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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 : 8.7.4 Prior Authorization for Residential Treatment Services : 8.7.4.3 Continued Stay Criteria for Residential Treatment Services

8.7.4.3
At least one of the following conditions must be present for continued stay in a residential treatment program:
Chemical Dependency Rehabilitation or Treatment Complications
The client recognizes or identifies with the severity of the alcohol or drug problem but demonstrates minimal insight into the client’s defeating the use of alcohol or drugs. However, documentation in the medical record indicates that the client is progressing in treatment; or
The client identifies with the severity of the alcohol or drug problem and manifests insight into the client’s personal relationship with mood-altering chemicals, yet does not demonstrate behaviors that indicate the development of problem-solving skills that are necessary to cope with the problem; and
Psychiatric or Medical Complications:
Documentation in the medical record indicates an intervening medical or psychiatric event that was serious enough to interrupt rehabilitation or treatment, but the client is again progressing in treatment.
Documentation in the medical record indicates that the client is being held pending an immediate transfer to a psychiatric, acute medical service, or inpatient detoxification alcohol or drug service.

Texas Medicaid & Healthcare Partnership
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