Section 2060.475  Continued Service Review Criteria

a)         A continued service review is an examination and comparison of the current treatment plan and all subsequent progress notes as they relate to each of the six dimensions of the ASAM criteria and the identification of any new problems that need to be addressed.  The resolution of current goals and objectives or the identification of new problems will determine:

1)         Amendments to the treatment plan;

2)         Continuation in the current level of care;

3)         Transfer to a different level of care;

4)         Discharge; or

5)         Determination of the next review date.

b)         A continued service review may occur at any time to determine continued service in the current level of care or to update components of the treatment plan if needed; however, at a minimum, continued service review shall occur:

1)         Every 60 calendar days or after every 10 hours of treatment (whichever occurs first) for patients in Level 1 and 3.1 care;

2)         Every 30 calendar days or after every 27 hours of treatment (whichever occurs first) for any patient in Level 2 care;

3)         Every 14 calendar days or after every 40 hours of treatment (whichever occurs first) for any patient in Level 2.5 care;

4)         Every 7 calendar days for any patient in Level 3.5 care;

5)         Every 24 hours for any patient in Level 3.2 or 3.7 care, unless another time frame is specified by the medical director; or

6)         For patients receiving medication in an opioid treatment program (OTP), and not receiving any clinical treatment service in any of the above referenced levels of care, every 30 days during the first 90 days of medication and every 90 days thereafter for any patient who has demonstrated 90 days of stable participation and for whom there has been no biomedical complication or change.

c)         The continued service review shall include the participation of the patient and be documented by progress note in the patient record.  The documentation shall be signed and dated by the patient and professional staff who conducted the review and dated and signed by the medical director, physician, nurse practitioner, or physician assistant working under their supervision only if there is a significant bio-medical change in ASAM Dimension 1 or 2 that requires medical or nursing monitoring or if there is a significant change in an identified mental health problem in ASAM Dimension 3 that requires a change in medication management or monitoring.

d)         When a continued service review recommends patient transfer to another level of care or discharge, such change will be completed within 48 hours after the date of the continued service review.