|Editor’s Note: ASAM Criteria set guidelines for length of stay and level of care for behavioral health. BHM Healthcare Solutions offers objective peer reviews based on medical necessity criteria, like ASAM’s, for complex, medical, and behavioral health cases. CLICK HERE to learn more about BHM.
The American Society of Addiction Medicine (ASAM) criteria is the most widely used and comprehensive set of guidelines for placement, continued stay, transfer, or discharge of patients with addiction and co-occurring conditions in medical reviews. Adolescent and adult treatment plans are developed through a multidimensional patient assessment over five broad levels of treatment that are based on the degree of direct medical management provided, the structure, safety and security provided, and the intensity of treatment services provided.
When a clinical review is performed, the ASAM Criteria is an incredibly helpful tool for both payers and providers to better understand the challenges and appropriate treatment plan options.
ASAM criteria are composed of six dimensions which represent six major life areas. Each dimension is evaluated by a risk rating from 0 (low risk) to 4 (high risk). Based on the scores in each of the dimensions, the treating provider will use this information to determine the biggest challenges and areas for improvement.
- Acute Intoxication and/or Withdrawal Potential:
- Individual’s past and current experiences with substance withdrawal
- Biomedical Conditions and Complications
- Individual’s health history and current physical needs
- Emotional, Behavioral, or Cognitive Conditions and Complications
- Individual’s MH history and current cognitive mental health needs
- Readiness to Change
- Individual’s readiness and interest for change
- Relapse, Continued Use or Continued Problem Potential
- Individual’s unique needs that influence their risk for continued use and/or relapse potential
- Recovering/Living Environment
- Individual’s current support and living environment
ASAM Criteria Levels of Care
The higher the rating received in each dimension, the higher level of care a member may require. A treatment plan will be created based on the outcomes of these dimensions.
There are multiple levels of care a member can be treated, depending on the level of intensity someone may require. Based on the evaluation of the member’s results from the above six dimensions, the member will be recommended a certain level of care. A member can move between the different levels of care, dependent on their needs.
Many states across the United States are utilizing the ASAM criteria to improve addiction treatment and care. The ASAM criteria provides a member assessment tool to determine needs and describes the continuum of addiction care treatment settings. With the ASAM criteria, managed care organizations can easily work with treating providers to ensure members are receiving the treatment that best fits their needs.
Click HERE to download the ASAM Criteria Toolkit.
Editor’s Note: ASAM Criteria set guidelines for length of stay and level of care for behavioral health. BHM Healthcare Solutions offers objective peer reviews based on medical necessity criteria, like ASAM’s, for complex, medical, and behavioral health cases. CLICK HERE to learn more about BHM.