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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 §3.8017Discharge Criteria for Partial Hospitalization Services

The patient is no longer considered eligible for partial hospitalization services for any particular episode when the patient meets the conditions under any one paragraph out of paragraphs (1)-(4) of this section.

  (1) Diagnosis. The patient no longer meets the diagnostic criteria as addressed in §3.8015(1) of this title (relating to Admission Criteria for Partial Hospitalization Services).

  (2) Psychiatric illness or medical complication. The patient must meet the conditions under subparagraph (A) or (B) of this paragraph, as follows:

    (A) documentation that a psychiatric or medical condition should be treated in another setting; or

    (B) documentation that a psychiatric or medical condition which is interfering with alcohol/drug recovery is not being treated.

  (3) Chemical dependency rehabilitation/treatment. The patient must meet all conditions under at least one subparagraph out of subparagraphs (A)-(C) of this paragraph.

    (A) Patient displays behaviors which demonstrate that the patient:

      (i) is medically stable;

      (ii) recognizes or identifies with the severity of chemical substance use;

      (iii) has insight into the patient's defeating relationship with alcohol/drugs;

      (iv) is applying the essential coping skills necessary to maintain sobriety either in a self-help fellowship and/or with post-treatment supportive care.

    (B) The provider and patient had developed an individualized aftercare plan to help the patient maintain the gains made during active treatment.

    (C) In the case of adolescents, the family or adult significant other refuses to participate in treatment, if the discharge plan is to return to the original setting.

  (4) Behavioral factors. The patient must meet the conditions under subparagraphs (A) and (B) of this paragraph.

    (A) Patient is consistently uncooperative, to the degree that no further progress is likely to occur.

    (B) Greater intensity of service or transfer to another treatment provider would not have a positive impact on the problem.


Source Note: The provisions of this §3.8017 adopted to be effective August 28, 1991, 16 TexReg 4403.

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