# Title 75 — Department of Human Services

## Article 75-09.1 — Substance Abuse Treatment Programs

## Chapter 75-09.1-07 — Outpatient Services - Adult ASAM Level I

### § 75-09.1-07-01. Definitions.

As used in this chapter:
1. "Assertive referral" means the identification of appropriate services and actively assisting the
client to connect with the service provider and follow through with the plan of service.
2. "Chronic" means diagnosed chemical dependency or severe and persistent mental illness as
described in the DSM and characterized by long duration and progression of symptoms,
frequent recurrence or relapse, and a prognosis that indicates continuous clinical care or
support or both to maintain stability and remission or reduction of symptoms.
3. "Chronic care and maintenance services" means outpatient services necessary and
appropriate to assist a client who is chronically chemically dependent or chronically mentally ill
or both to maintain stability and live in the community as independently as possible. Such
services include professionally directed case management, psychiatric care, support services,
monitored medication administration, professional addiction counseling, mental health
counseling, mental health and chemical dependency assessment, social services, supported
housing, and other services sufficient to allow a client to live outside an institutional setting.
This service may be provided as a component of services within a residential or transitional
living setting or other such facility but would not require formal attachment to that facility.
4. "Intentional community treatment and support" means proactively identifying client needs and
deficits and seeking to identify and put in place services or resources to address those needs
and deficits through assertive referral, active implementation, and continuous monitoring by
treatment personnel.
5. "Outpatient services" means an organized nonresidential service or an office practice that
provides professionally directed aftercare, individual, and other addiction services to clients
according to a predetermined regular schedule of fewer than nine contact hours a week.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-07-02. Provider criteria.

1. An outpatient services program shall offer no more than eight hours of programming per week.
2. An outpatient services program shall offer the program with the length of stay to be
determined by a client's condition and functioning.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31

### § 75-09.1-07-03. Program criteria.

1. An outpatient services program shall provide skilled treatment services that may include any
combination of the following:
a. Individual or group counseling, motivational enhancement, brief intervention,
cognitive-behavioral therapy, opioid substitution therapy, family therapy, educational
groups, occupational and recreational therapy, or other psychotherapy; or
b. Case coordination, case management, chronic care and maintenance services,
intentional community treatment support, or assertive community treatment.
2. An outpatient services program must provide services in an amount, frequency, and intensity
appropriate to a client's treatment plan.
3. An outpatient services program must address as the need arises with a client with a mental
health problem issues of psychotropic medication, mental health treatment, and their
relationship to substance use disorders.
4. An outpatient services program with a dual diagnosis enhanced program shall offer therapies
to actively address, monitor, and manage psychotropic medication, mental health treatment,
and the interaction with substance-related disorders.
5. Counseling or assessment of a client regarding the client's abuse of alcohol or a controlled
substance must be provided by a licensed addiction counselor as provided in North Dakota
Century Code chapter 43-45. The provision of case management and educational services do
not need to be performed by licensed addiction counselors. A licensed addiction counselor
must be present in all team meetings where level of care and treatment planning decisions are
made regarding a client receiving or referred for substance abuse services.
6. For chronic care and maintenance services, an outpatient services program shall offer
services that are comprehensive and have an indefinite and variable programming or
provision schedule determined by the client's stability, level of functioning, and assessed
needs for ongoing community support and maintenance services.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-07-04. Admission criteria.

For admission to outpatient services, the client shall meet the criteria set forth in subsections one
and two and at least one of the remaining criteria:
1. Meet diagnostic criteria for substance-induced disorders of the DSM; and
2. Meet admission criteria for ASAM level I outpatient services in all six ASAM dimensions and
meet at least one of the following:
a. Demonstrates the need to take extended time for evaluation or lacks motivation to make
a commitment to a more intensive recovery effort and requires motivational enhancement
strategies;
b. Has completed a higher intensity level of care but requires continued services until
recovery stabilizes;
c. Has evidence of a brief return to usage not resulting in significant physical or emotional
deterioration;

d. Requires outpatient counseling of an intensity that will meet the client's needs without
placement in a higher level of care;
e. Has not been through a prior treatment and exhibits motivation for recovery and meets
ASAM criteria for level I in dimensions one, two, three, five, and six or the client has low
severity of problems in ASAM dimensions one, two, three, five, and six;
f. Has a low severity of problems in ASAM dimensions one, two, three, five, and six but is
not motivated and requires motivation enhancement strategies best delivered in a level I
program; or
g. Has a severe and persistent mental illness that impairs the client's ability to consistently
follow through with mental health appointments, take prescribed psychotropic
medications, and maintain mental and personal stability in the community but does have
the ability to access services such as assertive community treatment and case
management or supportive living.
History: Effective October 26, 2004.
General Authority: NDCC 50-05-16, 50-31
Law Implemented: NDCC 50-31
