CONCURRENT REVIEW. LOCADTR as a Tool for Review. October 18, 2016
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1 CONCURRENT REVIEW LOCADTR as a Tool for Review October 18, 2016 The National Center on Addiction and Substance Abuse 2016
2 The LOCADTR Today NYS OASAS, in partnership with The National Center on Addiction and Substance Abuse (CASA), developed the LOCADTR 3.0. This web-based tool is used by SUD treatment providers, Managed Care plans, and other referral sources to determine the most appropriate level of care. LOCADTR 3.0 factors in client s risks and resources to identification an appropriate treatment setting in a patient-centered way that will be safe and effective given the clients situation and needs 2
3 The Numbers As of September 2016 Registered Users 7,352 OASAS Treatment provider 822 MCO user accounts 230,960 completed LOCADTRs 3
4 Final Level of Care Distribution Percentage as of September 2016 Reintegration-Residential 1.59 Rehabilitation-Residential, 3.69 Outpatient with MAT, 8.34 Stabilization - Residential, 3.11 Other, 3.02 Day Rehab, 5.2 Hospital Based Inpatient Detox, Inpatient, Outpatient, Intensive Outpatient Services, 6.02 Medically Supervised Withdrawal,
5 Defining the Process of Continued Stay A clinical review of case to determine if current level of care is still the most appropriate and to review progress of services. A Managed Care review and/or authorization for continued, extended or additional authorized services beyond what is currently authorized. 5
6 Legislative Parameters of Continued Stay Managed Medicaid plans and Providers must use LOCADTR 3.0 to make LOC decisions Contract requires that plans follow state guidelines for Utilization Management No prior approval for outpatient levels of care No routine UM for outpatient 6
7 Development of LOCADTR Continued Stay Module A new Module within the current LOCADTR providing a different function Not just determine if criteria for the current LOC is met but assessing on going treatment needs based on current LOC criteria as well as quality of treatment This module includes: Assessing for good quality of care - person centered, trauma informed care, utilization of evidence based practices. Assessing treatment planning - mental health, physical health, housing, recovery supports. 7
8 Continued Stay Module - Overview Choose current Level of Care MAT Needs * If not in detox 8
9 MAT Needs Example Concepts Being Considered Is the person on Medication Assisted Treatment (MAT)? Is the person experiencing withdrawal, urges, and/or craving? Is the person being referred for medical evaluation and consideration of MAT or medical management? Is there a plan for continuing medication as needed to the next level of care? 9
10 Continued Stay Module - Overview Choose current Level of Care MAT Needs * If not in detox Still appropriate for current Level of Care? * Questions specific to current LOC 10
11 Still appropriate for current Level of Care? Example Concepts Being Considered * Inpatient Rehabilitation LOC Does the person have serious medical symptoms that are not stable and continue to need to be managed in an inpatient rehabilitation setting for SUD treatment to be effective? Does the person have serous psychiatric symptoms that need to be managed in an inpatient rehab setting for SUD treatment to be effective? Is there risk of substance use in hazardous situations in amounts or frequencies that is likely to cause severe physical or emotional harm to self or other if inpatient setting discontinued? 11
12 Continued Stay Module - Overview Choose current Level of Care MAT Needs * If not in detox Still appropriate for current Level of Care? * Questions specific to current LOC Are they receiving good care? 12
13 Example Concepts Being Considered Is discharge planning occurring? Are there plans to connect the person to a peer or clinical person connected to the next likely level of care? Have you elicited commitment to recovery with motivational interviewing or similar techniques? Has the person received Trauma Informed care? 13
14 Continued Stay Module - Overview Choose current Level of Care MAT Needs * If not in detox Still appropriate for current Level of Care? * Questions specific to current LOC Are they receiving good care? Other treatment planning needs 14
15 Other treatment planning needs Example Concepts Being Considered Has the person received an assessment of mental health needs? Has the person received an assessment of chronic health needs? Does the person require additional recovery supports? Does the person have access to stable food and shelter? 15
16 Continued Stay Module - Overview Choose current Level of Care MAT Needs * If not in detox Still appropriate for current Level of Care? * Questions specific to current LOC Are they receiving good care? Other treatment planning needs 16
17 Questions/Discussion 17
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