 3,700 units Grand Total Units = 6,200 Ancillary Service UOS Calculation Required formulas to be used in the Renewal application: Note services may be conducted in group settings or individually. Group: # of participants per activity x # of activities per year = units of service Individual: # of contacts per week x 50 weeks per year = units service Note: If your program offers more than one type of ancillary service, you must provide a separate formula and calculation for each category of ancillary strategy. List the different Substance Abuse Service Units Section Page 17 of 24

18 calculations according to each unique type of service provided, then sum all to give total units of service. Your unit cost will be based on this aggregate total. Under no circumstances will there be separate costs attached to each service type within the same exhibit. The list of ancillary strategies paired with the number of units of service for each and the grand total of units paired with the single overall unit cost must also be transferred to the Exhibit B, DPH #1A page. Formulas shall be based on whole participants. There will be no partial participants. An ancillary program for heroin addicts employs (65) HIV Early Intervention and (66) Tuberculosis (TB) Services as strategies. Its work is with individuals. (65) HIV Early Intervention: 50 HIV contacts per week x 50 weeks per year = 2,500 units (66) Tuberculosis (TB) Services: 75 TB contacts per week x 50 weeks per year = 3,700 units Grand Total Units = 6,200 A Perinatal Outreach program conducts both individual and group activities. (22) Perinatal Outreach: 15 women x 12 forums per year = 180 units (13) Perinatal Outreach: 12 contacts per week x 50 weeks per year = 600 units Grand Total Units = 780 Narcotic Treatment Program Service UOS Calculation Required formulas to be used in Renewal application: Dosing: # contracted slots x 365 days per year x utilization rate = units of service Individual Counseling: # clients x # of 10 minute increments of individual counseling per month x 12 months per year = units of service Group Counseling: # clients x # of 10 minute increments of group counseling per month x 12 months per year = units of service Total Units = sum of the above Note: CBHS unit calculation requirements for this section are patterned off the State regulatory guidelines for narcotic treatment programs but are NOT exactly the same. CBHS requirements differ from the State in the manner in which dosing/dispensing units are calculated. CBHS allows the calculation formula to contain a utilization factor between % accounting for absentee rates. Also, CBHS requirements differ from the State in how payment for services is computed. There are no separate reimbursement rates for different services. In CBHS contracts all Substance Abuse Service units will be summed and a single unit cost computed. Substance Abuse Service Units Section Page 18 of 24

19 Reimbursement for NTP programs is based on billing the State Medi-Cal office at their rates for the itemized dosing, individual and group counseling units applicable to Medi-Cal eligible clients. The remaining units generated by non-medi-cal clients may be considered billable to CBHS at the all-inclusive rate which will equal the total/gross funding (DPH revenues + Other Revenues) divided by the total units of service. 300 contracted slots x 365 days per year x.93 (utilization rate) = 101,835 dosing units 300 clients x 5 (10 min. couns. increments) per month x 12 months = 18,000 indiv. couns. units 150 clients x 9 (10 min. couns. increments) per month x 12 months = 13,500 group counseling units total units of service = 121,185 Driving Under the Influence Service UOS Required formulas to be used in Renewal application: # contracted slots x # of contacts per week x 50 weeks = units of service 100 slots x 1 weekly meeting x 50 weeks = 5,000 total units Divide the total revenue by the number of units of service to arrive at the Substance Abuse Service unit cost and show the calculation. Unit cost calculations must be based on total/gross funding (DPH Revenues + Other Revenues). CBHS uses these Substance Abuse Service unit calculations based on available staff hours in its NNA Unit Report to the State of California, Department of Alcohol and Drug Programs (DADP). In general, the State Department of Alcohol and Drug Programs (DADP) requires CBHS to obtain information based on available staff hours to use as a capacity measure within each program called Net Negotiated Amount (NNA). Each contractor must report in addition to client contact based units of service described above units of service that are a State requirement in response to NNA. For residential programs (based on bed days) and narcotic treatment programs (based on slot days), the NNA units may appear the same. In other cases there will be a difference between units of service based on client contacts and units based on available staff hours. Substance Abuse Service Units Section Page 19 of 24

20 The term Net Negotiated Amount refers to CBHS s Net Funding from the State of California/DADP, NOT an amount based on the contractor s net funds from CBHS in any program. CBHS payments to contractors will be based on the Substance Abuse Services units described in section 4A above and will not be based on State units of service definitions. Note: The instructions below show that the NNA units are calculated for any contract program based on the total gross program funding (CBHS revenues plus contractor s other revenue) divided by total NNA units as defined below. State DADP Net Negotiated Amount (NNA) Terminology Available Capacity means the number of units of service (bed days, hours, slots, etc.) that a county actually makes available in the current fiscal year. Dedicated Capacity means the historically calculated service modality and service capacity that is adjusted for the projected expansion or reduction in services that the counties agree to make available to provide drug and alcohol services to persons otherwise eligible for county services. Modality means those necessary general activities to provide alcohol/drug prevention or treatment or both, which conform to the services available in the following categories: Support Services Primary Prevention Secondary Prevention Nonresidential Treatment Day Care Habilitative Residential Treatment Chemically Assisted Treatment - Methadone Chemically Assisted - Non Methadone Ancillary Services Driving Under the Influence Program State DADP Net Negotiated Amount (NNA) Definitions and Calculations Provide NNA units for each Program and each modality within that program if more than one modality is provided. Following are examples of how to calculate NNA units for each modality. Show calculations for each modality of NNA units in this section of your exhibit. All calculations must show deductions for sick leave, vacations, and holidays. NNA Support Services (Not applicable to CBHS contractors.) NNA Prevention Substance Abuse Service Units Section Page 20 of 24

21 Available staff hours. The number of staff available to provide prevention activities x the number of annual hours staff is available minus a hypothetical 30 days of vacation, holidays and sick leave = available staff hours. Unit cost is then calculated by dividing total revenues (CBHS + Other Revenues such as client fees, fundraising, etc.) by staff hours FTE staff works 40 hours each week to provide prevention activities. 40 hrs. x 46 weeks (52 weeks per year 2 weeks vacation, 2 weeks sick leave, 2 weeks holidays) = 1,840 hrs. for each 1.0 FTE staff FTE staff x 1,840 hrs. = 5,060 annual available staff hours. Total funding (CBHS + Other Revenues) is $250,000. Unit cost is calculated: $250,000/5,060 = $ NNA Nonresidential Available staff hours (direct service staff only) The number of staff available to provide direct non-residential activities x the number of annual hours staff is available = available staff hours. The FTE of staff available must match the total FTE on the corresponding Salaries & Benefits detail page of Exhibit B. Unit cost is then calculated by dividing total revenues (CBHS + Other Revenues such as client fees, fundraising, etc.) by staff hours FTE staff works 35 hours each week to provide non-residential activities. 35 hrs x 46 weeks (52 weeks per year 2 weeks vacation, 2 weeks sick leave, 2 weeks holidays) = 1,610 hrs for each 1.0 FTE staff FTE staff x 1,610 hrs = 13,122 annual available staff hours. If the total revenues (CBHS + Other Revenues, such as client fees, fundraising, etc.) for non-residential services is $476,223, the unit cost would be: $476,223/13,122 = $ NNA Day Care Habilitative Available days (days x capacity). The number of annual days the program is open for business x the number of slots available (capacity). Although the term Day Care Habilitative refers to Medi-Cal services, this same formula applies to all CBHS Substance Abuse Day Treatment Programs. Substance Abuse Service Units Section Page 21 of 24

22 Program is open 5 days a week throughout the year, but closes for 10 holidays. It has a capacity of 35 slots at any given time. Available days would = (5 days/ wk x 52 wks - 10 holidays) x 35 slots = 8,750 available days. If the total revenues (CBHS + Other Revenues such as client fees, fundraising, etc.) for the day treatment program = $486,991, the unit cost would be $486,991/8,750 = $ NNA Residential Treatment Available bed days (days x capacity). The annual number of days (365) x the number of beds. The program has 23 beds with total revenues (CBHS + Other Revenues such as client fees, fundraising, etc.) of $513,672. The number of available bed days = 365 x 23 or 8,395. The unit cost would be $513,672/8,395 = $ NNA Chemically Assisted Treatment Methadone Slot days (slots x available days) Maintenance and Detox. The annual number of days open x the number of slots The program is open every day except for two holidays. It has a capacity of 125 slots with total revenues (CBHS + Other Revenues such as client fees, fundraising, etc.) of $389,976. The number of slot days is (365-2) x 125 or 45,375 slot days. Unit cost is $389,976/45,375 = $8.60. NNA Chemically Assisted Treatment Non Methadone Slot days (slots x available days) Calculations are the same as NNA Chemically Assisted Treatment Methadone above. NNA Ancillary Services Available staff hours. Calculations are the same as NNA Nonresidential above. NNA Driving Under the Influence (DUI) Program The number of clients served annually. Provide the actual number of clients to be served for the year. Substance Abuse Service Units Section Page 22 of 24