Level of Care Guidelines. 6.1.1. The Contractor must establish written policies and procedures for authorization of behavioral health services that supports Great Rivers’ Level of Care Guidelines.
6.1.2. Great Rivers requires the Contractor to complete the ASAM 6 dimension for SUD and the utilization system LOCUS/CALOCUS for mental health to complete request for authorization.
Level of Care Guidelines. “Level of Care Guidelines” is a set of guidelines for placement, continued stay and transfer or discharge of individuals with SUD and co-occurring conditions.
Level of Care Guidelines. The Contractor and its subcontractors shall establish written policies and procedures for authorization of Behavioral Health services. Maintain written utilization management criteria that include the Mental Health Access to Care Standards and ASAM Levels of Care placement criteria. The Contractor’s Level of Care Guidelines shall be provided to DSHS upon request. DSHS reserves the right to request changes to the Contractor’s Level of Care Guidelines.
5.1.1. Criteria for authorization of initial Routine services including outpatient and residential treatment programs. These services do not meet the definition of urgent or emergent care.
5.1.2. The establishment of a covered Mental Health or Substance Use Disorder diagnosis based on DSM 5.
5.1.3. The ASAM criteria for initial authorizations, continuing stay and discharge for SUD services.
5.1.3.1. ASAM levels of care for outpatient and residential services include the following: Level 1 - Outpatient Services Level 2.1 – Intensive Outpatient Services Level 3.1 – Clinically Managed, Low Intensity Residential Services Level 3.3 – Clinically Managed, Population Specific, High Intensity, Residential Services. (This level of care not designated for adolescent populations) Level 3.5 – Clinically Managed, Medium Intensity Residential Services 5.1.3.2. ASAM levels of care for Withdrawal Management (Detoxification Services) Include the following:
Level of Care Guidelines. The Contractor and its subcontractors must establish written policies and procedures for authorization of Behavioral Health services, and maintain written utilization management criteria that include Level of Care G uidelines that reflect both the Access to Care Standards for Behavioral Health Organizations and the ASAM criteria.
