Development and Testing of an Addiction Treatment Level of Care Determination Tool

Abstract

Two studies examined inter-rater reliability and content-related validity of an addiction treatment level of care determination tool currently in use in New York, the LOCADTR 3.0. The studies occurred after tool implementation. In study 1, 139 providers used the LOCADTR 3.0 to determine level of care for four case vignettes. Inter-rater reliability coefficients were calculated. In study 2, 387,338 state records from existing data were analyzed to determine how often providers opted to override the LOCADTR 3.0 level of care determination by choosing an alternative level of care. In study 1, an acceptable inter-rater reliability (IRR = .57-.59) was found. Good indication of content-related validity was also found; participants chose the same level of care the study team chose for each vignette 80% of the time. In study 2, the override option was selected only 10% of the time, further establishing the content validity of the tool. These studies provide evidence for acceptable preliminary reliability and validity of the LOCADTR 3.0.

What's in an “ASAM-based Assessment?” Variations in Assessment and Level of Care Determination in Systems Required to Use ASAM Patient Placement Criteria

“…6,7 Medicaid is requiring justification of medical necessity for beneficiaries receiving treatment in higher levels of care. 8 The American Society for Addiction Medicine (ASAM) criteria for patient placement have become the most commonly used level of care determination tools in the SUD field. First published in 1991, the ASAM Patient Placement Criteria were developed to serve as consensus standards for the SUD treatment field and promote common language and placement guidelines for assigning patients to treatment at different levels and intensities.…”

“…Shifts in SUD funding are also making treatment matching increasingly necessary, as the federal government allows more flexibility for Medicaid coverage of treatment in residential SUD programs 6,7 . Medicaid is requiring justification of medical necessity for beneficiaries receiving treatment in higher levels of care 8 …”