Levels of Care – Treatment

Section 2060.410  Levels of Care – Treatment a)         Level 1 – Outpatient – Clinical services that are non-residential and that include assessment, treatment planning, continued assessment and service reviews, SUD individual and group treatment and discharge planning. Supportive services that enhance recovery may also include case management, MAR, patient education, and recovery support planning. All services shall be delivered according to the requirements specified in this Part.  The frequency and intensity of such services are determined by patient need but are generally provided in regularly scheduled sessions of fewer than nine hours of clinical services per week for adults and fewer than six hours of clinical services per week for adolescents. b)         Level 2 – Intensive Outpatient – Clinical services that are non-residential and that include assessment, treatment planning, continued assessment and service reviews, SUD individual and group treatment, and discharge planning.  Supportive services that enhance recovery may also include case management, MAR, patient education, and recovery support planning.  All services shall be delivered according to the requirements specified in this Part.  The frequency and intensity of such services are determined by patient need but are generally 9-19 hours of clinical services per week for adults and 6-19 hours of clinical services per week for adolescents. c)         Level 2.5 – Partial Hospitalization – Clinical services that are non-residential and that include assessment, treatment planning, continued assessment and service reviews, SUD individual and group treatment, and discharge planning.  Supportive services that enhance recovery may also include case management, MAR, patient education, and recovery support planning.  Services typically average five hours of individualized clinical service per day that are a mix of individual and group counseling based upon the assessed needs of the patient.  Level 2.5 generally includes 20 or more hours per week of intensive clinical services with direct access to psychiatric, medical, and laboratory services which help to meet identified needs that might warrant daily monitoring or management but that can be appropriately addressed in an outpatient setting. d)         Level 3.1 – Clinically-Managed Low Intensity Residential – Low intensity clinical services that include assessment, treatment planning, continued assessment and service reviews, SUD individual and group treatment, and discharge planning in a residential setting.  Supportive services that enhance recovery may also include case management, MAR, patient education, and recovery support planning.  Historically referenced as halfway houses or residential extended care, organizations shall identify, through administrative policy, staff/patient ratios that ensure patients can access all recommended hours of treatment.  Level 3.1 requires staff, awake and on duty, 24-hours a day, seven days per week, with clinical services delivered by professional staff at least five hours per week that primarily focus on the application of recovery skills, relapse prevention, and emotional coping strategies.  Services are most appropriate for patients who need time and structure to practice and integrate their recovery and coping skills in a residential supportive environment. e)         Level 3.2 – Clinically-Managed Residential Withdrawal Management – Level 3.2 care requires staff, awake and on duty, 24-hours a day, seven days per week, who provide supervision, observation, and support in a residential setting for patients who are intoxicated or experiencing withdrawal.  Withdrawal management allows for the induction/stable dose of MAR or withdrawal from a licit or illicit substance with no MAR if that is not indicated or per patient preference.  Services emphasize peer and social support rather than medical or nursing care and follow clinical protocols for referral and transfer of patients whose conditions deteriorate and appear to need medical or nursing interventions.  Clinical services, delivered by professional staff, include assessment, treatment planning, continued assessment and service reviews, SUD individual and group treatment, and discharge planning. Supportive services that enhance recovery may also include case management, MAR, patient education, and recovery support planning.  Historically referenced as social setting detoxification, Level 3.2 services focus on stabilization, enhancing the patient's understanding of SUDs, and referral to the appropriate level of care for continuation of treatment. f)         Level 3.5 – Clinically-Managed Medium to High Intensity Residential Services – Level 3.5 care requires staff, awake and on duty, 24-hours a day, seven days per week.  Clinical services range from medium to high intensity in a residential setting and organizations shall identify, through administrative policy, staff/patient ratios that ensure patients can access all recommended hours of treatment.  Services include assessment, treatment planning, continued assessment and service reviews, SUD individual and group treatment, and discharge planning.  Supportive services that enhance recovery may also include case management, MAR, patient education, and recovery support planning.  Level 3.5 services are tailored to the patient's readiness to change and are most appropriate for patients whose SUD is so severe that it requires a 24-hour supportive treatment environment to initiate or continue a recovery process that has failed to progress.  Services help patients stabilize and focus on the development of recovery skills so that they do not immediately continue to use in an imminently dangerous manner upon transfer to a less intensive level of care.  Lengths of services are variable with services designed to support ongoing recovery rather than resolve all identified social and psychological problems.  Clinical services must be offered daily and average a minimum of 25 hours per week, 7 days per week, over the length of stay. g)         Level 3.7 – Medically-Monitored Inpatient Withdrawal Management – Level 3.7 care requires staff, 24-hours a day, awake and on duty, seven days per week, who meet the requirements specified in Section 2060.320(c).  This level of withdrawal management allows for the induction or stable dose of MAR or withdrawal from a licit or illicit substance with no MAR if that is not indicated or per patient preference.  All services are delivered primarily by medical and nursing professionals for patients whose withdrawal signs and symptoms are sufficiently severe to require 24-hour evaluation in a residential setting.  Medical services are delivered under a defined set of physician-approved and -monitored procedures or protocols.  Clinical services include assessment, treatment planning, continued assessment and service reviews, SUD individual and group treatment, and discharge planning.  Supportive services that enhance recovery may also include case management, MAR, patient education, and recovery support planning.  Level 3.7 services focus on stabilization until withdrawal signs and symptoms are sufficiently resolved and the patient can be safely managed at a less intensive level of care or, conversely, referred for more acute medical management in an inpatient setting.