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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 §3.8008Continued Stay Criteria for Inpatient (Hospital or 24-hour Residential) Detoxification Services

(a) Eligibility for continued stay for inpatient (hospital or 24-hour residential) detoxification services shall be based on the patient meeting at least one of the criteria in paragraphs (1)-(3) of this subsection.

  (1) Chemical substance withdrawal complication. The patient must meet the criteria in one of the subparagraphs (A)-(C) of this paragraph, as follows:

    (A) incomplete medically stable withdrawal from alcohol/drugs, as evidenced by documentation of:

      (i) unstable vital signs;

      (ii) continued disorientation;

      (iii) abnormal laboratory findings related to chemical dependency;

    (B) continued cognitive deficit related to withdrawal with the deficit affecting the patient's ability to recognize alcohol/drug use as a problem; or

    (C) laboratory finding which, in the judgment of a physician, indicate that a drug has not sufficiently cleared the patient's system.

  (2) Major medical complications. Documentation must indicate that a medical condition or disorder (e.g., diabetes mellitus, uncontrolled) continues to present a health risk and is actively being treated.

  (3) Major psychiatric complication. The patient must meet the criteria in subparagraph (A) or (B) of this paragraph, as follows:

    (A) documentation that a DSM III-R AXIS I psychiatric condition or disorder, which, in combination with alcohol/drug use, continues to present a major health risk, is actively being treated; or

    (B) documentation that severe neurological and/or psychological symptoms have not been satisfactorily reduced but are actively being treated.

(b) The criteria in subsection (a)(1)-(3) of this section shall be considered in determining utilization review points referred to in §3.8010 of this title (relating to Recommended Length of Stay for Inpatient (Hospital or 24-hour Residential) Detoxification Services).


Source Note: The provisions of this §3.8008 adopted to be effective August 28, 1991, 16 TexReg 4403.

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