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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 §3.8024Continued Stay Criteria for Outpatient Treatment Services

(a) A patient is considered eligible for continued stay in the outpatient treatment service when the patient meets the diagnostic criteria and the conditions under at least one paragraph out of paragraphs (1) or (2) in subsection (b) of this section.

(b) Factors for continued outpatient treatment services are listed in paragraphs (1) and (2) of this subsection.

  (1) Alcohol/drug rehabilitation/treatment complications. The patient must meet the conditions of subparagraphs (A) or (B) of this paragraph.

    (A) Patient demonstrates an insight and understanding into the patient's personal relationship with mood-altering chemicals, yet is not effectively addressing the life functions of work, social or primary relationships without the use of mood altering chemicals.

    (B) Patient, while physically abstinent from chemical substance use, remains mentally preoccupied with such use to the extent that the patient is unable to adequately address primary relationships, social or work tasks, but there are indications that with continued treatment, the patient will effectively address these issues.

  (2) Psychiatric or medical complications. 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.


Source Note: The provisions of this §3.8024 adopted to be effective February 14, 1999, 24 TexReg 713

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