The patient is no longer considered eligible for inpatient
rehabilitation/treatment (hospital or 24-hour residential) services
for any particular episode when the patient meets the conditions of
any one paragraph out of paragraphs (1)-(4) of this section.
(1) Diagnosis. The patient no longer meets the diagnostic
criteria as addressed in §3.8011(1) of this title (relating to
Admission Criteria for Inpatient Rehabilitation/Treatment (Hospital
or 24-hour Residential) Services).
(2) Psychiatric illness or medical complication. The
patient must meet the conditions of 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 have 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), unless the attending provider
can document that the adolescent is making progress toward established
treatment goals and can demonstrate that active efforts are being
made to involve the family or adult significant other in treatment.
(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.
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