THE ASAM AND GREEN-SPRING ALCOHOL AND DRUG DETOXIFICATION AND REHABILITATION CRITERIA FOR UTILIZATION REVIEW

The authors examine the use of two sets of criteria, both dealing with substance abuse level-of-care determinations, yet having two differen t functions, and frequently yielding different decisions: The Green Sp ring Health Services (GSHS) Medical Necessity Criteria for Utilization Management and The American Society of Addiction Medicine (ASAM) Pati ent Placement Criteria. The GSHS criteria are used for rendering medic al-necessity determinations for individuals covered under a managed ca re program. These determinations involve assigning the least restricti ve and least intensive level of care capable of meeting the patient's needs through the use of the complete continuum of treatment service o ptions, including outpatient detoxification, intensive outpatient prog rams, partial hospitalization programs, and supervised residential set tings. The ASAM criteria are oriented toward treatment planning within substance abuse settings to coordinate patient placement between leve ls of care within a treatment program.