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ASAM Patient Placement Criteria: Understanding the Latest Updates © BHM Healthcare Solutions 2014 Learning Objectives To gain a comprehensive understanding of the latest ASAM Criteria updates and changes To understand how ASAM plays a critical role in determining Level of Care To apply knowledge obtained via case vignettes which will put attendee knowledge into play in making appropriate ASAM determinations © BHM Healthcare Solutions 2014 ASAM UPDATES © BHM Healthcare Solutions 2014 Updated ASAM Patient Placement Criteria © BHM Healthcare Solutions 2014 The Goal of the ASAM Criteria To unify the addiction field around a single set of criteria © BHM Healthcare Solutions 2014 ASAM Criteria Background • Previous Editions Patient Placement Criteria (1991) Patient Placement Criteria-2 (1996) Patient Placement Criteria-2R (2001) The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions (2013) © BHM Healthcare Solutions 2014 Underlying Concepts of The ASAM Criteria: Individualized, Clinicallydriven Treatment Patient/Participant Assessment BIOPSYCHOSOCIAL Dimensions Progress Severity of Illness/LOF Problems/Priorities Severity of Illness/LOF Plan INTENSITY OF SERVICEModalities and Levels of service © BHM Healthcare Solutions 2014 Assessment of Biopsychosocial Severity and Level of Function 1. Acute Intoxication and/or Withdrawal Potential 2. Biomedical conditions and complications 3. Emotional/Behavioral/Cognitive conditions and complications 4. Readiness to Change 5. Relapse/Continued Use/Continued Problem potential 6. Recovery Environment © BHM Healthcare Solutions 2014 Introduction to the Levels of Service © BHM Healthcare Solutions 2014 What’s Not New in The ASAM Criteria • The six assessment dimensions • The overall levels of care (though not Roman numerals) for addiction management • The “decision rules,” which link Intensity of Service back to the Severity of Illness maintained except for some updates in Withdrawal Management (“Detox”) © BHM Healthcare Solutions 2014 What is New in The ASAM Criteria • New Title: The ASAM Criteria – Treatment Criteria for Addictive, Substance Related, and Co-Occurring Conditions • Diagnostic Admission Criteria terminology changed to be compatible with DSM-5 • Section on working with managed care • Shaft away from “placement” criteria to “treatment” criteria It’s more than just “placement” © BHM Healthcare Solutions 2014 What is New in The ASAM Criteria • Table of Contents • Re-ordered to be more user friendly • Follows the flow from Historical Foundations to Guiding Principles to Assessment, Service Planning, and Placement Decisions Historical Foundations Guiding Principles to Assessment Service Planning © BHM Healthcare Solutions 2014 Placement Decisions What is New in The ASAM Criteria • Adolescent Criteria No longer separate/stand-alone Consolidated Adult and Adolescent content to minimize redundancy while preserving adolescent specific content © BHM Healthcare Solutions 2014 What is New in The ASAM Criteria • Appendices • Withdrawal Management Instruments • Dimension 5 constructs • Glossary • Withdrawal Management • The wording in the Levels of Care • Former section “Detoxification” becomes “Withdrawal Management” • Levels are now called WM-1, WM-2, WM-3, WM-4 • New approaches described to support increased use of less intensive levels of care for safe/effective management of withdrawal © BHM Healthcare Solutions 2014 What is New in The ASAM Criteria • Updated/revised terminology • Contemporary, strength-based, recovery-oriented: “Dual Diagnosis” • Now becomes “cooccurring disorders” “Inappropriate • Now becomes “high risk of substance use of abuse” substances” © BHM Healthcare Solutions 2014 What is New in The ASAM Criteria • Opioid use disorder specialized services “Opioid Maintenance Therapy” (OMT) • Now becomes “Opioid Treatment Services” (OTS) • Opioid antagonist medications • Opioid agonist medications • Their use in OTPs (regulated “Opioid Treatment Programs”) or in “Office-Based Opioid Treatment” (OBOT) © BHM Healthcare Solutions 2014 What is New in The ASAM Criteria • New Content and Sections • Additional text to improve application to address addiction treatment for Special Populations: • • • • Older Adults Persons in Safety Sensitive Occupations Parents with Children and Pregnant Women Persons in the Criminal Justice system (CJS) • Additional text to address treatment of conditions not traditionally included in specialty addiction treatment services: • Tobacco Use Disorder • Gambling Disorder © BHM Healthcare Solutions 2014 ADULT LEVELS OF CARE © BHM Healthcare Solutions 2014 Adult Levels of Care: Level 0.5 Early Intervention Dimensions Adult LOC 0.5 Early Intervention Dimension 1: Acute Intoxication and/or withdrawal potential No withdrawal risk Dimension 2: Biomedical Conditions and Complications None or very stable Dimension 3: Emotional, Behavioral, or None or very stable Cognitive Conditions and Complications Dimension 4: Readiness to Change Willing to explore how current use or high risk behaviors may affect personal goals Dimension 5: Relapse, Continued Use, or Continued Problem Potential Needs understanding of or skills to change current use patterns and/or high risk behavior Dimension 6: Recovery/Living Environment Social support system or significant others increase the risk of personal conflict about alcohol, tobacco, and/or other drug use © BHM Healthcare Solutions 2014 Adult Levels of Care: OTP-Level Opioid Treatment Program Dimensions Adult LOC: OTP-Level Opioid Treatment Program Dimension 1: Acute Intoxication and/or withdrawal potential Physiologically dependent on opioids and requires OTP to prevent withdrawal Dimension 2: Biomedical Conditions and Complications None or manageable with OP medical monitoring Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications None or very stable, or is receiving concurrent mental health monitoring Dimension 4: Readiness to Change Ready to change negative effects of use, not ready for total abstinence Dimension 5: Relapse, Continued Use, or Continued Problem Potential At risk of relapse or cont. use without ITP and structured therapy Dimension 6: Recovery/Living Environment Recovery environment is supportive and/or the patient has skills to cope © BHM Healthcare Solutions 2014 Adult Levels of Care: Level 1 Outpatient Services Dimensions Adult LOC: Level 1- Outpatient Services Dimension 1: Acute Intoxication and/or withdrawal potential Not exp. Significant withdrawal or at minimal risk of severe withdrawal. Manageable at Level 1(see withdrawal management criteria) Dimension 2: Biomedical Conditions and Complications None or very stable, or is receiving concurrent medical monitoring Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications None or very stable, or is receiving concurrent medical health monitoring Dimension 4: Readiness to Change Ready for recovery but needs motivation; or needs ongoing monitoring and disease management; or high severity in this dim. But not others: needs L 1 motivational enhancement strategies Dimension 5: Relapse, Continued Use, or Continued Problem Potential Able to maintain abstinence or control use and pursue recovery or motivational goals with minimal support Dimension 6: Recovery/Living Environment Recovery environment is supportive and/or the patient has skills to cope © BHM Healthcare Solutions 2014 Adult Levels of Care: Level 2.1 Intensive Outpatient Services(IOP) Dimensions Adult LOC: Level 2.1- IOP Dimension 1: Acute Intoxication and/or withdrawal potential Minimal risk of severe withdrawal, manageable at level 2-WM (see withdrawal management criteria) Dimension 2: Biomedical Conditions and Complications None or not a distraction from treatment. Manageable at Level 2.1 Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications Mild severity, with potential to distract from recovery; needs monitoring Dimension 4: Readiness to Change Variable engagement in treatment or lack of awareness of problem and requires structured program several x’s/week to promote progress Dimension 5: Relapse, Continued Use, or Continued Problem Potential Intensification of symptoms indicate high likelihood of relapse or cont. use or cont. problems without close monitoring several x’s/week Dimension 6: Recovery/Living Environment Recovery environment is not supportive, but with structure and support the patient can cope © BHM Healthcare Solutions 2014 Adult Levels of Care: Level 2.5 Partial Hospitalization Services Dimensions Adult LOC: Level 2.5-Partial Hospitalization Services Dimension 1: Acute Intoxication and/or withdrawal potential Moderate risk of severe withdrawal manageable at Level 2-WM (See withdrawal management criteria) Dimension 2: Biomedical Conditions and Complications None or not sufficient to distract from treatment. Such problems are manageable at Level 2.5 Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications Mild to moderate severity, with potential to distract from recovery; needs stabilization Dimension 4: Readiness to Change Poor engagement in treatment, ambivalence, or lack of progress; requires a near daily structured program or intensive engagement to promote progress Dimension 5: Relapse, Continued Use, or Continued Problem Potential Intensification of symptoms despite active participation in a Level 1 or 2.1 program; high likelihood of relapse or cont. use w/o near daily monitoring Dimension 6: Recovery/Living Environment Recovery environment is not supportive, but with structure, support, and relief from home environment the patient can cope © BHM Healthcare Solutions 2014 Adult Levels of Care: Level 3.1 Clinically Managed Low-Intensity Residential Services Dimensions Adult LOC: Level 3.1-Low Intensity Residential Services Dimension 1: Acute Intoxication and/or withdrawal potential No or minimal or stable withdrawal concurrently receiving Level 1-WM or Level 2-WM services Dimension 2: Biomedical Conditions and Complications None or stable, or receiving concurrent medical monitoring Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications None or minimal; not distracting recovery. If stable a co-occurring capable program is appropriate; if not a co-occurring enhanced program is required Dimension 4: Readiness to Change Cont. recovery but needs structured environment to maintain therapeutic gains Dimension 5: Relapse, Continued Use, or Continued Problem Potential Understands relapse but needs structure to maintain therapeutic gains Dimension 6: Recovery/Living Environment Environment is dangerous, but recovery is achievable if Level 3.1 24hr structure is available © BHM Healthcare Solutions 2014 Adult Levels of Care: Level 3.3 Clinically Managed Pop. Specific High Intensity Residential Services Dimensions Adult LOC: Level 3.3-Pop. Specific High Intensity Residential Services Dimension 1: Acute Intoxication and/or withdrawal potential At minimal risk of severe withdrawal, if withdrawal is present, manageable at Level 3.2-WM Dimension 2: Biomedical Conditions and Complications None or stable, or receiving concurrent medical monitoring Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications Mild to mod. Severity; needs structure to focus on recovery. Treatments should be designed to address sig. cognitive deficiencies; if stable a co-occurring program is appropriate; if not a co-occurring enhanced program is required Dimension 4: Readiness to Change Req. awareness and needs interventions only available at level 3.3 to engage and stay in treatment. If high severity in D4, but no other dimensions motivational enhancement strategies should be provided in Level 1 Dimension 5: Relapse, Continued Use, or Continued Problem Potential Little awareness and needs interventions available only at Level 3.3 to prevent current use with imminent dangerous consequences because of cognitive deficits or comparable dysfunction Dimension 6: Recovery/Living Environment Environment is dangerous and patient needs 24hr structure to learn to cope © BHM Healthcare Solutions 2014 Adult Levels of Care: Level 3.5 Clinically Managed High-Intensity Residential Services Dimensions Adult LOC: Level 3.5-High Intensity Residential Services Dimension 1: Acute Intoxication and/or withdrawal potential At minimal risk of severe withdrawal, if withdrawal is present, manageable at Level 3.2-WM Dimension 2: Biomedical Conditions and Complications None or stable, or receiving concurrent medical monitoring Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications Demonstrates inability to control impulses, or unstable or dangerous signs/symptoms require stabilization. Req 24hr setting to prepare for common integration and cont. care. Co-occurring enhanced setting req for those with severe and chronic mental illness Dimension 4: Readiness to Change Difficulty with or opposition to treatment with dangerous consequences. If high severity in D4 but no other Dimension, motivational enhancement strategies provided in Level.1 Dimension 5: Relapse, Continued Use, or Continued Problem Potential No recognition of the skills needed to prevent cont. use; with imminently dangerous consequences Dimension 6: Recovery/Living Environment Environment is dangerous, patient lacks skills to cope outside of a highly structured 24hr setting © BHM Healthcare Solutions 2014 Adult Levels of Care: Level 3.7 Medically Monitored Intensive Inpatient Services Dimensions Adult LOC: Level 3.7-Medically Monitored IIP Services Dimension 1: Acute Intoxication and/or withdrawal potential High risk of withdrawal, but manageable at Level 3.7-WM and does not req. the full resources of a licensed hospital Dimension 2: Biomedical Conditions and Complications Req’s 24hr medical monitoring but not intensive treatment Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications Moderate severity; needs 24hr structured setting; if the patient has a co-occurring mental disorder, req’s concurrent mental health services in a medically monitored setting Dimension 4: Readiness to Change Treatment adherence and impulse control is poor; needs motivating strategies in 24hr structured setting; if there is high intensity in D4 but no other Dimension, motivational strategies should be provided in Level 1 Dimension 5: Relapse, Continued Use, or Continued Problem Potential Unable to control use, with imminently dangerous consequences, despite active participation at less intensive LOC Dimension 6: Recovery/Living Environment Environment is dangerous and the patient lacks skills to cope outside of a highly structured 24hr setting © BHM Healthcare Solutions 2014 Adult Levels of Care: Level 4 Medically Managed Intensive Inpatient Services Dimensions Adult LOC: Level 3.7-Medically Monitored IIP Services Dimension 1: Acute Intoxication and/or withdrawal potential High risk of withdrawal req’s Level 4-WM and the full resources of a licensed hospital Dimension 2: Biomedical Conditions and Complications Req’s 24hr medical and nursing care and the full resources of a licensed hospital Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications Severe and unstable problems, req’s 24hr care with concomitant addition treatment (co-occurring enhanced) Dimension 4: Readiness to Change Problems in this Dimension do not qualify the patient for Level 4 services. If the patients only severity is in 4,5, and 6 w/o high severity in Dimensions 1,2, and 3 the patient does not qualify for Level 4. Dimension 5: Relapse, Continued Use, or Continued Problem Potential Problems in this dimension do not qualify the patient for Level 4 services. See further explanation in Dimension 4 Dimension 6: Recovery/Living Environment Problems in this dimension do not qualify the patient for Level 4 services. See further explanation in Dimension 4 © BHM Healthcare Solutions 2014 ADOLESCENT LEVELS OF CARE © BHM Healthcare Solutions 2014 Adolescent Levels of Care: Level 0.5 Early Intervention Dimensions Adolescent LOC 0.5 Early Intervention Dimension 1: Acute Intoxication and/or withdrawal potential No withdrawal risk Dimension 2: Biomedical Conditions and Complications None or very stable Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications A) Dangerous lethality; B) None or very stable. Any D3 issues are being addressed through concurrent mental health services and do not interfere with early intervention addition treatment services *see details Interference with Addiction and MH Recovery Efforts; C) Social Functioning; D) Ability for Self-Care; E) Course of Illness Dimension 4: Readiness to Change Willing to explore how current alcohol, tobacco, medication other drug use, and/or high-risk behaviors may affect achievement of personal goals Dimension 5: Relapse, Continued Use, or Continued Problem Potential Needs an understanding of, or skills to change, current alcohol, tobacco, other drug, or medication use patterns, and/or high-risk behaviors Dimension 6: Recovery/Living Environment Risk is initiation of or progression in substance use and/or high risk behaviors is increased by substance use or values about use. High risk behaviors of family, peers, or others in the adolescent’s social support system © BHM Healthcare Solutions 2014 Adolescent Levels of Care: Level 1 Outpatient Services Dimensions Adolescent LOC 1 Early Outpatient Services Dimension 1: Acute Intoxication and/or withdrawal potential No withdrawal risk Dimension 2: Biomedical Conditions and Complications None or very stable; or is receiving concurrent medical monitoring Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications A) Dangerous lethality; B) D3 Characterized by all of the following A) not at risk; B) minimal interference; C) mild to moderate impairment; D) mild to moderate difficulties w/daily living; E) minimal imminent risk *see details Interference with Addiction and MH Recovery Efforts; C) Social Functioning; D) Ability for Self-Care; E) Course of Illness Dimension 4: Readiness to Change Willing to engage in treatment; at least contemplating change but needs motivation and monitoring Dimension 5: Relapse, Continued Use, or Continued Problem Potential Able to maintain abstinence or control use and pursue recovery or motivational goals with minimal support Dimension 6: Recovery/Living Environment Family environment can support recovery with limited assistance © BHM Healthcare Solutions 2014 Adolescent Levels of Care: Level 2.1 Intensive Outpatient Services Dimensions Adolescent LOC 2.1 Intensive Outpatient Services Dimension 1: Acute Intoxication and/or withdrawal potential Minimal withdrawal or at risk of withdrawal Dimension 2: Biomedical Conditions and Complications None or stable, or distracting from treatment at a less intensive LOC; Manageable at L2.1 Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications A) Dangerous lethality; B) D3 Characterized by 1 or more of the following A) low risk; B) moderate interference; C) moderate impairment; D) moderate difficulties ; E) history predicts need for monitoring/interventions *see details Interference with Addiction and MH Recovery Efforts; C) Social Functioning; D) Ability for Self-Care; E) Course of Illness Dimension 4: Readiness to Change Req’s close monitoring and support several x’s/week to promote progress through stages of change because of variable treatment engagement Dimension 5: Relapse, Continued Use, or Continued Problem Potential Significant risk of relapse or cont. use or cont. problems and deterioration in level of functioning; poor prevention skills and needs close monitoring and support. Dimension 6: Recovery/Living Environment Environment is impeding his/her recovery and adolescent req’s close monitoring and support to overcome that barrier © BHM Healthcare Solutions 2014 Adolescent Levels of Care: Level 2.5 Partial Hospitalization Services Dimensions Adolescent LOC 2.5 Partial Hospitalization Services Dimension 1: Acute Intoxication and/or withdrawal potential Mild withdrawal or is at risk of withdrawal Dimension 2: Biomedical Conditions and Complications none or stable or distracting from treatment at a less intensive LOC; manageable at Level 2.5 Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications A) Dangerous lethality; B) D3 Characterized by one or more of the following 3 A) low risk of harm; B) moderate interference; C) moderate impairment; D) moderate difficulties ; E) history predicts need for near daily monitoring/interventions *see details Interference with Addiction and MH Recovery Efforts; C) Social Functioning; D) Ability for Self-Care; E) Course of Illness Dimension 4: Readiness to Change Req’s near daily structured program to progress because of little engagement or escalating use and impairment or no awareness of role of use in problems Dimension 5: Relapse, Continued Use, or Continued Problem Potential High risk of relapse or cont. use or cont. problems and deterioration in level of functioning; minimal prevention skills and needs daily monitoring and support Dimension 6: Recovery/Living Environment Environment renders recovery unlikely without near daily monitoring and support or frequent relief from his/her home environment © BHM Healthcare Solutions 2014 Adolescent Levels of Care: Level 3.1 Clinically Managed Low Intensity Residential Services Dimensions Adolescent LOC 3.1 Clinically Managed Low Intensity Residential Services Dimension 1: Acute Intoxication and/or withdrawal potential State of withdrawal is being managed concurrently at another LOC Dimension 2: Biomedical Conditions and Complications None or stable or receiving concurrent medical monitoring as needed Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications A) Dangerous lethality; B) D3 Characterized by one or more of the following 3 A) needs stable living environ.; B) moderate interference req 24hr support; C) moderate impairment 24hr supervision; D) moderate difficulties ; E) history predicts need for near daily monitoring/interventions *see details Interference with Addiction and MH Recovery Efforts; C) Social Functioning; D) Ability for Self-Care; E) Course of Illness Dimension 4: Readiness to Change Open to recovery but needs limited 24hr supervision to promote or sustain progress Dimension 5: Relapse, Continued Use, or Continued Problem Potential Understands potential for cont. use and has emerging recovery skills, needs supervision to reinforce skills or maintain gains Dimension 6: Recovery/Living Environment Environment poses a risk to his/her recovery so that he/she requires alternative residential secure placement or support © BHM Healthcare Solutions 2014 Adolescent Levels of Care: Level 3.5 Clinically Managed Medium Intensity Residential Services Dimensions Adolescent LOC 3.5 Clinically Managed Medium Intensity Residential Services Dimension 1: Acute Intoxication and/or withdrawal potential Mild to moderate withdrawal, does not need pharmacological management or frequent monitoring Dimension 2: Biomedical Conditions and Complications None or stable or receiving concurrent medical monitoring as needed Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications A) Dangerous lethality; B) D3 Characterized by one or more of the following 3 A) moderate but stable.; B) moderate to severe; C) moderate to severe impairment; D) moderate to severe difficulties ; E) history predicts destabilization w/o medium intensity treatment *see details Interference with Addiction and MH Recovery Efforts; C) Social Functioning; D) Ability for Self-Care; E) Course of Illness Dimension 4: Readiness to Change Needs intensive motivational strategies in a 24hr structured program to address engagement and/or lack of recognition of current severe impairment Dimension 5: Relapse, Continued Use, or Continued Problem Potential Unable to control use w/o 24hr structured program; unable to overcome triggers at a less intensive LOC or has high chronicity and/or poor response Dimension 6: Recovery/Living Environment Environment is dangerous to his/her recovery so that he/she requires residential treatment to promote recovery goals or for protection © BHM Healthcare Solutions 2014 Adolescent Levels of Care: Level 3.7 Medically Monitored High Intensity Inpatient Services Dimensions Adolescent LOC 3.7 Medically Monitored High Intensity Inpatient Services Dimension 1: Acute Intoxication and/or withdrawal potential Moderate to severe withdrawal but this is manageable at L3.7 Dimension 2: Biomedical Conditions and Complications Requires 24hr medical monitoring, but not intensive treatment Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications A) Dangerous lethality; B) D3 Characterized by one or more of the following 3 A) moderate risk of harm needing high intensity 24hr monitoring.; B) severe interference req 24hr support; C) severe impairment 24hr supervision; D) severe difficulties ; E) history predicts destabilization w/o high intensity IP Services *see details Interference with Addiction and MH Recovery Efforts; C) Social Functioning; D) Ability for Self-Care; E) Course of Illness Dimension 4: Readiness to Change Needs motivating strategies In a 24hr medically monitored program due to no treatment engagement or because he/she needs high intensity case management Dimension 5: Relapse, Continued Use, or Continued Problem Potential unable to interrupt high severity or frequency pattern of use and avoid dangerous consequences w/o high intensity 24hr interventions Dimension 6: Recovery/Living Environment environment is dangerous to his/her recovery and he/she requires residential treatment to promote recovery goals or for protection and assistance in transitioning to a less intensive LOC © BHM Healthcare Solutions 2014 Adolescent Levels of Care: Level 4 Medically Managed Intensive Inpatient Services Dimensions Adolescent LOC 4 Medically Managed Intensive Inpatient Services Dimension 1: Acute Intoxication and/or withdrawal potential Severe withdrawal and requires intensive active medical management Dimension 2: Biomedical Conditions and Complications Req’s 24hr medical and nursing care and the full resources of a licensed hospital Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications A) Dangerous lethality; B) D3 Characterized by one or more of the following 3 A) severe risk of harm; B) very severe interference; C) very severe, dangerous impairment; D) very severe difficulties ; E) history predicts destabilization w/o inpatient medical management *see details Interference with Addiction and MH Recovery Efforts; C) Social Functioning; D) Ability for Self-Care; E) Course of Illness Dimension 4: Readiness to Change Problems in this dimension do not qualify the patient for L4 services; If the patient’s only severity is in D4, 5, and 6 w/o high severity in D1,2, or 3 patient does not qualify for L4 Dimension 5: Relapse, Continued Use, or Continued Problem Potential Problems in this dimension do ot qualify the patient for L4 services; If the patient’s only severity is in D4, 5, and 6 w/o high severity in D1,2, or 3 patient does not qualify for L4 Dimension 6: Recovery/Living Environment Problems in this dimension do ot qualify the patient for L4 services; If the patient’s only severity is in D4, 5, and 6 w/o high severity in D1,2, or 3 patient does not qualify for L4 © BHM Healthcare Solutions 2014 Service Planning and Placement: Level of Withdrawal Management for Adults Level of Withdrawal Management For Adults Level Description Ambulatory Withdrawal Management without Extended On-site Monitoring 1-WM Mild withdrawal with daily or less than daily out-patient supervision; likely to complete withdrawal management and to continue treatment or recovery Ambulatory Withdrawal Management with Extended Onsite Monitoring 2-WM Moderate withdrawal with all day withdrawal management support and supervision; at night, has supportive family or living situation; likely to complete withdrawal management and increase likelihood of continuing treatment or recovery Clinically Managed Residential Withdrawal Management 3.2-WM Moderate withdrawal, but needs 24hr support to complete withdrawal management and increase likelihood of continuing treatment or recovery Medically Monitored Inpatient Withdrawal Management 3.7-WM Severe withdrawal needs 24hr nursing care and MD visits as necessary; unlikely to complete withdrawal management without medical, nursing monitoring Medically Managed Intensive Inpatient Withdrawal Management 4-WM Severe, unstable withdrawal and needs 24hr nursing care and daily physician visits to modify withdrawal management regimen and manage medical instability © BHM Healthcare Solutions 2014 Contact Information Website: www.bhmpc.com Email: [email protected] Twitter: @BHMHealthcare Phone Number: 1-888-831-1171 Fax Number: 1-888-818-2425 © BHM Healthcare Solutions 2013 39