Substance Use & Alcohol Treatment
Level of Care for Alcohol & Drug Treatment Referral (LOCADTR)
The Office of Addiction Services and Supports (OASAS) has created an online tool to make recommendations as to the appropriate level of care for individuals in need of substance use disorder treatment based on an individual's risks and resources.
The Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) is a clinical tool used with a provider's full assessment. LOCADTR was effective for the Medicaid and Child Health Plus products starting on 7/1/16 and for our Commercial, Federal Employee Program (FEP) and Medicare products effective 9/1/16. Effective 7/1/22 Medicare Advantage will use applicable National Coverage Determinations and Local Coverage Determination in relation to Mental Health Services for Medicare members.
- Initial Review - Substance UseOpen a PDF
- Concurrent Review - Substance UseOpen a PDF
- Any Review - GamblingOpen a PDF
Substance Use Review Questionnaire
Substance use reviews for inpatient detoxification, rehabilitation and residential levels of care will use the following questionnaire to document clinical information when determining medical necessity. This questionnaire will be used when the outcome of LOCADTR results in a discrepancy for the level of care being requested by the provider. The questionnaire is to ensure that all pertinent clinical information is documented to make the appropriate medical necessity determination.
- Substance Use Disorder Inpatient Rehabilitation & Residential QuestionnaireOpen a PDF
- Substance Use Disorder Inpatient Detoxification QuestionnaireOpen a PDF
For Medicare Advantage Members please use CMS link to search criteria for the services requested
American Society of Addiction Medicine (ASAM) Criteria
For Substance Use Disorder Partial Hospital Program requests outside of New York State, Excellus BCBS uses the ASAM Criteria to complete medical necessity reviews. The ASAM criteria is the most widely used and comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction and co-occurring conditions in the United States.
The Behavioral Health Department also uses the corporate medical policy called "Partial Hospitalization for Substance Use Disorders," to make its decision. A partial hospitalization program (PHP) request is considered 20 or more hours per week, sometimes also known as "day rehab," because the patient can spend evenings at home.
Find a Substance Use Provider
OASAS is the state designated agency for the coordination of state and federal relations in the area of substance use services. OASAS offers and maintains a Treatment Availability Dashboard for Inpatient, Residential and Outpatient Levels of care by county or zip code.
Behavioral Health Advocate
Our Plan has an advocate to help members understand decisions, how to ask for an appeal, or find a participating provider.