| (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).
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