| (a) Eligibility for continued stay in an inpatient
rehabilitation/treatment (hospital or 24-hour residential) program
shall be based on the patient's meeting at least one of the conditions
in paragraph (1) or (2) of this subsection.
(1) Chemical dependency rehabilitation/treatment complication.
The patient must meet the conditions in subparagraph (A) or (B) of
this paragraph.
(A) Patient recognizes or identifies with the severity
of the alcohol and/or drug problem, but demonstrates minimal insight
into the patient's defeating use of alcohol/drugs, but documentation
in the record indicates that the patient is progressing in treatment.
(B) Patient:
(i) identifies with the severity of the patient's
alcohol and/or drug problem and manifests insight into the patient's
personal relationship with mood-altering chemicals, yet does not demonstrate
behaviors indicating that the patient is developing problem solving
skills necessary to cope with the problem; and
(ii) would predictably relapse if moved to a lesser
level of care.
(2) Psychiatric or medical complications. The patient
must meet the conditions in subparagraph (A) or (B) of this paragraph.
(A) Documentation in the record indicates an intervening
medical or psychiatric event which was serious enough to interrupt
rehabilitation/treatment, but the patient is again progressing in
treatment.
(B) Documentation in the record indicates that the
patient is being held pending an immediate transfer to a psychiatric,
acute medical service, or inpatient detoxification alcohol/drug service.
(b) In determining the utilization review points discussed
in §3.8014 of this title (relating to Recommended Length of Stay
for Inpatient Rehabilitation/Treatment (Hospital or 24-hour Residential)
Services), the criteria in subsection (a)(1) and (2) of this section
shall be considered.
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