Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Children/Adolescents
|
|
- Victoria Wheeler
- 8 years ago
- Views:
Transcription
1 Medical Necessity In considering the appropriateness of any level of care, the four basic elements of Medical Necessity should be met: 1. A diagnosis as defined by standard diagnosis nomenclatures (DSM IV or its equivalent in ICD-9-CM) and an individual treatment plan appropriate for the participant s illness or condition. 2. Can reasonably be expected to restore a Member s condition to a usual and customary level of functioning for that individual 3. Have proven efficacy as defined by standard clinical references and empirical experience; and 4. Are rendered at the most cost-effective and safe level of care (within the health care benefit). 5. Support an abstinence model of treatment. Additionally and as outlined in Medicaid guidelines; 1. Be necessary to protect life, to prevent significant illness or significant disability; 2. Be individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the patient s needs; 3. Be consistent with the generally accepted professional medical standards as determined by the Medicaid program, and not experimental or investigational; 4. Be reflective of the level of service that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available, statewide; and 5. Be furnished in a manner not primarily intended for the convenience of the recipient, the recipient s caretaker or the provider. Procedures for Applying UM Criteria are designed to be appropriate for the uncomplicated patient and for the very complete delivery system; they may not be appropriate for the patient with complication or for a delivery system that does not include sufficient alternatives to a particular LOC and a particular patient. Therefore, CompCare considers at least the following factors when applying criteria to a given individual: Page 1 of 18
2 Age Comorbidities; including information obtained in consultation with the Primary Care Physician and/or the Health Plan UM team Complications Progress of treatment Psychological situation Home environment, when applicable The characteristics of the local delivery system available to a particular patient should also be considered: Availability of alternative levels of care, such as intensive outpatient programs, outpatient detoxification programs or residential treatment centers in the service area to support the patient after hospital discharge. Coverage of benefits for alternative levels of care, such as residential treatment centers where needed Ability of local providers to provide all recommended services within the estimated length of stay. When the above listed member and delivery system complications are identified the Care Management staff are directed to seek internal clinical guidance through case management peer review, discussion with the Director of Clinical Services or the physician advisor. Additionally, when the member is seeking detoxification, CompCare Care Management staff are directed to carefully consider member safety related to medical stability by questions that include, but are not limited to: Co-existing medical conditions and PCP treatment and management of medical conditions Member age Past detoxification history Type of treatment facility free standing or within a medical facility Multifamily groups are considered in addition to scheduled family therapy for the individual member and his/her family. Page 2 of 18
3 SUBSTANCE ABUSE OUTPATIENT TREATMENT Organized outpatient treatment for children and adolescents with chemical dependency may be delivered in a wide variety of settings and by addiction treatment staff with a variety of experience and credentials. The services must follow a defined set of policies and procedures or clinical protocols and usually encompass less than six contact hours per week. Individual, group and family sessions may occur with special emphasis on group and family involvement as individually indicated. The treatment is designed to help the young member achieve positive changes in his or her alcohol- or other drug-using behaviors. Areas that have a potential to undermine the goals of treatment or to impair the member s ability to cope with major life tasks without the non-medical use of alcohol or other drugs must be addressed in this treatment. These areas include major familial, attitudinal, behavioral and cognitive issues or beliefs. Treatment interventions and modalities are tailored to engage the members who are at varying levels of developmental maturity. This level of care is appropriate in a variety of circumstances. It may be used as 1) a step down from a more intensive level of care, 2) the initial level of care for a young member, or 3) an option to engage and enhance the motivation of a resistant young member who is not ready to commit to recovery and is in the early stages of change. Treatment at this level of care often requires linkages with other service providers. These may include referrals for psychiatric assessment and treatment, primary care medical assessment and treatment, psychological and/or educational testing for learning disorders, special or alternative education services, family therapies, juvenile justice probation and supervision, foster care support services and other social service agency interventions. For children and adolescents, there is an expectation of face-to-face family meetings and involvement in treatment unless the physician determines this is contra-indicated. Page 3 of 18
4 Admission: Outpatient Treatment 1.Must be met 2. Must meet ALL: A The member is not demonstrating any life-threatening withdrawal symptoms that require acute inpatient detoxification. B The member is not suffering medical/psychiatric complications of his/her substance abuse that would inhibit ability to actively participate in and benefit from participation in the treatment OR is receiving concurrent medical or psychiatric monitoring and is stable. C The member is able to maintain abstinence or control use and pursue recovery or motivational goals and needs limited support. D Must meet medical necessity The member s family and environment can support recovery with limited assistance. E F The member suffers from minimal to mild impairment in social, medical, family and/or work functioning secondary to substance abuse. The member demonstrates an interest in working toward the goal of rehabilitation, but needs motivating and monitoring strategies to strength readiness OR the member is in early stages of change and a more intensive level of care could be lead to passive compliance, increased conflict, withdrawal from treatment or be counterproductive. Continued Stay: Outpatient Treatment 1. Must meet ALL A The member and family/guardian have participated in the treatment plan development and discharge plan. B The member is making progress, but has not yet achieved the goals in the individualized treatment plan OR, if not making progress, has the capacity to resolve his or her problems OR new problems have been identified that are appropriately managed at the present level of care. C Continues to meet admission and medical necessity criteria Discharge: Outpatient Treatment 1. Must meet ONE A Continued stay guidelines are no longer met. B Appropriate and timely treatment is available at a less restrictive level of care. Page 4 of 18
5 SUBSTANCE ABUSE INTENSIVE OUTPATIENT TREATMENT Intensive Outpatient treatment for chemical dependency is a structured program run by professional staff trained in the treatment of chemical dependency. This level of care may or may not be facility based. The treatment is characterized primarily by a group approach, which has didactic and process components. Critical is the component of relapse prevention with specific adaptations for the individual. Teaching the disease concept of addiction, relapse prevention, addressing family issues with involvement of family or significant others in treatment, anger management, and social issues should be included. Treatment goals should focus on present identified behaviors and include the goal of abstinence with ongoing emphasis on attendance at community-based self-help. This level of care is to be considered as a first treatment option for members with support systems or use of a sober living environment and absence of significant physical and psychiatric complications. Frequency of attendance should be continually adjusted based on severity of signs and symptoms. IOP programs must meet a minimum of 3 hours per day/night for usually 3 days per week but can occur up to 7 days a week. Frequency and length of IOP programs should be determined by the member s presenting clinical condition, treatment history, current motivation for treatment, and support system. Medical monitoring may be indicated for this member s optimum well-being, but should not be a determining factor in member s participation in the program and can be obtained outside of the program s services. For children and adolescents, there is an expectation of face-to-face family meetings and involvement in treatment unless the physician determines this is contra-indicated. Page 5 of 18
6 Admission: Intensive Outpatient Treatment 1. Must be met Must meet medical necessity 2. Must meet ALL A The member is not demonstrating any life-threatening withdrawal symptoms that require acute inpatient detoxification. B The member is not suffering medical/psychiatric complications of his/her substance abuse that would inhibit ability to actively participate in and benefit from participation in the treatment. C The member is unable to maintain abstinence without a structured treatment intervention during a portion of the day. D The member s support system in supportive of recovery. If the member is without a support system the member has the ability to become involved in a self-help system. E The member suffers from significant impairment in social, medical, family and/or work functioning secondary to substance abuse. F The member demonstrates an interest in working toward the goal of rehabilitation. Continued Stay: Intensive Outpatient Treatment 1. Must be met Continues to meet admission and medical necessity criteria 2. Must meet ALL A The member and family/guardian have participated in the treatment plan development and discharge plan. B The member is making progress, but has not yet achieved the goals in the individualized treatment plan OR, if not making progress, has the capacity to resolve his or her problems OR new problems have been identified that are appropriately managed at the present level of care. C The member has been able to become abstinent but has been unable to address social, family, and/or work related tasks leading to structure. Discharge: Intensive Outpatient Treatment 1. Must meet ONE A Continued stay guidelines are no longer met. B Appropriate and timely treatment is available at a less restrictive level of care. AMBULATORY DRUG AND ALCOHOL DETOXIFICATION Page 6 of 18
7 The member should be accessed daily by a medical professional regarding vital signs, physical and behavioral symptoms. There should be 24-hour access to a physician should unexpected symptoms or worsening of symptoms occur. This level of care should be considered when the member has been medically assessed, and it is determined that the member does not require around-the-clock nursing care. Members entering this level of care should have support systems capable of accessing emergency services, and available if necessary to give medication. Admission: Ambulatory Drug and Alcohol Detoxification 1. Must be met Must meet medical necessity 2. & A or B must be met (For A to apply subset 1 or 2 must be checked) A The member is at risk for a severe withdrawal syndrome evidenced by a set of 1. symptoms clearly indicating an acute withdrawal process; Evidence of Alcohol and / or sedative-hypnotic withdrawal as manifested by the following: Anxiety, agitation, auditory disturbances, clouding of sensorium, delirium, diaphoresis, diarrhea, elevated vital signs (BP, temperature, pulse), headache, nausea and vomiting, seizures, tactile disturbances, tremor, visual disturbances (hallucinations). & In addition to the evidence of Alcohol, Sedative-hypnotic and/or Opiate withdrawal; the presenting signs/symptoms must cause: Clinically significant distress or impairment of social, occupational, or other important areas of functioning and Require active medical/behavioral treatment that can only be provided by daily A 2 monitoring with 24 hour access to a physician should symptoms worsen. The member is at risk for a severe withdrawal syndrome evidenced by a set of symptoms clearly indicating an acute withdrawal process; Evidence or Opiate withdrawal as manifested by the following: Abdominal cramps, agitation and anxiety, anorexia, arthralgias, diaphoresis, diarrhea, dilated pupils, elevated vital signs (BP, temp, pulse), irritability insomnia, lacrimation, muscle spasms, myalgias, piloerection, rhinorrhea, tachypnea, yawning. & In addition to the evidence of Alcohol, Sedative-hypnotic and/or Opiate withdrawal; the presenting signs/symptoms must cause: Clinically significant distress or impairment of social, occupational, or other important areas of functioning and Require active medical/behavioral treatment that can only be provided by daily Page 7 of 18
8 B monitoring with 24 hour access to a physician should symptoms worsen. The member exhibits behavioral conditions complicating the member s successful detoxification at a less restrictive level of care as evidenced by at least on of the following: 1. Major depression with severe vegetative symptoms and thought process impairment such that the member could not safely participate in a less restrictive level of care. Thought process impairment or abstract thinking impairment, to such a degree as to limit the member s ability to perform activities of daily living. Continued Stay: Ambulatory Drug and Alcohol Detoxification 1. Must meet BOTH A The member continues to suffer from withdrawal symptoms that require daily medical monitoring and intervention. B The treatment plan implemented for the member has not led to enough improvement in the member s condition such that the member could safely move to a less restrictive level of care and sustain improvement at that level. Discharge: Ambulatory Drug and Alcohol Detoxification 1. Must be met A Continued stay guidelines are no longer met. Page 8 of 18
9 SUBSTANCE ABUSE PARTIAL HOSPITALIZATION Provides a structured, coordinated, intense, comprehensive, multi-modal treatment for members who have access to a sober living environment. This approach includes teaching the disease concept of addiction, relapse prevention, family issues with involvement when appropriate, anger management and social issues teaching the member to develop structure within their own lives. Additionally, emphasis is placed on community self-help groups and relapse prevention. This level of care is not to be considered the first option for members with substance abuse issues but may be used as a safe alternative to inpatient treatment, however, should not be considered as an alternative to less restrictive treatment unless the member has a documented history of failure in Intensive Outpatient in the previous 6 months of treatment This level of care may also be appropriate for members who have lost their usual structured daily activities due to substance abuse, or due to co-morbid illness and lack coping skills to compensate. For these members, this level of care would be considered a focused program of transition that would stabilize the member and link him/her to community based resources and/or outpatient services. It has been determined that without the medical monitoring and direct access intervention for medical needs, the member would be too unstable to achieve optimum outcomes for and in his/her recovery process Medical monitoring is an identified need for members in this level of care and is indicated for the presenting primary diagnosis or a complicated dual presentation. By program design, medical monitoring and intervention is provided as part of the program. Though in certain situations, this level of care can exist separate from hospital based services, as a rule it is linked to a medical treatment facility. Partial hospitalization programs are run a minimum of 6 hours per day and are available a minimum of 5 days a week. Family treatment is indicated where the member may by living with family or significant others who are impacted by a member s substance use and/or are non-supportive of recovery but who are not actively opposed or sabotaging the rehabilitation goals For children and adolescents face-to-face meetings are a critical part of the treatment plan with frequency determined from clinical presentation but no less than once a week.. Multifamily groups are considered in addition to scheduled family therapy for the individual member and his/her family. Multifamily groups do not take the place of scheduled face-to-face family sessions. Page 9 of 18
10 Admission: Partial Hospitalization 1. Must be met Must meet medical necessity 2. Must Meet ALL A The member is not demonstrating and life-threatening withdrawal symptoms that require acute inpatient B The member is not suffering medical/ psychiatric complications that would prevent participation in the treatment provided. C The member has suffered such impairment with social, family, and/or work secondary to the substance abuse leading to inability to participate in routine daily activities had do not have coping skills to compensate. D The member is unable to maintain abstinence without structured treatment intervention during the day. E The member demonstrates an interest in working toward the goal of rehabilitation. Continued Stay: Partial Hospitalization 1. Must be met 2. Must meet ALL: A The member has participated in the development of the treatment plan and discharge plan. B The member has been able to become abstinent but has been unable to address social, family, and/or work related tasks leading to structure. C The treatment plan has not led to enough improvement to enable the member to be treated at a less restrictive level of care and sustain improvement. Discharge: Partial Hospitalization 1. Must Meet ONE A Continued stay guidelines are no longer met B Appropriate and timely treatment is available at a less restrictive level of care. Page 10 of 18
11 ACUTE INPATIENT DRUG AND ALCOHOL - DETOXIFICATION HOSPITALIZATION In-patient settings provide around-the-clock intensive, psychiatric medical and nursing care, continuous observation, and control of behavior as needed to ensure safety to members and others, as well as comprehensive multi-modal therapy for member and member support system. This level of care should not be considered until after the member has been evaluated medically. This level of care is not justified by simple intoxication or fear of relapse. For children and adolescents face-to-face meetings are a critical part of the treatment plan with frequency determined from clinical presentation but no less than once a week. (multi-family therapy does not take the place of individual family therapy). Initial Inpatient (Drug & Alcohol) DETOX Authorization 1. Must be met All components of Medical Necessity must be met 2. Must meet at least ONE: A OR B OR C (For A to apply subset 1 or 2 must be checked) A The member is at risk for a severe withdrawal syndrome evidenced by a set of symptoms 1 clearly indicating an acute withdrawal process; Evidence of Alcohol and / or sedativehypnotic withdrawal as manifested by the following: Anxiety, agitation, auditory disturbances, clouding of sensorial, delirium, diaphoresis, diarrhea, elevated vital signs (BP, temperature, pulse), headache, nausea and vomiting, seizures, tactile disturbances, tremor, visual disturbances (hallucinations). & In addition to the evidence of Alcohol, Sedative-hypnotic and/or Opiate withdrawal; the presenting signs/symptoms must cause: Clinically significant distress or impairment of social, occupational, or other important areas of functioning and Require active treatment that can only be provided by around the clock nursing A 2 care and medical intervention on a daily basis. The member is at risk for a severe withdrawal syndrome evidenced by a set of symptoms clearly indicating an acute withdrawal process; Evidence or Opiate withdrawal as manifested by the following: Abdominal cramps, agitation and anxiety, anorexia, arthralgias, diaphoresis, diarrhea, dilated pupils, elevated vital signs (BP, temp, pulse), irritability insomnia, lacrimation, muscle spasms, myalgias, piloerection, rhimorrhea, tachypnea, yawning. Page 11 of 18
12 B C & In addition to the evidence of Alcohol, Sedative-hypnotic and/or Opiate withdrawal; the presenting signs/symptoms must cause: Clinically significant distress or impairment of social, occupational, or other important areas of functioning and Require active treatment that can only be provided by around the clock nursing care and medical intervention on a daily basis. History of prior complicated and potentially life-threatening withdrawal such as seizures, delirium tremens or acute psychotic symptoms. The member has medical complications that, in combination with substance abuse, present a life-threatening health risk. A medical consultation is necessary to determine whether a medical admission is indicated for such a member. 3. Must meet at least ONE A The member exhibits behavioral conditions complicating the members successful detoxification at a less restrictive level of care evidenced by: Major depression with severe vegetative symptoms and thought process impairment such that the member could not safely participate in a less restrictive level of care. B The member exhibits behavioral conditions complicating the members successful detoxification at a less restrictive level of care evidenced by: Thought process impairment or abstract thinking impairment, to such a degree as to limit the member s ability to perform basic activities of daily living. Continued Stay, Inpatient Drug / Alcohol DETOX 1. Must meet ONE A The member continues to suffer from withdrawal symptoms that require active treatment efforts that can only be provided by around the clock intensive nursing care and documentation of daily physician contact with the member. B The member has developed a serious adverse reaction to medication requiring around the clock medical intervention that cannot be provided at a less restrictive level of care C The member s co-morbid medical or behavioral illness requires active treatment that can only be provided by around the clock nursing care and medical intervention on a daily basis 2. & Must Meet The treatment plan implemented for the member has not led to improvement in the member s condition to allow the member to safely move to a less restrictive level of the care and sustain improvement at that level. Page 12 of 18
13 Discharge Guidelines, Inpatient Drug /Alcohol DETOX 1. Must meet ONE A Continued stay guidelines are no longer met. B Appropriate and timely treatment is available at a less restrictive level of care. Page 13 of 18
14 SCHOOL-BASED TREATMENT School-based treatment is designed to identify mental health and substance abuse issues in children and adolescents and/or assist parents, teachers, and counselors in the treatment of a child or adolescent as outlined in an established formal educational/behavioral care treatment plan within a school setting. When a member has demonstrated an inability to attend treatment as prescribed. 1. School-Base Services must be justified as part of an overall formal educational/behavioral care treatment plan. For all requested services there must be an integrated treatment plan with clear goals and discharge criteria. 2. For School Based Services, group therapy is only adjunctive to individual and family therapy. In general, CompCare endorses individual and family interventions that focus on problem resolution rather than open-ended, process groups. 3. In addition, CompCare recognizes that unless there are issues of addiction or the member is at risk for hospitalization, any request for more than once a week treatment must be justified by the exact nature of the problem that is looking to be resolved and what the discharge criteria would be for that multisession intervention. 4. OP treatment for learning disabilities is generally not a covered benefit for OP therapy. Other Considerations 1. For School based programs, teacher referrals for (daily/episodic) behavior control are not considered in and of themselves a rationale for OP treatment. 2. CompCare does not pay for telephonic sessions, family or otherwise. 3. CompCare does not pay for case conferences nor does CompCare consider Case Conferences family therapy. School-based services are to be utilized under the following scenarios: a. When a member and/or their family have demonstrated an inability to attend treatment as prescribed. b. When a member and/ or their family has a life situation that makes treatment attendance very difficult and the process of getting to the appointments is a barrier to effective treatment. c. When a member has demonstrated an inability to successfully move from one level of care to another. d. When a member and/or their family requires a treatment boost in between office appointments to solidify treatment compliance and gains. e. When, in spite of active participation in another level of care, the extent to which issues in the home environment cannot be fully understood or resolved without direct intervention in that environment. Page 14 of 18
15 Initial Authorization - School-based treatment 1. Must meet A & B, C & D as applicable A All components of Medical Necessity must be met B There must be an integrated treatment plan with clear goals and discharge criteria. Services must be justified as part of an overall formal educational/behavioral care treatment plan. C For issues of addiction, 12 step program is part of the treatment plan. 2. & Must meet ONE A Member/Family report or express a subjective level of distress as it relates to behaviors and school performance. B Members symptoms must have resulted in a significant impairment of functioning in the home or school environment but these symptoms do not manifest themselves at a level that would call for a higher-level intervention. & Must meet C, D, E & as applicable F C Intervention is geared toward helping the family obtain resources and/or treatment options for the child in the community. D The treatment plan meets the needs of the child as is available. E Family involvement is face-to-face or there is a clear plan as to how to compensate for the lack of family availability in the treatment when the clinician is confronted with their absence. F For medication non-compliance, the treatment focuses on working with the child and family to improve the compliance with the medication component of the treatment plan. Continued Stay, School-based treatment 1. Must meet ONE A The treatment plan has not led to enough improvement in the child or adolescent s condition to allow the member to safely use community resources or a social support system to sustain improvement; or B The child or adolescent has developed new symptoms or the functioning has become so impaired so that the new diagnosis and treatment plan is indicated. Page 15 of 18
16 Discharge Guidelines, School-based treatment 1. Must meet ONE A Continued stay guidelines are no longer met. The problems noted on the treatment plan have been resolved sufficiently. B The child/adolescent or parent/caregiver is uncooperative or non-compliant with treatment and the absence of treatment poses no imminent risk of harm to child/adolescent or others. C After six (6) months of no improvement to any OP intervention, history and effectiveness of care show evidence that additional therapy will not create change or relief of symptoms (and family therapy has proved to be ineffective). Page 16 of 18
17 INPATIENT SUBSTANCE ABUSE REHABILITATION/ RESIDENTIAL TREATMENT Residential care is to be considered when a treatment milieu is considered necessary for a member to develop more adaptive coping mechanisms and facilitate a life style change in areas involving substance abuse. that can neither be addressed at a lower level of care nor require an inpatient intervention. The facility must have the capability to provide, as needed, medical and psychiatric monitoring of underlying physical and/or psychiatric illnesses and medical assessment and monitoring of withdrawal syndromes to ensure member safety. The treatment plan should address relapse prevention with individual adaptations. Prior to admission, less restrictive levels of care should be considered and attempted. This level of care is expected to stabilize the member is preparation for transition to a less restrictive level of care with a goal of reintegration into the community and is not to be considered solely for convenience or as an alternative to incarceration. For children and adolescents face-to-face meetings are a critical part of the treatment plan with frequency determined from clinical presentation but no less than once a week. (multi-family therapy does not take the place of individual family therapy). Page 17 of 18
18 Admission: Inpatient Rehabilitation/ Residential Treatment 1. Must be met Must meet medical necessity 2. Must meet ALL A The member is medically stable so that withdrawal symptoms, if present are not life threatening and can be safely monitored at this level of care. Member is not experiencing medical complications that prevent active participation and member is cognitively able to actively participate and benefit from treatment. B The member demonstrates an interest in working toward rehabilitation C The member has been unsuccessful in achieving abstinence for 6 months or more with active participation in IOP rehabilitation in the past 12 months. OR The member has failed to follow through with IOP Rehabilitation, including partial hospitalization, after 2 or more inpatient detoxifications. 3. & Must meet ONE A The member suffers form a co-morbid psychiatric illness or has bizarre thinking or psychomotor agitation/retardation that prevents participation at a less restrictive level of care. B The members living environment jeopardizes ability to achieve abstinence i.e.; family opposition to treatment or family actively involved in own substance abuse or severity dysfunctional living situation. C The member s social, family, occupational functioning is severely impaired secondary to substance abuse where much of the daily activity is focussed on obtaining, using or recuperating from substance abuse. Continued Stay: Inpatient Rehabilitation/ Residential Treatment 1. Must Meet Both A The member has participated in the development of the treatment plan including the discharge plan but continues to suffer from problems that caused the admission or additional problems have emerged. B The treatment plan has not led to enough improvement to allow member to move to a less restrictive level of care and sustain improvement. Discharge: Inpatient Rehabilitation/ Residential Treatment 1.Must meet ONE A Continued stay guidelines no longer met B Appropriate and timely treatment is available at a less restrictive level of care. Page 18 of 18
How To Know If You Should Be Treated
Comprehensive ehavioral Care, Inc. delivery system that does not include sufficient alternatives to a particular LOC and a particular patient. Therefore, CompCare considers at least the following factors
More informationHow To Know If You Can Get Help For An Addiction
2014 FLORIDA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA SUBSTANCE ABUSE LEVEL OF CARE CLINICAL CRITERIA Overview Psychcare strives to provide quality care in the least restrictive environment. An
More informationNew York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery
New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification
More informationClinical Criteria 4.201 Inpatient Medical Withdrawal Management 4.201 Substance Use Inpatient Withdrawal Management (Adults and Adolescents)
4.201 Inpatient Medical Withdrawal Management 4.201 Substance Use Inpatient Withdrawal Management (Adults and Adolescents) Description of Services: Inpatient withdrawal management is comprised of services
More informationADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015
The Clinical Level of Care Guidelines contained on the following pages have been developed as a guide to assist care managers, physicians and providers in making medical necessity decisions about the least
More information4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents)
4.40 STRUCTURED DAY TREATMENT SERVICES 4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents) Description of Services: Substance use partial hospitalization is a nonresidential treatment
More informationSUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]
SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual
More informationBehavioral Health Medical Necessity Criteria
Behavioral Health Medical Necessity Criteria Revised: 7/14/05 2 nd Revision: 9/14/06 3 rd Revision: 8/23/07 4 th Revision: 8/28/08; 11/20/08 5 th Revision: 8/27/09 Anthem Blue Cross and Blue Shield 2 Gannett
More informationPsychiatric Residential Treatment Facility (PRTF): Aligning Care Efficiencies with Effective Treatment. BHM Healthcare Solutions 2013 1
Psychiatric Residential Treatment Facility (PRTF): Aligning Care Efficiencies with Effective Treatment 1 Presentation Objectives Attendees will have a thorough understanding of Psychiatric Residential
More informationResidential Sub-Acute Detoxification Guidelines
I. Background Information A. Definition of Detoxification Residential Sub-Acute Detoxification Guidelines SAMSA s TIP #45, Detoxification and Substance Abuse Treatment: Treatment Improvement Protocols
More informationBehavioral Health Medical Necessity Criteria
Behavioral Health Medical Necessity Criteria Effective January 1, 2011 Revised and approved on 8/19/2010 The Office of Medical Policy and Technological Assessment (OMPTA) has developed policies that serve
More informationWORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL
WORKERS COMPENSATION PROTOCOLS WHEN PRIMARY INJURY IS PSYCHIATRIC/PSYCHOLOGICAL General Guidelines for Treatment of Compensable Injuries Patient must have a diagnosed mental illness as defined by DSM-5
More informationBehavioral Health Medical Necessity Criteria
Behavioral Health Medical Necessity Criteria Effective January 1, 2013 Revised and approved on 8/09/2012 Anthem Blue Cross 21555 Oxnard St. Woodland Hills, CA 91365 Toll free: 1-800-274-7767 The Office
More informationInpatient Behavioral Health and Inpatient Substance Abuse Treatment: Aligning Care Efficiencies with Effective Treatment
Inpatient Behavioral Health and Inpatient Substance Abuse Treatment: Aligning Care Efficiencies with Effective Treatment BHM Healthcare Solutions 2013 1 Presentation Objectives Attendees will have a thorough
More informationTREATMENT MODALITIES. May, 2013
TREATMENT MODALITIES May, 2013 Treatment Modalities New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) regulates the addiction treatment modalities offered in New York State.
More informationAppendix D. Behavioral Health Partnership. Adolescent/Adult Substance Abuse Guidelines
Appendix D Behavioral Health Partnership Adolescent/Adult Substance Abuse Guidelines Handbook for Providers 92 ASAM CRITERIA The CT BHP utilizes the ASAM PPC-2R criteria for rendering decisions regarding
More informationTHE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES
THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES PURPOSE: The goal of this document is to describe the
More informationMedical Necessity Criteria
Medical Necessity Criteria 2015 Updated 03/04/2015 Appendix B Medical Necessity Criteria Purpose: In order to promote consistent utilization management decisions, all utilization and care management staff
More informationLEVEL I SA: OUTPATIENT INDIVIDUAL THERAPY - Adult
LEVEL I SA: OUTPATIENT INDIVIDUAL THERAPY - Adult Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders of the American
More information75-09.1-08-02. Program criteria. A social detoxi cation program must provide:
CHAPTER 75-09.1-08 SOCIAL DETOXIFICATION ASAM LEVEL III.2-D Section 75-09.1-08-01 De nitions 75-09.1-08-02 Program Criteria 75-09.1-08-03 Provider Criteria 75-09.1-08-04 Admission and Continued Stay Criteria
More informationOptum By United Behavioral Health. 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines is a behavioral intervention program, provided in the context of a therapeutic milieu,
More informationOptum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Therapeutic group care services are community-based, psychiatric residential treatment
More informationLEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE)
LEVEL III.5 SA: SHT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders
More informationMEDICAL ASSOCIATES HEALTH PLANS HEALTH CARE SERVICES POLICY AND PROCEDURE MANUAL POLICY NUMBER: PP 27
POLICY TITLE: RESIDENTIAL TREATMENT CRITERIA POLICY STATEMENT: Provide consistent criteria when determining coverage for Residential Mental Health and Substance Abuse Treatment. NOTE: This policy applies
More informationLevel of Care Criteria Psychiatric Criteria
LEVEL OF CARE AND TREATMENT CRITERIA Level of Care Criteria Psychiatric Criteria Adult Half Day Partial Hospital Treatment Adult Psychiatric Home Care Child and Adolescent Half Day Partial Hospital Treatment
More informationPartial Hospitalization - MH - Adult (Managed Medicaid only Service)
Partial Hospitalization - MH - Adult (Managed Medicaid only Service) Definition Partial hospitalization is a nonresidential treatment program that is hospital-based. The program provides diagnostic and
More informationCIGNA MEDICAL NECESSITY CRITERIA
CIGNA MEDICAL NECESSITY CRITERIA for Treatment of Behavioral Health and Substance Use Disorders 839233 a 11/12 Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance
More informationMEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT
MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated
More informationPsychiatric Rehabilitation Clinical Coverage Policy No: 8D-1 Treatment Facilities Revised Date: August 1, 2012. Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 2.0 Eligible Recipients... 1 2.1 Provisions... 1 2.2 EPSDT Special Provision: Exception to Policy Limitations for Recipients
More informationMEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT
Summary of Changes MEDICAL POLICY MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD ADOLESCENT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 14, 2014 Status: Current Clarifications:
More informationPerformance Standards
Performance Standards Co-Occurring Disorder Competency Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best
More informationBehavioral Health Medical Necessity Criteria
Behavioral Health Medical Necessity Criteria Effective January 1, 2012 Revised and approved on 8/18/2011 The Office of Medical Policy and Technological Assessment (OMPTA) has developed policies that serve
More information8.401 Eating Disorder Partial Hospitalization Program (Adult and Adolescent)
8.40 STRUCTURED DAY TREATMENT SERVICES 8.401 Eating Disorder Partial Hospitalization Program (Adult and Adolescent) Description of Services: Eating Disorder partial hospitalization is a nonresidential
More informationInstructions for Funding Authorization/Reauthorization Process. Residential Alcohol and Other Drug Treatment Programs
Instructions for Funding Authorization/Reauthorization Process Clinician Instructions: Residential Alcohol and Other Drug Treatment Programs For initial authorization or authorization of continued stay,
More informationIntensive Outpatient Psychotherapy - Adult
Intensive Outpatient Psychotherapy - Adult Definition Intensive Outpatient Psychotherapy services provide group based, non-residential, intensive, structured interventions consisting primarily of counseling
More informationOptum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Statewide Inpatient Psychiatric Program Services (SIPP) Statewide Inpatient Psychiatric
More informationProcedure/ Revenue Code. Billing NPI Required. Rendering NPI Required. Service/Revenue Code Description. Yes No No
Procedure/ Revenue Code Service/Revenue Code Description Billing NPI Rendering NPI Attending/ Admitting NPI 0100 Inpatient Services Yes No Yes 0114 Room & Board - private psychiatric Yes No Yes 0124 Room
More informationINPATIENT SERVICES. Inpatient Mental Health Services (Adult/Child/Adolescent)
INPATIENT SERVICES Inpatient Mental Health Services (Adult/Child/Adolescent) Acute Inpatient Mental Health Services represent the most intensive level of psychiatric care and is delivered in a licensed
More informationAN INTRODUCTION ASAM
AN INTRODUCTION ASAM 2013 Ray Caesar LPC, LADC-MH Director of Addiction Specialty Programs ODMHSAS (405)522-3870 rcaesar@odmhsas.org AMERICAN SOCIETY OF ADDICTON MEDICINE ASAM ASAM is a professional organization
More informationAppendix B NMMCP Covered Services and Exceptions
Acute Inpatient Hospitalization MH - Adult Definition An Acute Inpatient program is designed to provide medically necessary, intensive assessment, psychiatric treatment and support to individuals with
More informationHow To Deliver A Substance Use Treatment
DMHAS ASAM SERVICE DESCRIPTIONS Please carefully review the Service Descriptions that are included in the DMHAS FFS Initiatives in this Annex A1 contract section. Initial the boxes below to identify the
More informationRULES OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES
RULES OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES CHAPTER 0940-05-47 MINIMUM PROGRAM REQUIREMENTS FOR ALCOHOL AND DRUG OUTPATIENT DETOXIFICATION TREATMENT FACILITIES TABLE
More informationChapter 7. Screening and Assessment
Chapter 7 Screening and Assessment Screening And Assessment Starting the dialogue and begin relationship Each are sizing each other up Information gathering Listening to their story Asking the questions
More informationJACKSON RECOVERY CENTERS Initial Substance Abuse Assessment Form. Substance used: Method: Age started: Last used: Frequency/progression of use:
JACKSON RECOVERY CENTERS Initial Substance Abuse Assessment Form PRESENTING PROBLEM DRUGS OF CHOICE Substance used: Method: Age started: Last used: Frequency/progression of use: Indicators of Addiction:
More informationCO-OCCURRING DISORDERS. Michaelene Spence MA LADC 8/8/12
CO-OCCURRING DISORDERS Michaelene Spence MA LADC 8/8/12 Activity Chemical Health? Mental Health? Video- What is Addiction HBO Terminology MI/CD: Mental Illness/Chemical Dependency IDDT: Integrated Dual
More information8.301 Residential Treatment Services (RTS) Eating Disorders (Adult and Adolescent)
8.30 RESIDENTIAL TREATMENT CENTER SERVICES 8.301 Residential Treatment Services (RTS) Eating Disorders (Adult and Adolescent) Description of Services: Residential Treatment Services are provided to individuals
More informationDepartment of Mental Health and Addiction Services 17a-453a-1 2
17a-453a-1 2 DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES General Assistance Behavioral Health Program The Regulations of Connecticut State Agencies are amended by adding sections 17a-453a-1 to 17a-453a-19,
More informationA Review of the Beacon Health Options Clinical Case Management
Clinical 3.50 CASE MANAGEMENT 3.504 Intensive Case Management (Child/Adolescent) Description of Services: Intensive Case Management provides for a single point of coordination/accountability in managing
More informationPerformance Standards
Performance Standards Outpatient Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best practice performances,
More informationState of Illinois. Department of Human Services/Division of Mental Health. Medical Necessity Criteria and Guidance Manual
Introduction Consistent with Rule 132, DHS/DMH is providing enhanced Medical Necessity Guidance for the following Rule 132 services: Assertive Community Treatment (ACT) adult only Community Support Team
More informationTREATMENT POLICY #10. Residential Treatment Continuum of Services
Michigan Department of Community Health, Behavioral Health and Developmental Disabilities Administration BUREAU OF SUBSTANCE ABUSE AND ADDICTION SERVICES TREATMENT POLICY #10 SUBJECT: Residential Treatment
More informationHow To Treat A Mental Illness At Riveredge Hospital
ABOUT US n Riveredge Hospital maintains the treatment philosophy of Trauma Informed Care. n Our commitment to providing the highest quality of care includes offering Animal Assisted Therapy, and Expressive
More informationWCHO PIHP/CA POLICY for the LIVINGSTON- WASHTENAW COORDINATING AGENCY Department: Coordinating Agency Author: Marci Scalera Approval Date 4/17/12
WCHO PIHP/CA POLICY for the LIVINGSTON- WASHTENAW COORDINATING AGENCY Department: Coordinating Agency Author: Marci Scalera Approval Date 4/17/12 Policy and Procedure Residential Treatment Services Policy
More informationOUTPATIENT DAY SERVICES
OUTPATIENT DAY SERVICES Intensive Outpatient Programs (IOP) Intensive Outpatient Programs (IOP) provide time limited, multidisciplinary, multimodal structured treatment in an outpatient setting. Such programs
More informationCOMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE
COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE INTRODUCTION High dose sublingual buprenorphine (Subutex) tablets are available in the following strengths 0.4 mg, 2 mg, and 8 mg. Suboxone tablets,
More informationAssessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal
Assessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal Roger Cicala, M. D. Assistant Medical Director Tennessee Physician s Wellness Program Step 1 Don t 1 It is legal in
More informationPERFORMANCE STANDARDS DRUG AND ALCOHOL PARTIAL HOSPITALIZATION PROGRAM. Final Updated 04/17/03
PERFORMANCE STANDARDS DRUG AND ALCOHOL PARTIAL HOSPITALIZATION PROGRAM Final Updated 04/17/03 Community Care is committed to developing performance standards for specific levels of care in an effort to
More informationMcLean Ambulatory Treatment Center Adult Partial Hospital and Residential Program for Alcohol and Drug Abuse 11 Mill Street Belmont, MA 02478-9106
Program Description Staffed by highly experienced psychiatrists, psychologists, social workers, nurses and addiction specialists, we are committed to working collaboratively with referring providers. Program
More informationRESIDENTIAL TREATMENT CENTER (RTC)
RESIDENTIAL TREATMENT CENTER (RTC) Service Description Residential Treatment Center (RTC) IOS provides 24-hour staff supervised all-inclusive clinical services in a community-based therapeutic setting
More information8.201 Acute Inpatient Eating Disorder (Adult and Adolescent)
8.20 INPATIENT SERVICES 8.201 Acute Inpatient Eating Disorder (Adult and Adolescent) Description of Services: Acute inpatient eating disorder treatment represents the most intensive level of psychiatric
More informationDiagnosis: Appropriate diagnosis is made according to diagnostic criteria in the current Diagnostic and Statistical Manual of Mental Disorders.
Page 1 of 6 Approved: Mary Engrav, MD Date: 05/27/2015 Description: Eating disorders are illnesses having to do with disturbances in eating behaviors, especially the consuming of food in inappropriate
More informationSOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011
SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011 This document is intended to be used with the Somerset Dual Diagnosis Operational Working guide. This document provides principles governing joint working
More informationMcLean Ambulatory Treatment Center Adult Partial Hospital and Residential Program for Alcohol and Drug Abuse 115 Mill Street Belmont, MA 02478-9106
Program Description Staffed by highly experienced psychiatrists, psychologists, social workers, nurses and addiction specialists, we are committed to working collaboratively with referring providers. Program
More informationThe purpose of this policy is to describe the criteria used by BHP in medical necessity determinations for inpatient CH treatment services.
Page 1 of 5 Category: Code: Subject: Purpose: Policy: Utilization Management Inpatient (IP) Chemical Health (CH) Level of Care Guidelines The purpose of this policy is to describe the criteria used by
More informationSPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE
SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital
More informationDay Treatment Mental Health Adult
Day Treatment Mental Health Adult Definition Day Treatment provides a community based, coordinated set of individualized treatment services to individuals with psychiatric disorders who are not able to
More informationAmerican Society of Addiction Medicine
American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,
More informationLevels of Care Criteria
Levels of Care Criteria Updated October 2011 E A N employee assistance network, inc. Doctor s Park, Suite 3-C 417 Biltmore Avenue Asheville NC 28801 800.454.1477 828.252.5725 Levels of Care Criteria Contents
More informationLEVEL II.1 SA: INTENSIVE OUTPATIENT - Adult
LEVEL II.1 SA: INTENSIVE OUTPATIENT - Adult Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance- Related Disorders of the American Society
More informationHAWAII ADMINISTRATIVE RULES TITLE 16 DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS CHAPTER 16
HAWAII ADMINISTRATIVE RULES TITLE 16 DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS CHAPTER 16 MENTAL HEALTH, ALCOHOL, AND DRUG ABUSE TREATMENT INSURANCE BENEFITS Subchapter 1 General Provisions 16-16-1 Purpose
More informationWest Virginia Bureau for Behavioral Health and Health Facilities Covered Services 2012
Assessment/Diagnostic & Treatment Services CATEGORY A & CATEGORY B Assessment/Diagnostic & Treatment Services are covered by Medicaid/Other third party payor or Charity Care - Medicaid Covered Services:
More informationProfessional Treatment Services in Facility-Based Crisis Program Children and Adolescents
Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Medicaid and North Carolina Health Choice (NCHC) Billable Service WORKING DRAFT Revision Date: September 11, 2014
More informationTreatment Facilities Amended Date: October 1, 2015. Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific... 1 2.2 Special
More informationPsychiatric Residential Treatment Facility Referral
Psychiatric Residential Treatment Facility Referral Date of referral: Psychiatric Residential Treatment Facility (PRTF) Referral Information Referral contact: Phone number: Referring facility/agency: Fax
More informationOptum By United Behavioral Health. 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines Assertive Community Treatment is a multi-disciplinary, selfcontained clinical team
More informationDEPARTMENT OF SERVICES FOR CHILDREN, YOUTH AND THEIR FAMILIES DIVISION OF CHILD MENTAL HEALTH SERVICES PROGRAM DESCRIPTIONS
DEPARTMENT OF SERVICES FOR CHILDREN, YOUTH AND THEIR FAMILIES DIVISION OF CHILD MENTAL HEALTH SERVICES PROGRAM DESCRIPTIONS OVERVIEW The Division of Child Mental Health Services provides both mental health
More informationLEVEL OF CARE GUIDELINES
LEVEL OF CARE GUIDELINES October 2012 Key Code: Throughout this document highlighting occurs to reflect direct language of either the State regulations or approved service definitions which were in effect
More informationQuality Management. Substance Abuse Outpatient Care Services Service Delivery Model. Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA)
Quality Management Substance Abuse Outpatient Care Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White
More informationPsychosocial Rehabilitation Program Services
Psychosocial Rehabilitation Program Services 2013 Overview Objectives Definitions What it is not What it is Who can provide What to focus on Populations of Service Documentation Requirements 2 Objectives
More informationMembers must meet medical necessity criteria for a particular LOC. Medically necessary services are those services that:
BEACON HEALTH STRATEGIES, LLC. / MASSACHUSETTS LEVEL OF CARE CRITERIA LEVEL OF CARE CRITERIA Beacon s Level of Care (LOC) criteria were developed from the comparison of national, scientific and evidence
More informationDoes This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective. Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A
Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A Disclaimer: This speaker has no financial disclaimers to report.
More informationDEPARTMENT OF PSYCHIATRY. 1153 Centre Street Boston, MA 02130
DEPARTMENT OF PSYCHIATRY 1153 Centre Street Boston, MA 02130 Who We Are Brigham and Women s Faulkner Hospital (BWFH) Department of Psychiatry is the largest clinical psychiatry site in the Brigham / Faulkner
More informationOptum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines (TBOS) Therapeutic behavioral on-site services are intended to prevent members under the
More informationSubacute Inpatient MH - Adult
Subacute Inpatient MH - Adult Definition Subacute Inpatient hospital psychiatric services are medically necessary short-term psychiatric services provided to a client with a primary psychiatric diagnosis
More informationHow To Get Counseling In Ohio
Attachment 1 Ohio Administrative Code» 3793:2 Program Standards» Chapter 3793:2-1 Alcohol and Drug Addiction Programs 3793:2-1-08 Treatment services. (A) The purpose of this rule is to define alcohol and
More informationThe Department of Children and Families Substance Abuse Program
The Department of Children and Families Substance Abuse Program Florida Supplement To the American Society of Addiction Medicine Patient Placement Criteria For the Treatment of Substance-Related Disorders
More informationToday s Topics. Session 2: Introduction to Drug Treatment. Treatment matching. Guidelines: where should a client go for treatment?
Session 2: Introduction to Drug Treatment Today s Topics Level of care determination How to know when treatment works What does treatment include Description of treatment modalities Naomi Weinstein, MPH
More informationContents Opioid Treatment Program Core Program Standards... 2
2016 OPIOID TREATMENT PROGRAM PROGRAM DESCRIPTIONS Contents Opioid Treatment Program Core Program Standards... 2 Court Treatment (CT)... 2 Detoxification... 2 Day Treatment... 3 Health Home (HH)... 3 Integrated
More information2015 OPIOID TREATMENT PROGRAM DESCRIPTIONS
2015 OPIOID TREATMENT PROGRAM PROGRAM DESCRIPTIONS Contents Opioid T reatment Program Core Program Standards... 2 Court Treatment (CT)... 2 Detoxification... 2 Day Treatment... 3 Health Home (HH)... 3
More informationAN OVERVIEW OF TREATMENT MODELS
AN OVERVIEW OF TREATMENT MODELS The 12-step Programs: Self-led groups that focus on the individual s achievement of sobriety. These groups are independent, self-supported, and are not aligned with any
More informationEvidence Based Approaches to Addiction and Mental Illness Treatment for Adults
Evidence Based Practice Continuum Guidelines The Division of Behavioral Health strongly encourages behavioral health providers in Alaska to implement evidence based practices and effective program models.
More informationAlcohol and Chemical Dependency Inpatient Treatment Programs
Alcohol and Chemical Dependency Inpatient Treatment Programs Road to Recovery For the treatment of alcohol or chemical dependency, Marworth s specialized programs incorporate a person s unique lifestyle,
More information12 Core Functions. Contact: IBADCC PO Box 1548 Meridian, ID 83680 Ph: 208.468.8802 Fax: 208.466.7693 e-mail: ibadcc@ibadcc.org www.ibadcc.
Contact: IBADCC PO Box 1548 Meridian, ID 83680 Ph: 208.468.8802 Fax: 208.466.7693 e-mail: ibadcc@ibadcc.org www.ibadcc.org Page 1 of 9 Twelve Core Functions The Twelve Core Functions of an alcohol/drug
More informationother caregivers. A beneficiary may receive one diagnostic assessment per year without any additional authorization.
4.b.(8) Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services (continued) Attachment 3.1-A.1 Page 7c.2 (a) Psychotherapy Services: For the complete description of the service providers,
More informationPerformance Standards
Performance Standards Targeted Case Management Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best practice
More informationMOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT
MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT June, 2014 Dean L. Babcock, LCAC, LCSW Associate Vice President Eskenazi Health Midtown Community Mental Health Centers Why is Evidence-Based
More informationConceptual Models of Substance Use
Conceptual Models of Substance Use Different causal factors emphasized Different interventions based on conceptual models 1 Developing a Conceptual Model What is the nature of the disorder? Why causes
More informationOptum By United Behavioral Health. 2015 New Jersey Managed Long-Term Services and Support (MLTSS) Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 New Jersey Managed Long-Term Services and Support (MLTSS) Medicaid Level of Care Guidelines (AMHR) AMHR provides services in/by a licensed community residence. Services
More information3.1 TWELVE CORE FUNCTIONS OF THE CERTIFIED COUNSELLOR
3.1 TWELVE CORE FUNCTIONS OF THE CERTIFIED COUNSELLOR The Case Presentation Method is based on the Twelve Core Functions. Scores on the CPM are based on the for each core function. The counsellor must
More informationAMERICAN SOCIETY OF ADDICTION MEDICINE Patient Placement Criteria for the Treatment of Substance-Related Disorders (Second Edition-Revised) 2001
AMERICAN SOCIETY OF ADDICTION MEDICINE Patient Placement Criteria for the Treatment of Substance-Related Disorders (Second Edition-Revised) 2001 LME Utilization Review Training LEARNING GOALS: By the end
More information