OAR 309-018-0183: SUD Residential ASAM Level of Care 3.5

Adolescent Clinically Managed Medium-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5 and Adult Clinically Managed High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5. In addition to any other requirements described in these rules and applicable statutes, programs licensed to render residential adolescent or adult Clinically Managed High-Intensity Substance Use Disorder Residential Services, ASAM Level of care 3.5 services shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements: (1) ASAM Level 3.5 programs shall ensure: (a) ASAM dimensional admission criteria: (A) Dimensions 1 and 2 are stable or can be managed at this Level of Care; and (B) Dimensions 3, 4, 5 and 6 are rated as moderate to severe risk without the structure of this setting. (b) ASAM Level of Care 3.5 programs shall ensure the structure of services includes each of the following: (A) Provide a 24-hour, structured, supportive recovery environment that both treats the substance use and supports the functional limitations of an individual with co-occurring social and psychological conditions; (B) Offer services and supports that are primarily habilitative, addressing educational and vocational limitations, and social and emotional dysfunctional behaviors through use of targeted interventions such as evidence based therapeutic interventions and skills training; (C) Program shall pace the delivering of information and services to the meet the ability of the individual; and (D) Documentation shall include a description of the individual’s co-occurring condition(s), the relationship between the co-occurring condition(s) and substance use, and the individual’s mental health status. (c) Staffing shall be made available as follows: (A) Utilize an interdisciplinary team approach as demonstrated through regular, documented meetings; (B) Staff shall include substance use disorders treatment staff, milieu staff, and medical treatment staff including LMP; (C) Program staff and milieu staff are on-site 24-hours, 7 days per week in staffing levels that are responsive to the number of the individuals present and the severity of symptoms, and at least one program staff is readily available to respond to and assist individuals; (D) Medical treatment staff are knowledgeable about biomedical, mental health, substance use, and the interactions of those conditions, have training in behavior management techniques, and are staffed to meet the needs of each individual; (E) LMP shall be available for consult 24-hours per day, 7 days per week; and (F) Supervisory or Management staff who are trained in substance use disorders treatment are available on-site or by phone 24 hours per day, 7 days per week. (d) A variety of services and supports shall be offered daily. Each week the services and supports offered shall include the following: (A) Stabilization services; (B) Motivational and engagement strategies and interventions; (C) Occupational or recreational activities; (D) Skill building to address Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL): (E) Health and medication education and management; (F) Close observation and monitoring of the individual’s adherence to medications administered by the program; (G) Relapse prevention, interpersonal, coping and community reintegration skills; (H) Family services, including services just for families or identified support persons; (I) Urinalysis screening when clinically indicated; (J) Intensive case management; and (K) Individual and group counseling sessions. (2) In addition to any other requirements described in these rules and applicable statutes, programs licensed to render residential Adolescent Clinically Managed Medium-Intensity Substance Use Disorder Residential Services, ASAM Level of care 3.5 services shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with the following requirements: (a) Adolescent ASAM dimensional admission criteria: (A) The adolescent meets ASAM Diagnostic Admission Criteria specifications in at least two dimensions; (B) If the adolescent is at risk of or experiencing acute or subacute intoxication or withdrawal, the symptoms are mild to moderate; (C) The adolescent needs 24-hour structured environment to make therapeutic gains; (D) The adolescent is able to tolerate and benefit from a planned program of therapeutic services and supports; and (E) The 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. (b) The facility and milieu shall be a 24-hour, safe, contained, and structured recovery environment. Services and supports are primarily habilitative, addressing behavioral, social, and emotional dysfunction through use of targeted interventions such as evidence based, pro-social, therapeutic interventions and skills training to facilitate healthy reintegration into the community. (c) Utilize an interdisciplinary team approach, as demonstrated through regular, documented meetings and by ensuring: (A) Milieu staff are on-site 24-hours, 7 days per week in staffing levels that are responsive to the number of the individuals present and the severity of symptoms and at least one program staff is readily available to respond to and assist individuals; (B) Behavioral health clinician(s) trained in recognizing the signs and symptoms of intoxication and withdrawal and the monitoring and treating of those conditions, and behavioral health crisis prevention and response; (C) Medical treatment staff able to implement protocols are staffed to meet the intensity of the oversight and treatment of each individual’s needs; (D) LMP with training in adolescence shall be available for emergency consult 24-hours per day, 7 days per week; and (E) Supervisory or Management staff who are trained in substance use disorders treatment are available on-site or by phone 24 hours per day, 7 days per week. (d) Services shall be offered daily and include the following: (A) Educational services shall be provided in accordance with local regulations and provide opportunities to remedy educational deficits; (B) Stabilization services, including: (i) Daily monitoring of withdrawal symptoms; and (ii) Close observation and monitoring of the individual’s adherence to medications administered by the program. (C) Relapse prevention, coping and community reintegration skills; (D) Family services, including services just for families or identified support persons; (E) Motivational and engagement strategies and interventions; (F) Urinalysis screening when clinically indicated; (G) Individual counseling sessions; and (H) Skill building, including teaching and practicing pro-social behaviors. (e) Address co-occurring conditions when applicable: (A) Arrange for or provide appropriate medical procedures, including laboratory and toxicology testing; (B) Arrange for or provide appropriate medical and psychiatric treatment through consultation, referral to a community provider or transfer to another Level of Care; (C) Have direct affiliation with other ASAM Levels of Care; (D) Pace the delivering of information and services to the meet the ability of the adolescent; and (E) Documentation shall include a description of the adolescent’s co-occurring conditions, the relationship between the co-occurring condition(s) and substance use, and the individual’s mental health status. (3) Adolescent ASAM Level of Care 3.5-WM Withdrawal Management Services are an additional and optional version of ASAM Level of Care 3.5 services for adolescents. Only programs licensed to render Adolescent Clinically Managed Medium-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5 may also apply to be licensed to render Adolescent ASAM Level of Care 3.5-WM services. When licensed as such, in addition to all requirements for Adolescent ASAM Level of Care 3.5 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements: (a) Medical protocols developed by a physician knowledgeable in withdrawal management that are used to: (A) Determine the nature of the medical monitoring and other interventions required, such as when medical oversight or services are needed; (B) Determine when to transfer to a higher or lower level of care; and (C) Administration of over-the-counter medication protocols. (b) Program staff provide an organized service that includes 24-hour supervision, observation and support to adolescents who are intoxicated or experiencing mild withdrawal; (c) Program staff are trained to implement those ASAM Level of care 3.2-WM physician protocols that are not required to be rendered by medical staff and that include: (A) Administration of over-the-counter medications for symptomatic relief; (B) Monitoring withdrawal symptoms and alert medical staff as indicated; (C) Identification when an adolescent requires a higher level of care and facilitate the transfer to that level of care; and (D) Prompt communication with medical staff when there is an indication that medical care is needed. (c) Medical services shall include: (A) Provision of 24-hour per day, 7-days per week program staff access to medical consultation; (B) Availability for 24-hour per day, 7-days per week medical evaluation; and (C) Monitoring the safety and outcome of the withdrawal management services. (d) There is an emphasis on staff, peer and social supports. (4 ) Co-occurring Enhanced ASAM Level of Care 3.5 services are an additional and optional version of ASAM Level of Care 3.5 services. Only programs licensed to render Clinically Managed High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5 may also apply to be licensed to render Co-occurring Enhanced ASAM Level of Care 3.5 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.5 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 3.5; (B) The individual meets diagnostic criteria for a co-occurring mental health disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information; and (C) The individual is experiencing a range of psychiatric symptoms that require active monitoring that are assessed as posing a risk of harm to self or others if the individual is not contained within a 24-hour structured environment. (b) Offer or coordinate psychiatric, medication evaluation, and laboratory services; (c) Be staffed by medical treatment staff or behavioral health clinicians. Program staff must be; (A) Able to assess and treat co-occurring disorders; (B) Trained in the biological and psychosocial aspects of substance use disorders and mental health disorders and treatment; (C) Trained in behavior management techniques specific to assessing and treating co-occurring disorders; (D) Able to identify the signs and symptoms of acute psychiatric decompensation; and (E) Ensure individuals receiving ASAM Level of Care 3.5 have access to a LMP 24 hours a day, 7 days a week for consultation. (5) Biomedical Enhanced ASAM Level of Care 3.5 services are an additional and optional version of ASAM Level of Care 3.5 services. Only programs licensed to render Clinically Managed High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.5 may apply to be licensed to render Biomedical Enhanced ASAM Level of Care 3.5 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.5 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 3.5; (B) Individual meets diagnostic criteria for a co-occurring biomedical condition, that is sufficient to distract from treatment or recovery efforts and requires medical monitoring, or the probability of such a diagnosis is determined through documented collateral information; and (C) The individual has a biomedical condition that requires a degree of staff attention by medical treatment staff that is not available in other Level 3.5 programs. (b) Ensure a physical examination is provided and documented within two weeks of entry, sooner if determined by the individual’s medical symptoms and condition; (c) Medical treatment staff assess and treat co-occurring disorders and have access to a LMP 24 hours a day, 7 days a week; and (d) Ensure nursing care and observation meet the intensity of the individuals’ needs.