1. Should Continuing Care Contacts be put only in SMART? Can there also be a paper file? If paper file, should it be the patient's treatment record or a separate continuing care folder?
Continuing Care is designed to be conducted in SMART. This is the way that ADAA will track those in this level of care. Only those programs that are SMART-capable will be able to participate in Continuing Care. If programs want to keep a separate file with a patient’s Continuing Care info in it(and it can be the file used from admission), that's fine as long as they are keeping the primary file in SMART.
2. Can a client be admitted from Level 0.5 to Continuing Care?
A patient in Level .5 would not be appropriate for Continuing Care in that it hasn't yet been established that this patient is an addict and ready for recovery. Continuing Care is more than just monitoring someone, it is keeping the addict engaged while they are working a program of recovery.
3. Are we including the adolescent programs as well? And once again it’s only those programs that have Level 1 treatment?
Yes, adolescent programs can also be included. The criteria for implementation of Continuing Care is that a program be Level 1, ADAA funded and use SMART. Adolescents are one of the groups that research has shown can especially benefit from Continuing Care.
4. If the patent refuses to complete the Check up, is this grounds for dis-enrollment from Continuing care?
No. The patient can remain in continuing Care. If the patient states that he/she does not want to remain in Continuing Care, then disenrollment/discharge may be done. Otherwise, assure the patient that he/she remains active in Continuing Care and schedule the next contact.
5. Does the patient have to come in to resign the Continuing Care Agreement?
No. A verbal agreement will suffice. Document the agreement in an Encounter Note. Of course, if a patient wants to sign a Release of Information, he/she will have to come in.
6. If a patient returns to Level 1 after being in Continuing Care, what happens to the funding source?
When a patient is enrolled in Continuing Care, the funding source is switched in SMART from MA/PAC (or whatever it was) to ADAA Grant Funded. If a patient returns to Level 1, the funding source again is switched from ADAA Grant Funding to MA/PAC.
7. Is texting a good way to maintain contact with a patient in Continuing Care?
We do not recommend texting except for confirming an appointment or something of that nature. There are confidentiality issues with texting. One program which makes it a routine practice to communicate with their teens uses texting regularly. Texting is not a good way to complete the check-up.
8. What things need to be completed before we can start using Continuing Care as part of our jurisdiction’s treatment continuum of care?
We are asking that all trainers submit a plan (one or two sentences via email describing how and when the training will be done), get a roster of attendees and their evaluations. Send them to:
55 Wade Ave.
Baltimore, Maryland 21228
The SMART trainer will be notified to turn the SMART Continuing Care Program on for those programs who have completed the training.
9. What will reimbursement will look like as we move toward a fee for service model?
We are not sure what it will look like if we move to a fee for service model for Continuing Care. What we do know is that we will eventually be moving from the 4 for 1 slot ratio to purchasing in units of hours of service. This will be true regardless of whether we continue to purchase via grant, fee for service, or it becomes Medicaid reimbursable.
10. Does ADAA have a suggested rate or method of reimbursement for Continuing Care? If so, what is the rate? If not, are we able to develop our own rate of reimbursement? If so, should the reimbursement rate be based on fee for service or flat rates?
If the County is contracting for outpatient rates by the slot, then continuing care reimbursement should be calculated at 25% of the per slot rate. However, if the County is contracting by the service, for example - hours of outpatient counseling, they should contract for the same amount as an hour of individual counseling (for Medicaid, this would be $80.00). We think the better choice is to contract for hours of continuing care, rather than counting by number of clients served or slots. In addition, they will have to require contractees to do sliding fee scale, just like any other service.