Section 2060.450  Mandated Treatment

a)         Patients with SUDs often initiate services resulting from a court order or employment that require completion of a specified early intervention (Level 0.5) or treatment level of care or a finite number of service hours; however, these directives shall not remove the responsibility of the organization to administer an ASAM assessment, as specified in Section 2060.435, and to communicate to the referral source or any third-party payor any subsequent recommended change in level of care or the length of individual treatment.  These directives may also require increased case management and reporting with referral sources.

b)         Organizations that accept patients with mandated treatment requirements shall:

1)         Adhere to criteria and associated clinical protocol developed and approved by the medical director that will allow admission and initial placement in the mandated level of care contained in the directive so that the patient can promptly initiate services;

2)         Have policies and procedures for the timely receipt and use of any prior screening or assessment information to minimize duplication of services;

3)         Follow all requirements for any required medical review and confirmation of diagnosis, initial placement, and treatment plan as specified in Section 2060.445;

4)         Follow all requirements in Subpart D regarding the delivery of SUD clinical services;

5)         Ensure that the patient and referral source has been informed that third-party insurance coverage may not authorize treatment in a level of care not deemed medically or clinically necessary;

6)         Obtain all necessary patient authorizations to ensure effective and timely communication with the referral source regarding patient progress, recommended changes in intensity or duration of treatment, discharge from treatment, and the patient's continuing care plan; and

7)         When possible, obtain agreements with referral sources regarding resolution of any discrepancy between the mandated treatment directive and the subsequent assessment, diagnosis, placement, and continued service recommendations.