ASAM levels of care are guidelines that help providers determine a person’s level of treatment. They utilize a person-centered approach that considers clinical severity, social and environmental needs, and recovery goals.
The ASAM criteria currently are the most widely used patient placement criteria for treatment and Medicare reimbursement. The criteria include a biomedical dimension that explores a person’s withdrawal potential and medical complications. For more information, contact A Better Life today.
Level I – Outpatient
The ASAM Levels of Care are used by clinicians to identify the appropriate level of treatment for a client with substance use disorder. The level of care is determined based on the severity of a client’s needs and the likelihood that they will achieve recovery in the chosen level of treatment. Levels of Care are based on a multidimensional patient assessment that considers a variety of factors including the patient’s needs, obstacles, and liabilities as well as strengths, resources, and support structure. Formerly known as the ASAM Patient Placement Criteria, The ASAM Levels of Care are currently being used by many state agencies to help organize their addiction treatment systems and improve care delivery.
Once a level of care has been determined, a person’s clinical needs are matched to the ASAM LOC continuum of services, which includes outpatient, residential, and medically managed services. DHCS requires that licensed AOD treatment programs obtain either a DHCS Level of Care Designation or an ASAM LOC Certification consistent with all of their program services. This includes level I – Outpatient Care, levels II and III – Partial Hospitalization Programs and Intensive Outpatient Programs, and Level IV – Recovery Residence.
Each year, the ASAM Level of Care Certification Program conducts an independent review and verification of treatment programs based on The ASAM Criteria. This is the first program of its kind to provide an evaluation of a treatment program’s capacity to deliver services consistent with The ASAM Criteria. The certification is administered by ASAM in partnership with CARF International.
Throughout their treatment, patients should be regularly reassessed by their providers to determine their progress and whether they need to transition to a more or less intensive level of care. A reassessment should also be conducted for any new signs, symptoms or concerns that may arise.
A strength-based multidimensional patient assessment is essential to identifying the appropriate level of care for each individual. The ASAM Level of Care Assessment Interview Guide, Fourth Edition, provides a standardized tool to assist clinicians in conducting a quality ASAM patient assessment. The Guide incorporates the core actionable components of The ASAM Criteria and helps to streamline the process of developing a individualized treatment plan for each patient. The Guide is free for download and available to all licensed clinicians.
Level II – Partial Hospitalization
As the next level up from outpatient treatment, partial hospitalization programs (PHP) offer a structured environment for those with serious substance use or co-occurring mental health issues. During the day, clients attend therapy sessions and participate in skills-building activities. At night, they return home or to a recovery residence where they can continue with daily living activities and maintain some independence in their lives.
The program is structured but not as intensive as a residential setting. Often, PHPs operate on a 5-day or 7-day schedule and offer 5 to 6 hours of programming per day. Some states may classify this level of care as inpatient rather than outpatient.
Clients who need PHP services may be transitioned from outpatient or residential treatment, and the length of stay can vary based on needs. The facility will perform a multidimensional assessment to determine the appropriate level of care for each individual. This includes assessing the clinical severity of the person’s condition, as well as their social and living situation.
These assessments are a core component of The ASAM Criteria, and they help determine the best level of care for each person. ASAM also offers a series of Assessment Guides that can be used to support these multidimensional assessments and provide guidance on how the evaluation process should unfold. These include the ASAM Dimensional Admission Criteria, the Treatment Planning Assessment, and repeated assessments as a person moves through the levels of care.
In addition, ASAM and UCLA are developing a tool called the ASAM-UCLA Dimensional Admission Criteria Navigator that will allow managed care organizations to leverage The ASAM Criteria in their utilization review processes. This will enable them to work with clinicians to ensure that plan participants are receiving the least intensive and most effective treatment possible.
For more information about these and other resources, visit the ASAM website. ASAM encourages providers, payers and managed care entities to utilize these tools as part of an integrated model of treatment that promotes a continuum of care and helps people find the right level of care for them.
Level III – Residential
Level III – Residential Care is a full spectrum of assistance, including housing, supervision, support services and medication management. This is often the most intensive of the levels of care and requires a commitment to a long-term recovery residence. Many of these facilities promote a person-centered approach to addiction treatment and offer services like support groups, occupational therapy and education on how to manage relapse prevention and reintegration into the community.
As a person progresses through their recovery, they are regularly reassessed. The Transition and Continued Service Criteria of The ASAM Criteria are used to determine if the person is ready to move to a lower level of care, requires a higher level of care or should remain at their current level of care. This is an important component of the Continuum of Care and helps to ensure that the treatment plan continues to match the person’s needs.
In addition to the Six Dimensions of Addiction Treatment, The ASAM Criteria now includes a seventh dimension called “Readiness to Change” to assess a person’s readiness for change and their capacity to make the necessary changes in their life. A new Assessment Guide has been developed to standardize the clinical interview and collect just enough information across the dimensions to make a level of care recommendation. It is available as a free download for clinicians.
ASAM has also launched a free online resource to help payers and managed care entities implement The ASAM Criteria. This tool supports the utilization review process by facilitating the identification of an appropriate level of care for the person seeking treatment and allows them to be referred to a program that is certified to deliver that level of care.
The tool is a simple, intuitive way to identify the appropriate level of care for people seeking help for addiction and other complex health conditions. It also helps to facilitate a person-centered approach to care by supporting the identification of individual goals and priorities.
Level IV – Intensive Outpatient
Often referred to as “inpatient” or “residential treatment”, this level of care is designed for patients with severe functional impairments and who are struggling to maintain recovery at home. Residential treatment programs provide round-the-clock monitoring and intensive treatment in a structured environment. This level of care includes medical detox, as well as individual and group therapy, family counseling and life skills training. Residential treatment programs can also address co-occurring mental health disorders, such as anxiety and depression.
This is the highest level of care that ASAM defines. It is for patients who are not making progress at lower levels of care, have recurrent relapses or have significant clinical risk. This level of care provides 24-hour treatment and high-level clinical monitoring, including drug and alcohol detox and medication-assisted treatments for substance and/or alcohol use disorder.
Intensive outpatient treatment, also known as IOP, is a step-down from residential treatment. It allows clients to continue living at home and pursuing work and family responsibilities while getting intensive treatment for addiction. IOPs usually include weekly sessions with your therapist, group therapy and family support groups. It is recommended that IOP is used in conjunction with other levels of care as an stepping stone to a full recovery program.
At each point in the continuum of care, a patient is regularly reassessed for treatment progress and to determine if they need a transition to less intensive, require more intense services or should remain at their current level of service. These reassessments are done using the ASAM Level of Care Standards, which were developed and updated in The ASAM Criteria, Fourth Edition.
These standards allow clinicians to assess the needs of their patients, match them to a suitable level of care and deliver outcome-oriented addiction treatment. Managed care organizations can license The ASAM Criteria Dimensional Admission Criteria to apply as medical necessity criteria for their plan participants.