The ASAM and Green Spring Alcohol and Drug Detoxification and Rehabilitation Criteria for Utilization Review

Abstract

The authors examine the use of two sets of criteria, both dealing with substance abuse level‐of‐care determinations, yet having two different functions, and frequently yielding different decisions: The Green Spring Health Services (GSHS) Medical Necessity Criteria for Utilization Management and The American Society of Addiction Medicine (ASAM) Patient Placement Criteria. The GSHS criteria are used for rendering medical‐necessity determinations for individuals covered under a managed care program. These determinations involve assigning the least restrictive and least intensive level of care capable of meeting the patient's needs through the use of the complete continuum of treatment service options, including outpatient detoxification, intensive outpatient programs, partial hospitalization programs, and supervised residential settings. The ASAM criteria are oriented toward treatment planning within substance abuse settings to coordinate patient placement between levels of care within a treatment program.

A Level of Care Instrument for Children's Systems of Care: Construction, Reliability and Validity

“…Both the Level of Care Assessment Tool (LOCAT) and the Green Spring Health Services' Medical Necessity Criteria for Utilization Management tool (Book, Harbin, Marques, & Silverman, 1995) were proprietary and not available, even to the clinical practitioners caring for the patients. Other instruments, such as the Level of Need-Care Assessment (Uehara, Smukler, & Newman, 1994), and American Society of Addiction Medicine criteria (ASAM; McKay, Cacciola, McLellan, Alterman, & Wirtz, 1997), were available publically.…”

Reliability of Multidimensional Substance Abuse Treatment Matching

“…While the ASAM Criteria approach has face validity, it has yet to be empirically validated in field trials. 9 Establishing the validity of decisions derived from the PPC in relation to clinical outcome measures is a critical step in any consideration of their widespread implementation in treatment matching. 10 The question of the validity of the ASAM PPC cannot be considered independently of the question of reliability.…”

The ASAM Patient Placement Criteria

“…10 The data-driven process will take the scientific documentation of PPC beyond the status of consensus treatment guidelines 11 and beyond the recent spate of hypothetical critiques. 12,13 There is already a consensus endorsement of the face validity of the ASAM PPC from a comprehensive independent review undertaken by CSAT in 1995. 13 The research literature in general provides extensive support for the principle of PPC multidimensional needs assessment in treatment planning.…”