Level of Care for Alcohol and Drug Treatment Referral (LOCADTR)
LOCADTR 3.0 is a web based level of care determination application. NYS OASAS in partnership with The National Center on Addiction and Substance Abuse at Columbia University developed this tool to determine the most appropriate level of care for substance use disorder.
Substance use reviews for inpatient detoxification, rehabilitation and residential levels of care will use the following questionnaire to document clinical information when determining medical necessity. This questionnaire will be used when the outcome of LOCADTR results in a discrepancy for the level of care being requested by the provider. The questionnaire is to ensure that all pertinent clinical information is documented to make the appropriate medical necessity determination.
For Substance Use Disorder Partial Hospital Program requests outside of New York State, Excellus BCBS uses the ASAM Criteria to complete medical necessity reviews.
A partial hospitalization program (PHP) request is considered 20 or more hours per week, sometimes also known as “day rehab,” because the patient can spend evenings at home.
The ASAM criteria is the most widely used and comprehensive set of guidelines for placement, continued stay and transfer/discharge of patients with addiction and co-occurring conditions in the United States.
The Behavioral Health Department also uses the corporate medical policy called “Partial Hospitalization for Substance Use Disorders,” to make its decision.
Our plan also has a Behavioral Health Advocate who is available to help you understand a decision, how to ask for an appeal or find a participating provider. To talk to the Behavioral Health Advocate, please call 1-844-809-7518 (Members with Medicaid, Child Health Plus, or HARP plans should call 1-844-635-2662).