January 25, 2017 - News
Effective 1/1/17, access to Inpatient Substance Use Disorder (SUD) treatment increased substantially, as new NY State regulations now govern Inpatient SUD coverage/utilization management (UM) applicable to the first 14 days of Inpatient detox and/or rehab levels of care.
For customary referral sources (and non-standard referral sources, e.g., self-referrals, family member referrals, etc.), the new regs will make admitting to Tully Hill easier, in that…
The new regulations’ 14-day coverage/UM requirements also apply to Inpatient admissions at EACH level of care (e.g., can get up to 14 days detox coverage, then up to 14 days IP rehab coverage, given justification for same is present); to patients transferring from 1 facility to another (patient gets 14 days at facility he/she transfers to); and to multiple admissions. They do NOT apply to non-NY State-regulated, non-NY State-issued, and ERISA-regulated plans or any plans’ out-of-network benefits.
This means customary referral source referrals to Tully Hill for admission with these plans will now be decided by referral sources and our clinical and medical staff (which will decide by themselves about admission for self-referrals, family member referrals, non-standard referrals, etc.).
The new regs also mean evaluating patients and admitting them to Tully Hill transitions the medical, clinical, and financial oversight of the first 14 days of treatment of an admitted patient – and subsequent insurance plan approval of same – to Tully Hill.
This transition reinforces even more our need to work together, to ensure that a patient meets Inpatient SUD treatment criteria when he / she is referred.
The new regulations stipulate that the LOCADTR 3.0 and ASAM 2013 3rd edition criteria tools will now be used to determine Inpatient treatment criteria. This makes it necessary for referral sources to complete in full the appropriate referral form template (Hospital, Outpatient, Medical Practice) available here: Take The Next Steps , when referring a patient or client to us.
And PLEASE NOTE – the template itself is a checklist of information/material we need, not a 1-page form to return to us with each item checked off, unaccompanied by the actual information.
THANK YOU for noting these important and welcome changes, and for continuing to trust Tully Hill to treat and care for your patients/clients and their families. Please call 315-696-6114 ext. 135 if you have any questions or need more information about these new regulations and admission process.