N.H. Admin. Code § He-W 513.11

Current through Register No. 36, September 5, 2024

Section He-W 513.11 - ASAM Level of Care Service Descriptions

The covered services in He-W 513.05 above that are required to be provided in accordance with the levels of care in ASAM Criteria (2013), available as noted in Appendix A, shall include the following:

(a) Services required to be provided consistent with Level 1, ASAM Criteria (2013), shall include:

(1) Affiliation with other levels of care, including:

a. Other levels of specialty substance use disorder treatment for additional problems identified through a comprehensive biophysical assessment; and

b. Coordination of services and service planning within a provider agency, with other providers, and with other human service agencies and systems such as local health and social services departments;

(2) Continued treatment planning individualized to the recipient's needs;

(3) Medical, psychiatric, psychological, laboratory, and toxicology services on-site or through consultation or referral, and in accordance with He-W 513.11(h);

(4) Coordinating discharge or transfer planning an referrals for counseling and community recovery support groups;

(5) Random drug screening to monitor and reinforce treatment gains as appropriate to the recipient's treatment plan;

(6) Stabilization of imminent risk;

(7) Services in an amount, frequency, and intensity appropriate to the objectives of the treatment plan;

(8) For recipients with mental health conditions, the addressing of the issues of psychotropic medication, mental health treatment, and their relationship to substance use and addictive disorders as the need arises;

(9) Skill restoration therapy to reduce or remove barriers to recipients who are achieving and maintaining recovery;

(10) Emergency services by telephone 24 hours a day, 7 days a week;

(11) Assistance in accessing transportation services for recipients who lack transportation;

(12) Motivational enhancement and engagement strategies appropriate to the recipient's stage of readiness and desire to change;

(13) Family therapy for the direct benefit of the recipient in accordance with the recipient's needs and treatment goals identified in the treatment plan and for the purpose of assisting in the recipient's recovery; and

(14) Skilled treatment services which may include evaluation, individual and group counseling, motivational enhancement, family therapy with recipient present, psychoeducational groups, psychotherapy, addiction pharmacotherapy, medication management, or other skilled therapies;

(b) Services required to be provided consistent with Level 2.1, ASAM Criteria (2013), shall include:

(1) The services in (a) (1) - (13) above;

(2) A planned format of therapies delivered on an individual and group basis and adapted to the recipient's developmental stage and comprehension level; and

(3) Skilled treatment services which:

a. May include evaluation, individual and group counseling, motivational enhancement, family therapy with individual present, psychoeducational groups, psychotherapy, addiction pharmacotherapy, medication management, or other skilled therapies; and

b. Shall be provided a minimum of 9 hours per week for individuals age 21 and over and a minimum of 6 hours per week for individuals under age 21;

(c) Services required to be provided consistent with Level 2.5, ASAM Criteria (2013), shall include:

(1) The services in (a) (1) - (13) above;

(2) A planned format of therapies delivered on an individual and group basis and adapted to the patient's developmental stage and comprehension level; and

(3) Skilled treatment services which:

b. Shall be provided a minimum of 20 hours per week;

(d) Services required to be provided consistent with Level 3.1, ASAM Criteria (2013), shall include:

(1) The services in (a) (1) - (9) and (a) (12) - (13) above;

(2) A planned format of therapies delivered on an individual and group basis and adapted to the patient's developmental stage and comprehension level;

(3) Daily clinical services to improve the individual's ability to structure and organize tasks of daily living and recovery to include individual skills development and restoration to prevent continuation or recurrence of substance misuse;

(4) Planned clinical program activities which:

a. Shall be adapted to the individual's developmental stage, level of comprehension, level of understanding, and physical abilities for the purpose of stabilizing and maintaining the stability of the individual's substance use disorder symptoms and to help him or her develop and apply recovery skills;

b. May include relapse prevention, exploring interpersonal choices, medication education and management, addiction pharmacotherapy, psychoeducational groups, skill development services, health education, family reintegration, recovery support services, or development of a social network supportive of recovery; and

c. Consist of at least 5 hours per week of professionally directed treatment; and

(5) Monitoring of the individual's adherence to taking any prescribed medications or permitted over the counter medications or supplements;

(e) Services required to be provided consistent with Level 3.5, ASAM Criteria (2013), available as noted in Appendix A, shall include:

(1) The services in (a) (1) - (9) and (a) (12) - (13) above;

(2) A planned format of therapies delivered on an individual and group basis and adapted to the patient's developmental stage and comprehension level;

(4) Planned clinical program activities which:

(5) Monitoring of the individual's adherence to taking any prescribed medications or permitted over the counter medications or supplements;

(f) Services required to be provided consistent with Level 1-WM, ASAM Criteria (2013), available as noted in Appendix A, shall include:

(1) The services in (a) (1) - (8) and (a) (10) - (11) above;

(2) A comprehensive medical history and physical examination of the individual at admission;

(3) A range of cognitive, behavioral, medical, mental health, and other skilled therapies administered to the individual on a group or individual basis which:

a. Shall be designed to enhance the individual's understanding of addiction, the completion of the withdrawal management process, and referral to an appropriate level of care for continuing treatment;

b. Shall be clinically necessary based on the individual's progress through withdrawal management and the assessed needs in ASAM Dimensions 2 through 6; and

c. May include multidisciplinary individualized assessment and treatment, health education services, and medical nursing care and observation;

(4) Family involvement in the withdrawal management process for the direct benefit of the individual in accordance with the individual's needs and treatment goals identified in the individual's treatment plan and for the purpose of assisting in the individual's recovery;

(5) Individual assessment, medication or non-medication methods of withdrawal management, patient education, non-pharmacological clinical support, and involvement of family members or significant others in the withdrawal management process with the individual present; and

(6) Inclusion in therapies of physician or nurse monitoring, assessment, and management of signs and symptoms of intoxication and withdrawal;

(g) Services required to be provided consistent with Level 3.7-WM, ASAM Criteria (2013), available as noted in Appendix A, shall include:

(1) The services in (a) (1) - (8) above;

(2) A comprehensive medical history and physical examination of the individual at admission;

(3) A range of cognitive, behavioral, medical, mental health, and other skilled therapies administered to the individual on a group or individual basis which:

b. Shall be clinically necessary based on the individual's progress through withdrawal management and the assessed needs in ASAM Dimensions 2 through 6; and

c. May include multidisciplinary individualized assessment and treatment, health education services, and medical nursing care and observation;

(5) Daily clinical services to assess and address the needs of each individual which may include:

a. Appropriate medical services;

b. Individual and group therapies; and

c. Withdrawal support; and

(6) Hourly nurse monitoring of the individual's progress and medication administration as needed; and

(h) Services described in He-W 513.11(a) (3) shall be provided in accordance with the following:

(1) Medical and psychiatric consultation shall be available within 24 hours by telephone or, if in person, within a time frame appropriate to the severity and urgency of the consultation requested for services provided at Level 1, ASAM Criteria (2013), available as noted in Appendix A;

(2) Psychiatric and other medical consultation shall be available within 24 hours by telephone and within 72 hours in person for services provided at Level 2.1, ASAM Criteria (2013), available as noted in Appendix A;

(3) Psychiatric and other medical consultation shall be available within 8 hours by telephone and within 48 hours in person for services provided at Level 2.5, ASAM Criteria (2013), available as noted in Appendix A; and

(4) Telephone or in-person consultation with a physician or any other practitioner licensed to perform the duties designated for a physician shall be available 24 hours a day, 7 days a week for emergency services provided at Level l-WM and Level 3.7-WM, ASAM Criteria (2013), available as noted in Appendix A.

N.H. Admin. Code § He-W 513.11

Derived From Volume XXXVIII Number 50, Filed December 13, 2018, Proposed by #12681, Effective 11/27/2018, Expires 11/27/2028.