SUBSTANCE ABUSE COMPREHENSIVE OUTPATIENT

SUBSTANCE ABUSE COMPREHENSIVE OUTPATIENT

TREATMENT PROGRAM

SA Comprehensive Outpatient Treatment (SACOT) Program means a periodic service that is a time-limited, multi-faceted 

approach treatment service for adults who require structure and support to achieve and sustain recovery. SACOT Program is 

a service emphasizing reduction in use and abuse of substances and/or continued abstinence, the negative consequences of 

substance abuse, development of social support network and necessary lifestyle changes, educational skills, vocational skills

leading to work activity by reducing substance abuse as a barrier to employment, social and interpersonal skills, improved 

family functioning, the understanding of addictive disease, and the continued commitment to a recovery and maintenance 

program. These services are provided during day and evening hours to enable individuals to maintain residence in their 

community, continue to work or go to school, and to be a part of their family life. The following types of services are included 

in the SACOT Program: 

1. Individual counseling and support; 

2. Group counseling and support; 

3. Family counseling, training or support; 

4. Biochemical assays to identify recent drug use (e.g., urine drug screens); 

5. Strategies for relapse prevention to include community and social support systems in treatment; 

6. Life skills; 

7. Crisis contingency planning; 

8. Disease management; and 

9. Treatment support activities that have been adapted or specifically designed for persons with physical disabilities or 

persons with co-occurring disorders of mental illness and substance abuse/dependence or mental 

retardation/developmental disability and substance abuse/dependence. 

SACOT programs can be designed for homogenous groups of recipients e.g., individuals being detoxed on an outpatient basis; 

individuals with chronic relapse issues; pregnant women, and women and their children; individuals with co-occurring MH/SA 

disorders; individuals with HIV; or individuals with similar cognitive levels of functioning. SACOT includes case management 

to arrange, link or integrate multiple services as well as assessment and reassessment of the recipient’s need for services. 

SACOT services also inform the recipient about benefits, community resources, and services; assists the recipient in accessing 

benefits and services; arranges for the recipient to receive benefits and services; and monitors the provision of services. 

Consumers may be residents of their own home, a substitute home, or a group care setting; however, the SACOT Program 

must be provided in a setting separate from the consumer’s residence. 

A service order for SACOT must be completed prior to or on the day that the services are to be provided by a physician, 

licensed psychologist, physician’s assistant or nurse practitioner according to their scope of practice. 

This service must operate at least 20 hours per week and offer a minimum of 4 hours of scheduled services per day, with 

availability at least 5 days per week with no more than 2 consecutive days without services available. The recipient must be in 

attendance for a minimum of 4 hours a day in order to this for this service. Group counseling services must be offered each 

day the program operates. Services must be available during both day and evening hours. A SACOT Program may have 

variable lengths of stay and reduce each individual’s frequency of attendance as recovery becomes established and the 

individual can resume more and more usual life obligations. The program conducts random drug screening and uses the 

results of these tests as part of a comprehensive assessment of participants’ progress toward goals and for Person Centered 

Planning.

PROVIDER REQUIREMENTS

SACOT Program must be delivered by practitioners employed by a substance abuse provider organization that meet the 

provider qualification policies, procedures, and standards established by DMH and the requirements of 10A NCAC 27G. These 

policies and procedures set forth the administrative, financial, clinical, quality improvement, and information services 

infrastructure necessary to provide services. Provider organizations must demonstrate that they meet these standards by being 

endorsed by LME. Within three years of enrollment as a provider, the organization must have achieved national accreditation. 

The organization must be established as a legally recognized entity in the United States and qualified/registered to do business 

as a corporate entity in the State of North Carolina. 

THE SHIP GROUP COMMUNITY SERVICES 

Policies & Procedures Manual

- 170 -

Organizations that provide SACOT must provide “first responder” crisis response on a 24/7/365 basis to recipients who are

receiving this service.

STAFFING REQUIREMENTS

Persons who meet the requirements specified for SIC, LCAS, LCAS-P, and CSAC under Article 5C may deliver SACOT 

Program. The program must be under the clinical supervision of a LCAS or SIC who is on site a minimum of 90% of the hours 

the service is in operation. Clinical services may also be provided by staff that meet the requirements specified for QP or AP 

status for Substance Abuse according to 10A NCAC 27G .0104, under the supervision of a SIC. The maximum face-to-face 

staff-to-client ratio is not more than 10 adult consumers to 1 QP based on an average daily attendance. Paraprofessional level 

providers who meet the requirements for Paraprofessional status according to 10A NCAC 27G .0104 and who have the 

knowledge, skills, and abilities required by the population and age to be served may deliver SACOT Program, under the 

supervision of LCAS, CSAC or SIC. Paraprofessional level providers may not provide services in lieu of on-site service 

provision to recipients by a qualified SIC, LCAS, LCAS-P, or CSAC.

SERVICE TYPE / SETTING

Facility licensed in accordance with 10A NCAC 27G .4500

CLINICAL REQUIREMENTS

Recipients must have ready access to psychiatric assessment and treatment services when warranted by the presence of 

symptoms indicating a co-occurring non-substance related Axis I or Axis II disorder (e.g. major depression, schizophrenia, 

borderline personality disorder). These services shall be delivered by a psychiatrist who meet requirements as specified in 

NCAC 27G .0104. The providers shall be familiar with the SACOT Program treatment plan for each recipient seen in 

consultation, shall have access to SACOT Program treatment records for the recipient, and shall be able to consult by phone 

or in person with the SIC, LCAS or CSAC providing SACOT Program services.

UTILIZATION MANAGEMENT

Authorization by the statewide vendor is required. The amount, duration, and frequency of the services must be included in an

individual’s authorized Person Centered Plan. Services may not be recommended to occur less frequently than the structured 

program’s requirements set forth in the service description above. Recipients receiving Substance Abuse Comprehensive 

Outpatient Treatment (SACOT) services may be seen for the initial 60 days of treatment without a prior authorization. Services 

provided after this initial 60 day “pass-through” period require authorization from the Medicaid approved vendor. This passthrough is available only once per calendar year. Reauthorization shall not exceed 60 days. All utilization review activity shall 

be documented in the Provider’s Service Plan. 

This service is billed with a minimum of 4 hours per day billed in hourly increments. If it is a Medicaid-covered service, utilization 

management will be done by the statewide vendor. 

If it is a non-covered Medicaid service or non-Medicaid client, then the utilization review will be done by the LME.

ENTRANCE CRITERIA

The recipient is eligible for this service when 

A. There is an Axis I diagnosis of a Substance Abuse disorder diagnosis. 

AND

B. Level of Care Criteria Level II.5 NC Modified A/ASAM

CONTINUED STAY CRITERIA

The desired outcome or level of functioning has not been restored, improved, or sustained over the time frame outlined in the

recipient’s Person Centered Plan or the recipient continues to be at risk for relapse based on history or the tenuous nature of 

the functional gains or any one of the following applies: 

1. Recipient has achieved initial Person Centered Plan goals and continued service at this level is needed to meet additional

goals. 

2. Recipient is making satisfactory progress toward meeting goals. 

3. Recipient is making some progress, but the PCP (specific interventions) needs to be modified so that greater gains, which 

are consistent with the recipient's pre-morbid level of functioning, are possible or can be achieved. 

4. Recipient is not making progress; the Person Centered Plan must be modified to identify more effective interventions. 

5. Recipient is regressing; the Person Centered Plan must be modified to identify more effective interventions. 

THE SHIP GROUP COMMUNITY SERVICES 

Policies & Procedures Manual

- 171 -

AND

Utilization review must be conducted every 30 days and is so documented in the Person Centered Plan and the service record.

DISCHARGE CRITERIA

Recipient’s level of functioning has improved with respect to the goals outlined in the Person Centered Plan, inclusive of a 

transition plan to step down, or no longer benefits, or has the ability to function at this level of care and any of the following 

apply: 

1. Recipient has achieved positive life outcomes that support stable and ongoing recovery. 

2. Recipient is not making progress, or is regressing and all realistic treatment options have been exhausted indicating 

a need for more intensive services. 

3. Recipient/family no longer wishes to receive SACOT services. 

DOCUMENTATION REQUIREMENTS

Minimum standard is a daily full service note for each day of SACOT that includes the recipient’s name, Medicaid identification 

number, date of service, purpose of contact, describes the provider’s interventions, the time spent performing the intervention, 

the effectiveness of interventions, and the signature and credentials of the staff providing the service. A documented discharge 

plan will be discussed with the recipient and included in the record.

EXPECTED OUTCOMES

The expected outcome is abstinence. Secondary outcomes (i.e., in abstinent patients) include: sustained improvement in 

health and psychosocial functioning, reduction in any psychiatric symptoms (if present), reduction in public health and/or safety 

concerns, and a reduction in the risk of relapse as evidenced by improvement in empirically-supported modifiable relapse risk 

factors. For individuals with co-occurring MH/SA disorders, improved functioning is the expected outcome.

SERVICE EXCLUSIONS/LIMITATIONS

SACOT cannot be billed during the same authorization as SA Intensive Outpatient Program, all detoxification services levels 

(with the exception of Ambulatory Detoxification) or Non-Medical Community Residential Treatment or Medically Monitored 

Community Residential Treatment. 

Note: For recipients under the age of 21, additional products, services, or procedures may be requested even if they do not appear in 

the N.C. State Plan or when coverage is limited to those over 21 years of age. Service limitations on scope, amount, or frequency 

described in the coverage policy may not apply if the product, service, or procedure is medically necessary.

THE SHIP GROUP COMMUNITY SERVICES 

Policies & Procedures Manual