Substance Use Disorder Treatment
Level of Care for Alcohol & Drug Treatment Referral (LOCADTR)
The Office of Addiction Services and Supports (OASAS) created LOCADTR to assist providers, health plans, and other referral sources in determining the most appropriate level of care for members with substance use disorder and/or problem gambling disorder. The tool identifies the most appropriate setting for treatment closest to the member’s community. Note: You will need New York State credentials to log in to LOCADTR.
- Initial Review - Substance UseOpen a PDF
- Concurrent Review - Substance UseOpen a PDF
- Any Review - GamblingOpen a PDF
Substance Use Review Questionnaires
The following questionnaires are used to determine medical necessity for inpatient detoxification, rehabilitation, and residential levels of care when the outcome of LOCADTR is different than the level of care you have requested. Note: These questionnaires are not used when care is being requested for Medicare Advantage members.
- Inpatient Rehabilitation & Residential QuestionnaireOpen a PDF
- Inpatient Detoxification QuestionnaireOpen a PDF
Medicare Advantage Members
Effective July 1, 2022, Medicare Advantage will use National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) when reviewing for all behavioral health services, including substance use disorder treatment. Use the Medicare Coverage Database (MCD) link below to search criteria for these services.
American Society of Addiction Medicine (ASAM) Criteria
We use national criteria from ASAM to complete medical necessity reviews for substance use disorder partial hospitalization program (PHP) requests outside of New York State. ASAM criteria are the most widely used and comprehensive set of guidelines for these program.
Find a Substance Use Disorder Treatment Provider
Treatment Availability Dashboard
As the state-designated agency coordinating substance use disorder treatment services, OASAS maintains a Treatment Availability Dashboard for finding inpatient, outpatient, and residential treatment programs 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.