Christine Stuart file photo
Gian-Carl Casa listens at a recent Bond Commission meeting (Christine Stuart file photo)

HARTFORD, CT – A controversial directive stating that alcohol and drug counselors (LADCs) are only permitted to treat abuse disorders, even when a patient has a co-occurring behavioral health diagnosis, was rescinded late last week.

The original directive had come under strong criticism from the president and CEO of CT Community Nonprofit Alliance.

The Department of Social Services (DSS) had originally issued a policy statement which said: “It is not within the scope of practice for an LADC to treat an individual with a diagnosed health disorder.

“If the individual has a co-occurring disorder (mental health and substance abuse disorder), the LADC may treat the substance use disorder but not the mental health condition,” according to the original statement.

But in a follow-up bulletin, DDS said an LADC’s practice may include: “conducting a substance use disorder screening or psychosocial history evaluation of an individual to document the individual’s use of drugs prescribed for pain, other prescribed drugs, illegal drugs and alcohol to determine the individual’s risk for substance abuse, (B) developing a preliminary diagnosis for the individual based on such screening or evaluation, (C) determining the individual’s risk for abuse of drugs prescribed for pain, other prescribed drugs, illegal drugs and alcohol, (D) developing a treatment plan and referral options for the individual to ensure the individual’s recovery support needs are met, and (E) developing and submitting an opioid use consultation report to an individual’s primary care provider to be reviewed by the primary care provider and included in the individual’s medical record.”

This updated ‘provider bulletin’ does not change the DSS/Medicaid payment process, but only notifies them of a statute that refers to their scope of practice, Krista Ostaszewski, a spokeswoman for DDS, said.
CT Community Nonprofit Alliance President and CEO Gian-Carl Casa, in a letter to Social Services Commissioner Roderick Bremby before the policy decision was rescinded, had urged Bremby “to reconsider and rescind the transmittal to protect effective treatment in Connecticut.”

“Changing this policy now, as the state faces a funding crisis and an opioid epidemic, is taking a step away from effective treatment of individuals struggling with drug and alcohol addictions,” Casa said in his original letter to Bremby.

After the policy change was rescinded, Casa sent a follow-up letter thanking Bremby for the reversal.

“On behalf of community-based mental health and substance abuse providers across the state, we thank you for rescinding the provider bulletin issued on December 20 concerning payments for services by Licensed Alcohol and Drug Abuse Counselors (LADCs).

“We appreciate your and the agency’s sensitivity to the concerns we and others raised about it,’’ Casa said in his follow-up letter.

In his follow-up letter to Bremby, however, Casa added: “Unfortunately, your department’s actions only partially address the problem. The statute, and interpretations of it by the Department of Public Health (DPH), could continue to pose problems for LADCs as they treat people with addictions, many of whom have behavioral health issues.”

Casa reiterated: “In an era in which opioid abuse is almost daily costing lives it is important than LADCs continue to have the ability to provide counseling for co-occurring behavioral health issues.”