9102.1 The ASARS treatment framework shall be based on four (4) levels of care established by the American Society for Addiction Medicine (ASAM). Treatment under the ASARS Program shall also support continuity of services across multiple levels of care. Delivery of ASARS shall be based on the beneficiary's level of care and length of the treatment episode.

9102.2 Levels of care under the ASARS program are as follows:

(a) Level IV shall represent beneficiaries who are at high risk of experiencing withdrawal due to a diagnosed substance use disorder. Beneficiaries who present for Level IV treatment shall require twenty-four (24) hour psychiatric care with related addiction treatment;

(b) Level III shall represent beneficiaries who are at risk of experiencing withdrawal due to a diagnosed substance use disorder, but who do not require the full resources of a licensed hospital. Beneficiaries who present for Level III treatment shall require placement in facilities that offer twenty-four (24) structured settings;

(c) Level II shall represent beneficiaries who are at minimal or moderate risk of severe withdrawal. Beneficiaries who present for Level II treatment shall require near-daily programs offering intensive engagement in order to progress after exhibiting signs of readiness to change; and

(d) Level I shall represent beneficiaries who experience minimal or no risk of significant or severe withdrawal. Beneficiaries who present for Level I treatment shall be able to maintain abstinence from substances while pursuing recovery goals with minimal support.

9102.3 The average lengths of ASARS treatment episodes, by level of care, shall be as follows:

(a) Level IV: Three (3) to five (5) days;

(b) Level III: Approximately twenty-eight (28) days;

(c) Level II: Thirty (30) to forty-five (45) days; and

(d) Level I: Approximately one hundred twenty (120) days (excluding Medication Assisted Treatment).

9102.4 Prior authorization shall be required if a beneficiary experiences a relapse that requires him or her to repeat treatment at a level of care that was previously received during the same twelve (12)-month period.

SOURCE: Final Rulemaking published at 59 DCR 11144 (September 28, 2012).