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Substance Use Disorder Services
Definitions
Assessor: A person qualified to perform a substance use assessment, operating within the scope of his/her appropriate license/certification.
Substance: Alcohol, solvents, and controlled substances as defined in MN Stat. 152.01, subd. 4, as well as other mood-altering substances.
Substance Abuse: A pattern of inappropriate and harmful substance use that could be linked to specific situations in a member’s life, such as loss of a job, death of a loved one, or sudden change in life. Substance abuse does not involve a pattern of pathological use, but it may progress toward it.
Substance Use Disorder (SUD): A pattern of substance use as defined in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM).
Substance Use Disorder (SUD) Treatment Services: A planned program of care for the treatment of substance use disorders or substance abuse to minimize or prevent further substance abuse. Diagnostic, evaluation, prevention, referral, detoxification, and aftercare services not included in the licensed rehabilitative program are not PrimeWest Health-covered services.
Substance Use Assessment: An assessment interview and written listing of the member’s specific problems related to substance use and risk description that will enable the assessor to determine an appropriate treatment planning decision.
Guest Dosing: Guest dosing is the practice of administering a medication used for the treatment of opioid use disorders to a person who is not a client of the program that is administering or dispensing the medication. The client must be enrolled in an opioid treatment program (OTP) elsewhere in the state or country and receiving the medication on a temporary basis because the client is not able to receive the medication at the program where the client is enrolled. Such arrangements shall not exceed 30 consecutive days in any one program and are not for the convenience or benefit of either program. Guest dosing may also occur when the client’s primary clinic is not open and the client is not receiving take-out doses.
Because guest dosing only occurs when the person receiving the medication is not enrolled at the OTP providing the medication and receives no other services, guest dosing is not considered “treatment” by the Alcohol and Drug Abuse Division (ADAD). A “guest doser” is, by definition, not admitted under Rule 31, and as such, PrimeWest Health cannot pay for guest dosing, nor may providers bill PrimeWest Health-entitled individuals for guest doses.
Telehealth: The delivery of a substance use disorder treatment service while the client is at an originating site and the licensed health care provider is at a distant site as specified in section
Licensed Professional in Private Practice: A person qualified to provide SUD treatment services while operating within the scope of their appropriate license and who does not affiliate with other licensed or unlicensed professionals to provide alcohol and drug counseling services (affiliation does not include conferring with another professional or making a client referral).
Managed Care Organization (MCO)/Prepaid Health Plan: An organization that contracts with Minnesota Health Care Programs (MHCP) to provide medical services, including SUD treatment services, to members in exchange for a prepaid capitation rate and uses authorized funds.
Referral: If the assessor determines the member meets the criteria for substance abuse, a referral should be made to an appropriate program of the member's choice.
PW_03-19_148
Updated_08/24/2022
