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Addiction and Recovery Treatment Services (ARTS) Provider Attestation Form

Addiction and Recovery Treatment Services (ARTS) Provider Attestation Form 2025

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The document is the Addiction and Recovery Treatment Services (ARTS) Provider Attestation Form from the Virginia Department of Medical Assistance Services. It outlines the requirements for providers to attest that they meet the American Society of Addictions Medicine (ASAM) criteria for substance use disorder treatment services. Providers must submit this form along with an organizational staff roster and other necessary documents to begin the credentialing process for Medicaid eligibility. The form emphasizes compliance with ASAM standards, professional liability insurance, and consent for information verification.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Corporate Entity Legal Name, NPI, Address, and Agency in the designated fields. Ensure all information is accurate as it will be used for credentialing.
Complete the TIN# section. This is essential for tax identification purposes.
In the Network Organizational Credentialing Standards Attestation section, confirm that your agency meets ASAM Level of Care requirements by checking the appropriate boxes and providing necessary documentation.
Fill out the Facility attestation section, certifying that only qualified staff will treat Medicaid eligible members. Include printed name, title, date, and signature.
For contracted sites of care, provide detailed information for each site including legal name, program name, tax ID#, address, and treatment setting type.

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What is SAMHSA and what do they do?

The Substance Abuse and Mental Health Services Administration (SAMHSA) works to improve substance abuse and mental health treatment services to those who are most in need of them.

What is a SAMHSA certified OTP?

OTP Certification SAMHSAs Division of Pharmacologic Therapies (DPT), part of the SAMHSA Center for Substance Abuse Treatment (CSAT), is responsible for certifying that an Opioid Treatment Program (OTP) conforms with federal regulations governing treatment for substance use disorders.

What is Samhsa certification?

People with OUD typically have a disability because they have a drug addiction that substantially limits one or more of their major life activities. Drug addiction is considered a physical or mental impairment under the ADA.

What is SAMHSA certified?

SAMHSA or the Substance Abuse and Mental Health Services Administration is an agency under the U.S. Department of Health and Human Services. If a drug testing laboratory is SAMHSA-ceritifed, the laboratory is recognized and approved federally.

How to become a SAMHSA certified lab?

In order to become SAMHSA certified, a lab must successfully test three rounds of PT samples and complete a lab inspection that occurs while the third round of PT samples are being tested by the lab. After that, the lab must undergo inspection three months after certification and submit itself to semiannual inspection.