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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 §3.8028Continued Stay Criteria for Outpatient Detoxification Treatment Services

(a) A patient is considered eligible for continued stay in the outpatient detoxification 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 detoxification treatment services are listed in paragraphs (1) and (2) of this subsection.

  (1) Chemical substance withdrawal complications. The patient must meet the conditions of subparagraphs (A) or (B) of this paragraph.

    (A) Patient, while physically abstinent from chemical substance use, is exhibiting incomplete stable withdrawal from alcohol/drugs, as evidenced by psychological and physical cravings.

    (B) Patient, while physically abstinent from chemical substance use, is exhibiting incomplete stable withdrawal from alcohol/drugs, as evidenced by significant drug levels.

  (2) Psychiatric or medical complications. Documentation in the record indicates an intervening medical or psychiatric event which was serious enough to interrupt outpatient detoxification treatment, but the patient is again progressing in treatment.


Source Note: The provisions of this §3.8028 adopted to be effective February 14, 1999, 24 TexReg 713

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