The New York State Office of Alcoholism and Substance Abuse Services (OASAS) has created an online tool to make recommendations as to the appropriate level of care for individuals in need of substance use disorder treatment based on an individual's risks and resources. The Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) is a clinical tool used with a provider's full assessment. LOCADTR was effective for the Medicaid and Child Health Plus products starting on 7/1/16 and for our Commercial, Federal Employee Program (FEP) and Medicare products effective 9/1/16.
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.
LOCADTR does not constitute medical advice. Treating practitioners are responsible for the medical advice and for the treatment of their patients. As a result, we recommend that you review these criteria with your doctor to fully understand how the criteria related to your situation.
For Inpatient Substance Use Reviews including inpatient detoxification, inpatient rehabilitation and residential levels of care; the following questionnaire will be used 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.
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 844-809-7518.