Common use of ASAM Level of Care Determination Clause in Contracts

ASAM Level of Care Determination. 18.3.1 Contractor shall use the ASAM Criteria to determine placement into the appropriate level of care (LOC) for all members and is separate and distinct from determining medical necessity. Additional guidance on ASAM Level of Care determinations is as follows: 18.3.2 A full ASAM Criteria assessment is not required to deliver prevention and early intervention services for members under 21; a brief screening ASAM Criteria tool is sufficient for these services. 18.3.3 A full ASAM assessment, or initial provisional referral tool for preliminary level of care recommendations, shall not be required to begin receiving DMC-ODS services. 18.3.4 A full ASAM assessment does not need to be repeated unless the member’s condition changes. 18.3.5 These requirements for ASAM level of care assessments apply to NTP clients and settings. 18.3.6 Residential and inpatient DMC-ODS services are subject to prior authorization. 18.3.7 Member placement and level of care determinations shall ensure that members are able to receive care in the least intensive level of care that is clinically appropriate to treat their condition.