__ b. This level of care is required to complete detoxification and enter into treatment or self-help recovery as evidenced by any of the following:
Requires medication and has a recent history of detoxification at a less intensive level of care, marked by inability to complete detoxification. And enter into continuing addiction treatment, and continues to have insufficient skills or supports to complete detoxification; OR
Has a recent history of detox at a less intensive level of care, marked by inability to complete detox. And enter into continuing addiction treatment, and continues to have insufficient skills or supports to complete detox.; OR
Comorbid physical, emotional, behavioral or cognitive condition that increases clinical severity of the withdrawal and complicates detox. Is manageable in a Level III.7-D setting.
LEVEL IV-D – MEDICALLY MANAGED INTENSIVE INPATIENT DETOXIFICATION.
Patient must meet (a) or (b);
Risk of severe withdrawal as evidence by any of the following:
Alcohol withdrawal and CIWA-Ar score is 10 or greater. The patient requires: monitoring more often than hourly; intravenous medication or infusions; or close behavioral monitoring due to high levels of agitation, confusion or extremes of vital signs; OR
Alcohol and sedative-hypnotic withdrawal with seizures, delirium tremens or severe, persistent hallucinations; OR
Daily sedative-hypnotic use at more than therapeutic levels for more than 4 weeks, and has accompanying acute mental or physical disorder complicating withdrawal; OR
Daily sedative-hypnotic use for at least 6 months, in combination with daily alcohol use or regular use of another mind-altering drug known to pose a severe withdrawal syndrome, and accompanying acute mental or physical disorder complicating withdrawal; OR
Severe opiate withdrawal that has not been stabilized or managed at a less intensive level of service; OR
Antagonist medication is to be used in a rapid withdrawal ( as in pharmacological induction and resolution of opiate withdrawal with naloxone in 6 Hours; OR
Stimulant intoxication or withdrawal requires psychiatric or medical monitoring more frequently than hourly because of psychotic impulsive behavior or depressive suicidality; OR
Recent (within 24 hours) serious head trauma or loss of consciousness, with persistent mental status or neurological changes resulting in need for at least close hourly observation; OR
Drug overdose or intoxication has compromised patient’s mental status, cardiac function, or vital signs or functions; OR
Significant acute biomedical disorder poses substantial risk of serious or life-threatening consequences during withdrawal; OR
Drug overdose compromises mental status, cardiac functioning, or other vital signs.
requires medical support and comfort care in this level of care for either of the following reasons:
1. Detoxification regimen or response to the regimen requires monitoring or intervention more frequently than hourly; OR
2. Detoxification or stabilization is required while patient is pregnant until she can be safely treated in a less intensive level of care.