| (a) Eligibility for continued stay in a residential
rehabilitation/treatment 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 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 that indicate that the patient is developing problem solving
skills necessary to cope with the problem.
(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 utilization review points discussed
in §3.8018 of this title (relating to Recommended Length of Stay
for Partial Hospitalization Services), the criteria in subsection
(a)(1) and (2) of this section shall be considered.
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