309-018-0182 SUD Residential ASAM Level of Care 3.3 Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.3 In addition to any other requirements described in these rules and applicable statutes, programs licensed to render residential adolescent and adult Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.3 shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following standards programming: (1) ASAM Level 3.3 programs shall ensure: (a) ASAM dimensional admission criteria: (A) Dimensions 1, 2 and 3 symptoms are assessed as mild to moderate risk, or are stabilized by this 24-hour structured environment; (B) Dimensions 4, 5 and 6 are assessed as moderate to high risk; (C) Individual needs 24-hour structured environment to make therapeutic gains; (D) Individual is able to tolerate and benefit from a planned program of therapeutic services and supports; and (E) Individual 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) Provide a structured, supportive, recovery environment with a less intensive milieu that treats both the substance use and supports the functional limitations of a co-occurring cognitive disorder or impairment, and: (A) Programs shall either accept documentation from a medical or mental health professional describing a cognitive condition, or a program staff working within their scope shall document the condition; (B) Program shall match the pace of delivery of information and services to the cognitive ability of the individual; (C) Program shall deliver concrete information in an intentionally repetitive manner to the extent assistive to the individual; and (D) Program shall facilitate the individual in obtaining low-barrier access to mental, physical, dental and other ancillary health care services throughout the episode of care and in a timeframe that meets the urgency of the condition; and (c) Staffing shall be made available as follows: (A) 24-hour, 7 day per week staffing that is responsive to the number of individuals present and the severity of symptoms; (B) Program shall be trained in substance use disorders, able to identify signs and symptoms of concern as related to substance use, mental health and suicidality, and able to stabilize imminent danger; and (C) At least one LMP is available for staff consultation on-site or by phone 24 hours per day. (d) The program shall offer services in a manner described above that include: (A) Urinalysis screening when clinically indicated; (B) Intensive case management; (C) Individual counseling; and (D ) Group counseling and skill building services. (2) Co-occurring Enhanced ASAM Level of Care 3.3 services are an additional type of ASAM Level of Care 3.3 services. Only programs licensed to render Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.3 may apply to also be licensed to render Co-occurring Enhanced ASAM Level of Care 3.3 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.3 services , programs shall , at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements: (a) Individuals placed at Co-occurring Enhanced ASAM Level of Care 3.3 shall meet the following criteria: (A) ASAM Dimensional criteria required for ASAM Level of Care 3.3; and (B) Individual meets diagnostic criteria for a co-occurring mental health disorder, per DSM-5-TR, that meet the stability criteria for placement in a co-occurring capable program or the probability of such a diagnosis is determined through documented collateral information. (b) Offer psychiatric services: (A) Including medication consultation and laboratory services; (B) Psychiatric services shall be made available within 8 hours by telephone, or off-site within 24 hours. Off-site services shall be closely coordinated; and (C) Be staffed by credentialed psychiatrists and behavioral health clinicians working within their scope. Program staff shall: (i) Assess and treat co-occurring disorders; and (ii) Have specialized training in behavior management techniques specific to assessing and treating co-occurring disorders. (c) Program staff shall render a psychiatric history, examination, and diagnostic assessment within two weeks of entry and continue to reassess, as determined by the urgency of the individual’s mental health condition. (3) Biomedical Enhanced ASAM Level of Care 3.3 services are an additional and optional type of ASAM Level of Care 3.3 services. Only programs licensed to render Clinically Managed Population-Specific High-Intensity Substance Use Disorder Residential Services, ASAM Level of Care 3.3 may apply to also be licensed to render Biomedical Enhanced ASAM Level of Care 3.3 services. When licensed as such, in addition to all requirements for ASAM Level of Care 3.3 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements: (a) Individuals placed at Biomedical Enhanced ASAM Level of Care 3.3 shall meet the following criteria: (A) ASAM Dimensional criteria required for ASAM Level of Care 3.3; and (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. (b) Ensure a physical examination is provided and documented within two weeks of entry, or sooner as determined by the individual’s medical condition; (c) Be staffed by credentialed medical treatment staff who assess and treat co-occurring disorders and have access to consult a LMP 24 hours a day, 7 days a week; and (d) Ensure nursing care and observation are provided and meet the intensity of the individual’s needs. Statutory/Other Authority: ORS 161.390-161.400, 413.042, 428.205-428.270, 430.640 & 443.450 Statutes/Other Implemented: ORS 430.010, 430.205-430.210, 430.254-430.640, 430.850-430.955, 443.400-443.460, 443.991, 461.549 & 743A.168 History: BHS 10-2023, adopt filed 04/07/2023, effective 04/07/2023