309-018-0184 SUD Residential ASAM Level of Care 3.7 Medically Monitored Intensive Substance Use Disorder Inpatient Services, ASAM Level of Care 3.7. In addition to any other requirements described in these rules and applicable statutes, programs approved to render Adult Medically Monitored Intensive Inpatient Services, ASAM Level of Care 3.7, or Adolescent Medically Monitored High-Intensity Impatient Services, ASAM Level of Care 3.7, offer a planned and structured regimen of 24-hour professionally directed evaluation, observation, medically monitoring and substance use disorder treatment to in an inpatient setting, and shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements: (1) ASAM Level 3.7 programs shall ensure: (a) ASAM dimensional admission criteria: (A) Meet specifications for at least two of the six dimensions and one of those two dimensions is Dimension 1, 2, or 3. (B ) The 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 are experiencing difficulties with mood, behavior, or cognition related to a substance use or mental health condition, or mood, behavior, or cognition symptoms are problematic but do not meet DSM-5-TR criteria for a mental health disorder; an d (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) Biomedical assessment shall include: (A) A comprehensive nursing assessment at the time of entry; and (B) A physical examination, or a review of physical examination conducted within the past 7 calendar days, performed by a physician within 24 hours of entry. (c) At a minimum, ensure staffing as follows: (A) Program staff or milieu staff are on-site 24-hours, 7 days per week in staffing levels that are responsive to the number of the individuals present and the severity of symptoms and at least one program staff is readily available to respond to and assist individuals; (B) Utilize an interdisciplinary team approach, as demonstrated through regular, documented meetings and by ensuring: (i) LMP(s) trained in addiction medicine or addiction psychiatry oversee the treatment process and assures the quality of care, and shall be onsite daily and available for consultation 24-hours per day, 7 days per week; (ii) Medical treatment staff that have training to identify signs and symptoms of acute psychiatric conditions, including psychiatric decompensation, and to intervene using crisis prevention and response protocols, shall be available on-site 24-hours per day, 7 days per week; (iii) Supervisory or Management staff, which may include LMP, who are trained in substance use disorders treatment are available on-site or by phone 24 hours per day, 7 days per week; and (iv) Behavioral health clinician(s) render services on-site at least 5 days per week. (d) Program shall provide daily medical and behavioral services and supports that meet the documented needs of the individual as identified in the assessments and service plan, and include; (A) Medical monitoring, including close observation and monitoring of the individual’s adherence to medications; (B) Medical stabilization services when medical staffing meets the needs of the individuals; and (C) Planned behavioral, skill building and other supportive service program activities that are adapted as needed to the individual’s level of comprehension and include; (i) Health and medication education and management; (ii) Individual and group counseling and skill building; (iii) Motivational and engagement strategies and interventions; (iv) Relapse prevention, interpersonal, coping and community reintegration skills; (v) Urinalysis screening when clinically indicated; and (vi) Intensive case management. (e) Programs shall facilitate access to medical, psychiatric, laboratory, toxicology, mental health, physical, dental and other ancillary health care services and supports according to the severity of the individual’s condition and throughout the episode of care. (2) In addition to any other requirements described in these rules and applicable statutes, programs licensed to render residential Adolescent Medically Monitored High-Intensity Inpatient Services, ASAM Level of Care 3.7 services shall meet and maintain documentation demonstrating ongoing compliance with, at a minimum, the following requirements: (a) Adolescents placed at ASAM Level of Care 3.7 shall meet the following dimensional admission criteria: (A) ASAM Diagnostic Admission Criteria specifications in at least two dimensions, one of which is Dimension 1, 2 or 3; (B) Intoxication or withdrawal is manageable at this level of care, as described by The ASAM Criteria, Third Edition ; (C) The adolescent needs 24-hour structured environment to stabilize and make therapeutic gains; (D) The adolescent 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) The facility and milieu shall be a 24-hour, safe, contained, and structured recovery environment. Services and supports are primarily habilitative, addressing behavioral, social, and emotional dysfunction through use of targeted interventions such as evidence based, pro-social, therapeutic interventions and skills training to facilitate healthy reintegration into the community. (c) Utilize an interdisciplinary team approach, as demonstrated through regular, documented meetings and by ensuring: (A) Milieu staff are on-site 24-hours, 7 days per week in staffing levels that are responsive to the number of the individuals present and the severity of symptoms, and at least one milieu staff is readily available to respond to and assist adolescents; (B) Behavioral health clinician(s) trained in adolescent development, recognizing the signs and symptoms of intoxication and withdrawal and the monitoring and treating of those conditions, and behavioral health crisis prevention and response; (C) Medical treatment staff, knowledgeable about adolescent development, are able to implement protocols are staffed to meet the intensity of the oversight and treatment of each individual’s needs; (D) LMP with training in adolescent development shall be available to assess the adolescent within 24 hours of admission and thereafter as medically necessary, and available for emergency consult 24-hours per day, 7 days per week; and (E) Supervisory or Management staff who are trained in substance use disorders treatment are available for consult on-site or by phone 24 hours per day, 7 days per week. (d) Services shall be offered daily and include the following: (A) Educational services shall be provided in accordance with local regulations and provide opportunities to remedy educational deficits; (B) Daily stabilization services by medical treatment staff, including, at a minimum: (i) Daily assessment, treatment and close monitoring of withdrawal symptoms; (ii) Close observation and monitoring of the adolescent’s adherence to medications administered by the program; and (iii) Any adjustments to protocols made by LMP are documented. (C) Relapse prevention, coping and community reintegration skills; (D) Family services, including services just for families or identified support persons; (E) Motivational and engagement strategies and interventions; (F) Urinalysis screening when clinically indicated; (G) Individual counseling sessions; and (H) Skill building, including teaching and practicing pro-social behaviors. (e) Address co-occurring conditions when applicable: (A) Arrange for or provide appropriate medical procedures, including laboratory and toxicology testing; (B) Arrange for or provide appropriate medical and psychiatric treatment through consultation, referral to a community provider or transfer to another Level of Care; (C) Have direct affiliation with other ASAM Levels of Care; (D) Pace the delivering of information and services to the meet the ability of the adolescent; and (E) Documentation shall include a description of the adolescent’s co-occurring conditions, the relationship between the co-occurring condition(s) and substance use, and the individual’s mental health status. (3) Co-occurring Enhanced ASAM Level of Care 3.7 services are an additional type of ASAM Level of Care 3.7 services. Only programs licensed to render Medically Monitored Intensive Substance Use Disorder Inpatient Services, ASAM Level of Care 3.7 may apply to be licensed to render Co-occurring Enhanced ASAM Level of Care 3.7 services to adolescents or adults. When licensed as such, in addition to all requirements for ASAM Level of Care 3.7 services, programs shall, at a minimum, meet and maintain documentation demonstrating ongoing compliance with each of the following requirements: (a) Individuals placed at ASAM Level of Care 3.7 shall meet each of the following criteria: (A) Dimensional admission specifications for 3.7; (B) Diagnostic criteria for a co-occurring mental health disorder, per DSM-5-TR, or the probability of such a diagnosis is determined through collateral information; (C) Experiencing a range of psychiatric symptoms that require active monitoring and which are assessed as posing a risk of harm to self or others if the individual is not contained within a 24-hour structured environment. (b) Co-occurring Enhanced ASAM Level of Care 3.7 programs shall ensure the structure of services includes each of the following: (A) Promote the stabilization of the individual’s substance and mental health needs and symptoms through integration and coordination of substance use, mental health and physical health services; (B) Services are delivered by medical treatment staff and behavioral health clinicians who are trained to assess and treat co-occurring psychiatric disorders, and implement behavioral modification interventions; (C) A comprehensive psychiatric history, an examination and a psychodiagnostic assessment are performed within a reasonable time, as determined by the individual’s needs; (D) Active reassessment of the individual’s mental status at a frequency determined by the urgency of symptoms; (E) Symptom management through mental health treatment and medication management services; and (F) Document the individual’s co-occurring disorders, the relationship between the mental health and substance use disorders, and the overall assessment of functioning and mental health status (4) Biomedical Enhanced ASAM Level of Care 3.7 services are an additional type of ASAM Level of Care 3.7 services. Only programs licensed to render Medically Monitored Intensive Substance Use Disorder Inpatient Services, ASAM Level of Care 3.7, may apply to be licensed to render Biomedical Enhanced ASAM Level of Care 3.7 services to adolescents or adults. When licensed as such, in addition to all requirements for ASAM Level of Care 3.7 services, programs shall, at a minimum , meet and maintain documentation demonstrating ongoing compliance with each of the following requirements: (a) Individuals placed at ASAM Level of Care 3.7 have a biomedical condition that requires a degree of staff attention or intervention that is not available in other Level 3.7 programs; (b) Ensure the services are delivered by medical treatment staff who can monitor, assess and treat co-occurring biomedical conditions; (c) Ensure the intensity of nursing care and observation is adaptive to sufficiently meet the needs of all individuals; and (d) Promote the stabilization of the individual’s behavioral and physical health needs and symptoms. 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