Substance Use Disorder Treatment
Our plan also has a Behavioral Health Advocate who is available to help members understand decisions, how to ask for an appeal, or find a participating provider. Members can talk to the Behavioral Health Advocate directly at 1-844-809-7518 (Members with Medicaid, Child Health Plus, or HARP plans should call 1-844-635-2662).
Level of Care for Alcohol and Drug Treatment Referral (LOCADTR)
LOCADTR 3.0 is a web based level of care determination application. NYS OASAS in partnership with The National Center on Addiction and Substance Use at Columbia University developed this tool to determine the most appropriate level of care for substance use disorder.
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.
- Download Substance Use Disorder Inpatient Rehabilitation & Residential QuestionnaireOpen a PDF
- Download Substance Use Disorder Inpatient Detoxification QuestionnaireOpen a PDF
American Society of Addiction Medicine (ASAM) Criteria
For Substance Use Disorder Partial Hospital Program requests outside of New York State, Excellus BCBS Univera Healthcare 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.