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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 §3.8025Discharge Criteria for Outpatient Treatment Service

The patient is considered eligible for discharge from the outpatient treatment service when he or she meets the conditions for discharge as stated in any one of paragraphs (1)-(4) of this section.

  (1) A documented assessment which supports that the patient does not meet the diagnostic criteria for alcohol/drug dependence or abuse.

  (2) Psychiatric illness or medical complication. The patient must meet the conditions in subparagraphs (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) Alcohol/drug rehabilitation/treatment. The patient must meet all the conditions in subparagraphs (A) or (B) of this paragraph.

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

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

      (ii) has insight into the patient's defeating relationship with alcohol/drugs: and

      (iii) is applying the essential coping skills necessary to cope with the alcohol and/or drug problem and to maintain abstinence.

    (B) Patient is functioning adequately in assessed deficiencies in the life task areas of work, social functioning, or primary relationships.

  (4) Behavioral factors. The patient must meet all the conditions in 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 §3.8025 adopted to be effective February 14, 1999, 24 TexReg 713

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