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2012 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 8. Substance Use Disorder (SUD) Services (Abuse and Dependence) : 8.7 Prior Authorization : 8.7.3 Prior Authorization for Residential Detoxification Treatment Services : 8.7.3.2 Continued Stay Criteria for Residential Detoxification Treatment Services

8.7.3.2
Eligibility for continued stay for residential detoxification services is based on the client meeting at least one of the criteria for chemical substance withdrawal, major medical complications, or major psychiatric complications.
Chemical Substance Withdrawal
The client must exhibit one of the following conditions with regard to chemical substance withdrawal complications:
Major Medical Complications
The client must meet the following condition with regard to major medical complications:
Documentation in the medical record must indicate that a medical condition or disorder (e.g., uncontrolled diabetes mellitus) continues to present a health risk and is actively being treated.
Major Psychiatric Complications
The client must meet at least one of the following with regard to major psychiatric complications:
Documentation in the medical record that a DSM III-R AXIS I psychiatric condition or disorder that, in combination with alcohol or drug use, continues to present a major health risk, is actively being treated.

Texas Medicaid & Healthcare Partnership
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