ASAM 4th Edition Review

Purpose

In October 2023, the American Society of Addiction Medicine released Volume I of the ASAM Criteria 4th edition, which was updated to reflect the latest research and adult clinical best practices that facilitate better outcomes and patient-centered care. The updated edition promotes a) A Chronic Care Model of Treatment, b) Integration of Care, c) Co-occurring Care; d) Access to Recovery Support Services; e) Harm Reduction—principles that correspond substantially with SAMHSA priorities and HHS’s Overdose Prevention Strategy.

The analysis over the coming months by the Department of Health with assistance from Milliman will review the implementation of the currently adopted ASAM Criteria 3rd edition and consider the transition to ASAM Criteria 4th edition. The review will include ASAM-suggested changes by level of care for levels with significant changes that are pertinent to rate development for potential future adoption. Engagement with providers will occur through a detailed survey and online webinars.

Overview of ASAM Criteria 4th Edition

The American Society of Addiction Medicine (ASAM) Criteria is a comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions. Level of care recommendations and treatment plans are developed based on multidimensional patient assessments that consider the patient’s biomedical, psychological, and social needs. The updated edition promotes a) A Chronic Care Model of Treatment, b) Integration of Care, c) Co-occurring Care; d) Access to Recovery Support Services; e) Harm Reduction—principles that correspond substantially with SAMHSA priorities and HHS’s Overdose Prevention Strategy.

Resources

LDH All-Provider Kick-Off: SUD Rate Review

Provider Survey

LDH is collecting feedback from providers regarding their operations. This survey is due July 15, 2024. Survey and instructional links are provided below:

If you have any questions regarding the SUD review process, you may email LA.IRM.Feedback@milliman.com .

Rate Review

The rate analysis over the coming months by the Department of Health with assistance from Milliman will review the currently adopted ASAM Criteria 3rd edition and consider the transition to ASAM Criteria 4th edition. The rate review will include ASAM-suggested changes by level of care for levels with significant changes that are pertinent to rate development. Rate adjustments and transition to ASAM criteria 4^th edition are dependent on implementation readiness and budget availability.