Ala. Admin. Code r. 580-9-44-.21

Level III.1: Clinically Managed Low Intensity Residential Treatment Program

This regulation establishes operating standards for Alabama's Level III.1 Clinically Managed Low Intensity Residential Treatment Program (ASAM 3.1), a 24-hour structured residential substance use disorder treatment setting. Covered programs must meet admission criteria based on DSM and ASAM PPC-2R dimensional criteria, provide core clinical services including individual/group/family counseling, medication management, and case management, and maintain adequate qualified personnel including a full-time program coordinator and assigned primary counselors. Specific sub-program requirements apply to adolescent, co-occurring disorders, and women-with-dependent-children program variants.

Ala. Admin. Code r. 580-9-44-.21 - Level III.1: Clinically Managed Low Intensity Residential Treatment Program 

 State Regulations 

 Compare

(1)
 Rule
 Compliance. In addition to compliance with the rules as specified in this
 chapter, each Level III.1 Clinically Managed Low Intensity Residential
 Treatment Program shall comply with the rules as specified in the following
 chapters. 
(a)
 Program Description. The entity
 shall develop, maintain and implement a written program description that
 defines the Level III.1 Clinically Managed Low Intensity Residential Treatment
 Program it provides, as according to Rule
 
580-9-44-.13
 and the following
 specifications: 
1.
 Location. The entity shall
 specifically identify and describe the setting in which the Level III.1 Program
 shall be provided. Services shall be provided in any facility that meets all
 applicable federal, state and local certification, licensure, building,
 life-safety, fire, health and zoning regulations including the DMH facility
 certification standards.

2.

 Admission Criteria: The entity shall develop, maintain and document
 implementation of written criteria for admission to its Level III.1 Program, in
 compliance with the requirements of Rule
 
580-9-44-.13
(9)
 
 and the following specifications: 
(i)
 The
 entity's admission criteria shall specify the target population for its Level
 III.1 Services, which shall include, at a minimum, individuals:
 
(I)
 Whose assessed severity of illness
 warrants this level of care including, but not limited to:
 
I.
 Individuals who have a need for structure
 and support in a twenty-four (24) hour drug-free environment in order to:
 
A.
 Engage in treatment.

B.
 Sustain participation in regular
 productive, daily activities or current treatment for physical or mental
 disorders.

C.
 Develop, integrate
 and practice recovery and coping skills.

D.
 Continue treatment for a substance use
 disorder as a step-down from a more intense level of
 care.

(ii)
 The entity shall provide written
 documentation in individual case records that each client admitted to a Level
 III.1 Program meets:
(I)
 The diagnostic
 criteria for a substance use disorder as defined in the most recent edition of
 the Diagnostic and Statistical Manual for Mental Disorders.

(II)
 The dimensional criteria for admission
 to this level of care as defined in the most recent edition of the ASAM
 PPC-2R.

(iii)
 Adolescent
 Program Specific Criteria: The entity shall provide written documentation in
 individual case records that each adolescent admitted to a Level III.1 Program
 meets: 
(I)
 The diagnostic criteria for a
 substance use disorder as defined in the most recent edition of the Diagnostic
 and Statistical Manual for Mental Disorders.

(II)
 The adolescent dimensional criteria for
 admission to this level of care as defined in the most recent edition of the
 ASAM PPC-2R.

(iv)

 Co-occurring Disorders Program Specific Criteria: The entity shall provide
 written documentation in individual case records that each individual admitted
 to a Level III.1 Co-occurring Enhanced Treatment Program meets: 
 
(I)
 The diagnostic criteria for a substance
 dependence and mental illness disorder as defined in the most recent edition of
 the Diagnostic and Statistical Manual for Mental Disorders.

(II)
 The dimensional criteria for admission
 to this level of care as defined in the most recent edition of the ASAM
 PPC-2R.

(v)
 Women and
 Dependent Children Program Specific Criteria: The entity shall provide written
 documentation in individual case records that each client admitted to a Level
 III.1 Program for Women and Dependent Children: 
 
(I)
 Meets the diagnostic criteria for a
 substance dependence disorder as defined in the most recent edition Diagnostic
 and Statistical Manual for Mental Disorders; and

(II)
 The dimensional criteria for admission
 to this level of care as defined in the most recent edition of the ASAM
 PPC-2R.

(III)
 Is pregnant;
 or

(IV)
 Has care and custody of
 dependent children; or

(V)
 Has lost
 custody of dependent children and has the potential for family
 reunification.

3.
 Core Services: Each Level III.1 Low
 Intensity Residential Program shall demonstrate the capacity to provide a basic
 level of treatment services appropriate to the needs of its clientele. 
 
(i)
 At a minimum, the entity shall
 demonstrate and document its capacity to provide a twenty-four (24) hour
 structured residential treatment environment with the following core services: 
 
(I)
 Placement assessment.

(II)
 Individual counseling.

(III)
 Group counseling.

(IV)
 Family counseling.

(V)
 Psychoeducation.

(VI)
 Peer support.

(VII)
 Daily living skills.

(VIII)
 Medication management.

(IX)
 Alcohol and/or drug
 screening/testing.

(X)

 Transportation.

(XI)
 Case
 management:
I.
 Case planning.

II.
 Linkage.

III.
 Advocacy.

IV.
 Monitoring.

(ii)
 Medical Services. Medical services,
 including a physical examination, shall be provided as specified by the
 entity's medical protocols established as required by Rule
 
580-9-44-.13
(24)
.

(iii)
 Adolescent Program Specific Criteria:
 Each Level III.1 Adolescent Low Intensity Residential Treatment Program shall
 document the capacity to provide each of the core services and the following
 services: 
(I)
 Activity therapy.

(II)
 Academic or vocational
 services.

(iv)

 Co-occurring Disorders Program Specific Criteria: Each Level III.1 Co-occurring
 Disorders Low Intensity Residential Treatment Program shall document the
 capacity to provide each of the core services and the following services: 
 
(I)
 Basic living skills.

(II)
 Crisis intervention services.

(III)
 Activity therapy.

(IV)
 Intensive case
 management.

(v)
 Women and
 Dependent Children Program Specific Criteria: Each Level III.1 Women and
 Dependent Children Low Intensity Residential Treatment Program shall document
 the capacity to provide each of the core services and the following services: 
 
(I)
 Transportation.

(II)
 Child sitting services.

(III)
 Developmental delay and prevention
 services.

(IV)
 Activity
 therapy.

(V)
 Parenting skills
 development.

4.

 Therapeutic Component Implementation. The entity shall document implementation
 of regularly scheduled treatment sessions that are provided in an amount,
 frequency and intensity appropriate to the client's assessed needs and
 expressed desires for care. 
(i)
 Service
 strategies for each Level III.1 Residential Program shall include, at a
 minimum: 
(I)
 Maintenance of an alcohol and
 illicit drug-free residential environment.

(II)
 Implementation of individualized
 counseling plan strategies.

(III)

 On duty, awake staff shall provide supervision of client's health, welfare and
 safety twenty-four (24) hours a day.

(IV)
 All clients enrolled in Level III.1
 Programs shall have access to clinical services twenty-four (24) hours a day,
 seven (7) days a week.

(V)
 The
 entity shall document the provision of planned counseling and recovery support
 services and activities that shall, at a minimum, include: 
 
I.
 Motivational and engagement
 strategies.

II.
 Relapse
 prevention.

III.
 Interpersonal
 choice/decision making skill development.

IV.
 Development of a social network
 supportive of recovery.

V.
 Daily
 living and recovery skills development.

VI.
 Random drug screening.

VII.
 Health education.

VIII.
 Medication management and
 administration.

(ii)
 Adolescent Program Specific Criteria:
 Each Level III. 1 Adolescent Low Intensity Residential Treatment Program shall
 document the capacity to provide the service strategies and the following
 therapeutic components: 
(I)
 Client education
 on key adolescent development issues, including but not limited to, adolescent
 brain development and the impact of substance use, emotional and social
 influence on behavior, value system development, puberty/physical development,
 sexuality and self-esteem.

(II)

 Recreation and leisure time skills training.

(III)
 Gender specific treatment.

(IV)
 Family, community and school
 reintegration services.

(V)

 Academic or vocational services.

(iii)
 Co-occurring Disorders Program Specific
 Criteria: Each Level III.1 Co-occurring Disorders Low Intensity Residential
 Program shall document the capacity to provide the service strategies and the
 following therapeutic components: 
(I)
 Groups
 and classes that address the signs and symptoms of mental health and substance
 use disorders.

(II)
 Groups, classes
 and training to assist clients in becoming aware of cues or triggers that
 enhance the likelihood of alcohol and drug use or psychiatric decompensation
 and to aid in development of alternative coping responses to those
 cues.

(III)
 Dual recovery groups
 that provide a forum for discussion of the interactions of and interrelations
 between substance use and mental health disorders.

(IV)
 Intensive case
 management.

(iv)
 Women
 and Dependent Children Program Specific Criteria: Each Level III.1 Low
 Intensity Residential Treatment Women and Dependent Children Program shall
 document the capacity to provide the service strategies and the following
 therapeutic components: 
(I)
 Gender specific
 services which address issues of relationships, parenting, abuse and
 trauma.

(II)
 Primary medical care
 including prenatal care.

(III)

 Primary pediatric care for children.

(IV)
 Therapeutic interventions for children
 which address their developmental needs and issues of sexual abuse and
 neglect.

(V)
 Outreach to inform
 pregnant women of the services and priorities.

(VI)
 Interim services while awaiting
 admission to this level of care.

(VII)
 Recreation and leisure time skills
 training.

(VIII)
 Academic or
 vocational services.

(IX)
 Financial
 resource development and planning.

(X)
 Family planning
 services.

5.

 Documentation: Each Level III.1 Intensive Outpatient Program shall provide the
 following documentation in each client record: 
 
(i)
 Individualized progress notes shall be
 recorded each day for each respective service provided in Level III.1
 Services.

6.
 Support
 Systems. Each Level III.1 Program shall develop, maintain and document
 implementation of written policies and procedures which govern the process used
 to provide client access to support services on site, or through consultation
 or referral, which shall minimally include: 
 
(i)
 Telephone or in person consultation with
 a physician available twenty-four (24) hours a day, seven (7) days a
 week.

(ii)
 Telephone or in person
 consultation with emergency services twenty-four (24) hours a day, seven (7)
 days a week.

(iii)
 Direct
 affiliation with, or coordination through referral to more and less intensive
 levels of care.

(iv)
 Direct
 affiliation with, or coordination through referral to supportive services,
 including vocational rehabilitation, literacy training and adult
 education.

(v)
 Mutual self-help
 groups which are tailored to the needs of the specific client
 population.

7.
 Program
 Personnel. Each level III.1 Low Intensity Residential Program shall employ an
 adequate number of qualified individuals to provide personalized care for its
 clientele and to meet the program's goals and objectives. 
 
(i)
 Program Coordinator. Each Level III.1 Low
 Intensity Residential Treatment Program shall have a full-time program
 coordinator or manager who shall have a minimum of three (3) years' work
 experience in a direct service area treating clients with substance use or
 co-occurring mental health and substance use disorders, plus other
 qualifications and credentials as designated in writing by the governing
 authority.

(ii)
 Direct Care
 Personnel. All direct care personnel shall have the qualifications as specified
 to provide the specific services delineated in the entity's program description
 for this level of care.

(iii)

 Clinical Personnel. The entity shall maintain an adequate number of clinical
 personnel to sustain the Level III.1 Program as delineated in its operational
 procedures.

(iv)
 Administrative
 Support Personnel. The entity shall maintain an adequate number of support
 personnel to sustain the program's administrative functions.

(v)
 Every client in a Level III.1 program
 shall be assigned to a specific primary counselor for care
 management.

(vi)
 Each primary
 counselor shall maintain a case load not to exceed fifteen (15) clients with
 active cases at any one time.

(vii)

 Adolescent Program Specific Criteria.
(I)

 Direct Care Personnel. All direct care personnel shall be qualified as a
 qualified paraprofessional to provide the specific services delineated in the
 entity's operational plan for this level of care.

(II)
 Clinical Personnel. The entity shall
 maintain an adequate number of clinical personnel to sustain the Level III.1
 Low Intensity Residential Program as delineated in its operational
 plan.

(III)
 Administrative Support
 Personnel. The entity shall maintain an adequate number of support personnel to
 sustain the program's administrative functions.

(IV)
 Every client in a Level III.1 Adolescent
 Low Intensity Residential Treatment Program shall be assigned to a specific
 primary counselor for care management.

(V)
 Each primary counselor shall maintain a
 case load not to exceed fifteen (15) clients with active cases at any one
 time.

(viii)
 Co-occurring
 Disorders Program Specific Criteria. 
(I)
 Each
 Level III.1 Co-occurring Enhanced Low Intensity Residential Program shall have
 access to psychiatric services (led by a qualified psychiatrist or nurse
 practitioner) that are fully capable of evaluating, diagnosing and prescribing
 medications to clients with co-occurring disorders. On-call psychiatric
 services shall be available twenty-four (24) hours a day, seven (7) days a
 week.

(II)
 The treatment
 organization/agency shall have access to an Alabama licensed physician, full
 time, part time, or on contract, who shall be available to the program for
 client care and shall assume liability for the medical aspects of the
 program.

(III)
 Treatment staff that
 provide therapy and ongoing clinical assessment services to individuals
 diagnosed with co-occurring disorders shall have, at a minimum: 
 
I.
 A master's degree in a behavioral health
 related field with a minimum of two (2) years' work experience with individuals
 who have co-occurring disorders, mental health, or substance use
 disorders.

II.
 Specialized training
 to work with individuals who have co-occurring disorders.

(V)
 All other direct care personnel in a
 Level III.1 Co-occurring Enhanced Low Intensity Residential Program shall be
 qualified as a qualified paraprofessional to provide the specific services
 delineated in the entity's operational plan for this level of care.

(VI)
 Clinical Personnel. The entity shall
 maintain an adequate number of clinical personnel to sustain the Level III.1
 Co-occurring Enhanced Residential Program as delineated in its operational
 plan.

(VII)
 Administrative Support
 Personnel. The entity shall maintain an adequate number of support personnel to
 sustain the program's administrative functions.

(VIII)
 Every client in a Level III.1
 Residential Program shall be assigned to a specific primary counselor for care
 management.

(IX)
 Each primary
 counselor shall maintain a case load not to exceed sixteen (16) clients with
 active cases at any one time.

(viii)
 Women and Dependent Children Program
 Specific Criteria: 
(I)
 Direct Care Personnel.
 All direct care personnel shall be qualified as a qualified paraprofessional to
 provide the specific services delineated in the entity's operational plan for
 this level of care.

(II)
 Clinical
 Personnel. The entity shall maintain an adequate number of clinical personnel
 to sustain the Level III.1 Low Intensity Women and Dependent Children
 Residential Program as delineated in its operational plan.

(III)
 Administrative Support Personnel. The
 entity shall maintain an adequate number of support personnel to sustain the
 program's administrative functions.

(IV)
 Every client in a Level III.1 Women and
 Dependent Children Program shall be assigned to a specific primary counselor
 for care management.

(V)
 Each
 primary counselor shall maintain a case load not to exceed ten (10) clients
 with active cases at any one time.

8.
 Training. The entity shall provide written
 documentation that all Level III.1 Program personnel satisfy the competency and
 training requirements as specified in Rule
 
580-9-44-.02
(3)
.

9.
 Service Intensity: The entity shall
 document that the amount and frequency of Level III.1 Low Intensity Residential
 Treatment Services are established on the basis of the unique needs of each
 client served. To assist in addressing these needs the entity shall ensure the
 availability of no less than five (5) hours of structured services each
 week.

10.
 Length of Service: The
 entity shall provide written documentation that the duration of treatment in
 each Level III.1 Low Intensity Residential Program shall vary as determined by:
 
(i)
 The severity of the client's
 illness.

(ii)
 The client's ability
 to comprehend the information provided and use that information to implement
 treatment strategies and attain treatment goals.

(iii)
 The appearance of new problems that
 require another level of care; or

(iv)
 The availability of services at an
 assessed level of need when a Level III.1 Residential Program has been utilized
 to provide interim services.

11.
 Service Availability: The entity shall
 provide written documentation describing the process utilized to establish
 hours of availability for screening, assessment and intake service, and
 counseling services at its Level III.1 Low Intensity Residential Program. At a
 minimum, this process shall:
(i)
 Include
 consideration of the needs of the target population, including work, school and
 parenting responsibilities.

(ii)

 Include consideration of transportation accessibility.

(iii)
 Not be based solely on standard eight
 (8) to five (5), Monday through Friday office
 hours.

Notes

Ala. Admin. Code
 r. 
580-9-44-.21

 New Rule: Filed January
 26, 2012; effective March 1, 2012.

Amended by
 
Alabama
 Administrative Monthly Volume XLI, Issue No. 04, January 31,
 2023
, eff. 
3/17/2023
.

Author:
 Substance Abuse Services Division

Statutory Authority:

Code of Ala.
 1975
, §
 
22-50-11
.

State regulations are updated quarterly; we currently have two versions available.
 Below is a 
comparison between our most recent version and the prior quarterly release.

 More comparison features will be added as we have more versions to compare.

 No prior version found.

 State Regulations Toolbox