Or. Admin. Code § 309-018-0181

Current through Register Vol. 63, No. 12, December 1, 2024

Section 309-018-0181 - SUD Residential ASAM Level of Care 3.1

Clinically Managed Low-Intensity Residential Substance Use Disorder Services ASAM Level of Care 3.1 In addition to any other requirements described in these rules and applicable statutes, programs licensed to render adolescent or adult residential ASAM Level of care 3.1 services shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following standards:

(1) ASAM Level 3.5 programs shall ensure:

(a) ASAM dimensional admission criteria:

(A) The individual meets ASAM dimensional admission criteria in each of the Dimensions;

(B) Dimensions 1, 2 and 3 symptoms are assessed as mild to moderate risk, or are stabilized by this 24-hour structured environment;

(C) Dimensions 4, 5 and 6 are assessed as moderate to high risk;

(D) Individual needs 24-hour structured environment to make therapeutic gains;

(E) Individual is able to tolerate and benefit from a planned program of therapeutic services and supports; and

(F) Individual meets diagnostic criteria for a moderate or severe substance use or addictive disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information.

(b) Program is able to consult with an LMP daily.

(c) Program has direct affiliation with other levels of care and with other service providers.

(2) In addition to any other requirements described in these rules and applicable statutes, programs licensed to render residential adolescent Clinically Managed Low-Intensity Substance Use Disorder Residential Services, ASAM Level of care 3.1 services shall meet and maintain documentation demonstrating ongoing compliance with the following requirements:

(a) Adolescents may be placed in ASAM Level 3.1 while concurrently receiving ASAM Level 2.5 services;

(b) Adolescent ASAM dimensional admission criteria:

(A) Adolescent meets criteria in at least two of the Dimensions;

(B) Adolescent is able to tolerate and benefit from a planned program of therapeutic services and supports; and

(C) Adolescent meets diagnostic criteria for a moderate or severe substance use or addictive disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information.

(c) Adolescent ASAM Level 3.1 programs shall ensure the structure of services includes each of the following:

(A) Offer at least 5 hours per week of low-intensity substance use disorders treatment services and supports in a Recovery Environment to assist the individual in stabilization and developing recovery and relapse prevention skills;

(B) When clinically indicated, the program shall facilitate the continuation of or opportunity to obtain medications to treat opioid use disorders; and

(C) Facilitate individuals in obtaining low-barrier mental, physical, dental and other ancillary health care services and supports throughout the treatment episode of care.

(d) Staff are knowledgeable about adolescent development and in therapeutic engagement. Staffing shall be made available as follows:

(A) At least one milieu or program staff shall be present on the premises of the program and readily accessible and responsive to residents 24 hours a day, 7 days per week;

(B) Substance use disorders treatment staff are onsite rendering services 5 days per week;

(C) 24 hour, 7 day per week consultation available with a substance use disorders treatment staff, or a supervising or managing staff; and

(D) Program staff are able to consult with a LMP daily.

(e) Program shall offer an array of services and supports to meet the documented needs of the individual, including at minimum;

(A) Individual and group counseling sessions;

(B) Urinalysis screening when clinically indicated; and

(C) Psychoeducation, motivational enhancement and skill building.

(3) Co-occurring Capable ASAM Level of Care 3.1 license. Only programs licensed to render Clinically Managed Low-Intensity Residential Substance Use Disorder Services ASAM Level of Care 3.1 may choose to apply to also be licensed to render Co-Occurring Capable ASAM Level of Care 3.1 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.1 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Demonstrate that each individual placed at this ASAM Level of Care meets the following criteria:

(A) ASAM Dimensional criteria required for ASAM Level of Care 3.1;

(B) Describe how the individual meets diagnostic criteria for a co-occurring mental health disorder, per DSM-5-TR, that meet the stability criteria for placement in a co-occurring capable program, or emotional, behavioral or cognitive symptomology that are troubling or suggestive of a mental health disorder are causing the individual distress but do not meet the threshold for a DSM-5-TR diagnosis; and

(C) The mental health condition or symptoms are stable, or concerns are stabilized when in a 24-hour recovery environment.

(b) Offer mental health evaluation and counseling services;

(c) Offer or coordinate psychiatric services when clinically indicated, including medication management and the opportunity to obtain medications to treat mental health conditions; and

(d) Document within the service plan the individual's mental health symptoms, the relationship between the mental health and substance use and addictive disorders and disorders, and describe the individual's mental health status.

(4) Co-occurring Enhanced ASAM Level of Care 3.1 license. Only programs licensed to render Clinically Managed Low-Intensity Residential Substance Use Disorder Services ASAM Level of Care 3.1 may choose to apply to also be licensed to render Co-Occurring Enhanced ASAM Level of Care 3.1 services. When licensed as such, in addition to the requirements for ASAM Level of Care 3.1 services, programs shall, at a minimum, meet and maintain documentation demonstrating the ongoing compliance with the following requirements:

(a) Individuals placed at this ASAM Level of Care shall meet the following ASAM admission criteria:

(A) ASAM dimensional criteria required for ASAM Level of Care 3.1; and

(B) Individual meets diagnostic criteria for a co-occurring mental health disorder, per DSM-5-TR, that meet the stability criteria for placement in a co-occurring capable program or the probability of such a diagnosis is determined through collateral information.

(b) Offer mental health evaluation and counseling;

(c) Offer psychiatric services, including when clinically indicated, medication management and the opportunity to obtain medications to treat mental health conditions; and

(d) Document within the service plan the individual's mental health symptoms, the relationship between the mental health and substance use and addictive disorders and describe the individual's mental health status.

(5) Biomedical Enhanced ASAM Level of Care 3.1 license. Only programs licensed to render Clinically Managed Low-Intensity Residential Substance Use Disorder Services ASAM Level of Care 3.1 may choose to also apply to be licensed to render Biomedical Enhanced ASAM Level of Care 3.1 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.1 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements:

(a) Individuals placed at this ASAM Level of Care shall meet the following criteria:

(A) ASAM Dimensional criteria required for ASAM Level of Care 3.1; and

(B) Biomedical condition is stable or does not require medical or nursing monitoring and individual is capable of self-administering medications; or

(C) Biomedical condition is not severe enough to warrant impatient treatment but is sufficient to distract from treatment or recovery efforts and requires medical or nursing monitoring by the program or through an established arrangement with another provider.

(b) Medical treatment staff assess, treat and monitor biomedical disorders and monitor medication administration;

(c) The intensity of medical and nursing oversight and care meets the individual's needs; and

(d) Program staff have access to consult a LMP 24 hours a day, 7 days a week.

Or. Admin. Code § 309-018-0181

BHS 10-2023, adopt filed 04/07/2023, effective 4/7/2023

Statutory/Other Authority: ORS 161.390-161.400, 413.042, 428.205-428.270, 430.640 & 443.450

Statutes/Other Implemented: ORS 430.010, 430.205-430.210, 430.254-430.640, 430.850-430.955, 443.400-443.460, 443.991, 461.549 & 743A.168