<<Prev Rule

Texas Administrative Code

Next Rule>>
TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 3LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER HHSTANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS
RULE §3.8007Admission Criteria for Inpatient (Hospital or 24-hour Residential) Detoxification Services

An individual is considered eligible for inpatient (hospital or 24-hour residential) admission for detoxification services when the individual either meets the conditions of paragraphs (1) and (2) of this section or fails two previous treatment episodes of outpatient detoxifications.

  (1) Diagnosis. The diagnosis must meet the criteria for the definition of chemical dependence, as detailed in either the most current revision of the international classification of diseases, or the most current revision of the diagnostic and statistical manual for professional practitioners.

  (2) Other factors for admission to inpatient (hospital or 24-hour residential) treatment for detoxification. Once the diagnostic criteria for chemical dependency have been met, the conditions of at least one subparagraph out of subparagraphs (A)-(C) of this paragraph must also be met. Determination of whether treatment should be provided for an individual patient in a hospital or in an other-treatment-center-based program shall depend on the category or categories of dysfunction explained in subparagraphs (A)-(C) of this paragraph.

    (A) Category 1: chemical substance withdrawal. The individual must meet the conditions in one of the clauses (i)-(vi) of this subparagraph, as follows:

      (i) impaired neurological functions as evidenced by:

        (I) extreme depression (e.g., suicidal); and/or

        (II) altered mental state with or without delirium as manifested by:

          (-a-) disorientation to self;

          (-b-) alcoholic hallucinosis;

          (-c-) toxic psychosis;

          (-d-) altered level of consciousness, as manifested by clinically significant obtundation, stupor, or coma; and/or

        (III) history of recent seizures or past history of seizures on withdrawal; and/or

        (IV) presence of any presumed new asymmetric and/or focal findings (i.e., limb weakness, clonus, spasticity, unequal pupils, facial asymmetry, eye ocular movement paresis, papilledema, or localized cerebellar dysfunction, as reflected in asymmetrical limb incoordination);

      (ii) unstable vital signs combined with a history of past acute withdrawal syndromes, that are interpreted by a physician to be indication of acute alcohol/drug withdrawal;

      (iii) evidence of coexisting serious injury or systemic illness, newly discovered or progressive;

      (iv) clinical condition (e.g., agitation, intoxication, or confusion) which prevents satisfactory assessment of items cited in clauses (i)-(iii) of this subparagraph, indicating placement in an inpatient service may be justified;

      (v) neuropsychiatric changes of a severity and nature that place the patient at imminent risk of harming self or others (e.g., pathological intoxication or alcohol idiosyncratic intoxication, etc.);

      (vi) serious disulfiram-alcohol (Antabuse) reaction with hypothermia, chest pains arrhythmia, or hypotension.

    (B) Category 2: medical complications. The individual must present a documented condition or disorder which, in combination with alcohol and/or drug use, presents a physician-determined health risk (e.g., GI bleeding; gastritis; anemia, severe; diabetes mellitus, uncontrolled; hepatitis; malnutrition; cardiac disease, hypertension, etc.).

    (C) Category 3: major psychiatric illness. The individual must meet the conditions of at least one clause out of clauses (i)-(v) of this subparagraph, as follows:

      (i) a documented DSM III-R AXIS I condition or disorder which, in combination with alcohol and/or drug use, compounds a pre-existing or concurrent emotional or behavioral disorder and presents a major risk to the individual;

      (ii) severe neurological and psychological symptoms: (e.g., anguish; mood fluctuations; overreactions to stress, lowered stress tolerance; impaired ability to concentrate; limited attention span; high level of distractibility; extreme negative emotions; extreme anxiety);

      (iii) danger to others and/or homicidal;

      (iv) uncontrolled behavior endangering self or others, or documented neuropsychiatric changes of a severity and nature that place the individual at imminent risk of harming self or others;

      (v) mental confusion and/or fluctuating orientation.


Source Note: The provisions of this §3.8007 adopted to be effective August 28, 1991, 16 TexReg 4403; amended to be effective February 14, 1999, 24 TexReg 713

Link to Texas Secretary of State Home Page | link to Texas Register home page | link to Texas Administrative Code home page | link to Open Meetings home page