# Title 75 — Department of Human Services

## Article 75-09.1 — Substance Abuse Treatment Programs

## Chapter 75-09.1-02 — Clinically Managed Low-Intensity Residential Care - Adult ASAM Level III.1

### § 75-09.1-02-01. Definitions.

For the purposes of this chapter:
1. "Clinically managed low-intensity residential care" means providing an ongoing therapeutic
environment for clients requiring some structured support in which treatment is directed
toward applying recovery skills, preventing relapse, improving emotional functioning,
promoting personal responsibility, and reintegrating the individual into the worlds of work,
education, and family life, adaptive skills that may not have been achieved or have been
diminished during the client's active addiction. Such programs must offer at least five hours
per week of low-intensity treatment the focus of which will be on issues in ASAM dimensions
four, five, six, and three, if appropriate mental health services are available onsite or by
contractual arrangement. Clinically managed low-intensity residential care is also designed for
the client suffering from chronic, long-term alcoholism or drug addiction and affords an
extended period of time to establish sound recovery and a solid support system. The
residential component of clinically managed low-intensity residential care may be combined
with low-intensity outpatient, intensive outpatient, or day treatment.
2. "Program" means a clinically managed low-intensity residential care program.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-02-02. Provider criteria.

1. A program shall maintain a safe, comfortable, alcohol-free, and drug-free environment.
2. A program shall provide to clients or help clients gain access to full meal service that meets
established nutritional guidelines.
3. A program shall implement written referral procedures and agreements with providers of
services to enable clients to receive necessary aftercare, other therapeutic services,
vocational rehabilitation, educational instruction, literacy training, and attendance at local
support groups.
4. A program shall provide staff twenty-four hours per day.
5. A program shall offer a minimum of five hours a week of professionally directed treatment in
addition to other treatment services offered to clients such as partial hospitalization or
intensive outpatient treatment. Professionally directed treatment must include two support or
group sessions a week for clients.
6. A program shall collaborate with care providers to develop an individual treatment plan for
each client with time-specific goals and objectives.
7. A program shall maintain a record of the client's progress and activities in the program.

History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-02-03. Program criteria.

1. A program shall provide services designed to improve a client's ability to structure and
organize the tasks of daily living and recovery.
2. A program shall provide educational and informational programming to enhance client
recovery.
3. A program shall provide activities to promote a client's social skill development.
4. A program shall provide support group meetings available onsite or transportation assistance
to offsite support group meetings.
5. A program shall provide transportation assistance to enable clients to use offsite rehabilitation
services.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-02-04. Admission criteria.

Before a program may admit a client, the client must:
1. Meet diagnostic criteria for a substance dependence disorder of the DSM; and
2. Meet specifications in each of the six ASAM patient placement criteria dimensions.
Specifically, the client must:
a. Have no signs or symptoms of withdrawal or have withdrawal needs that can be safely
managed by the program;
b. Not have a physical condition or complication impacting immediate safety and well-being
requiring twenty-four-hour medical or nursing interventions and the client is capable of
self-administering any prescribed medications;
c. Not have an emotional, behavioral, or cognitive condition or complication impacting
immediate safety and well-being, requiring twenty-four-hour medical or nursing
interventions unless in a dual diagnosis program;
d. Be at a stage of readiness to change in which the client requires twenty-four-hour
structured milieu, acknowledges the existence of a substance use problem, is capable of
self-care, and is sufficiently ready to change or is appropriately placed in a level I
outpatient services or level II intensive outpatient services and is receiving clinically
managed low-intensity residential care concurrently because of the need for engagement
and motivational strategies or requires a twenty-four-hour structured milieu to promote
treatment progress and recovery because past motivational strategies on an outpatient
treatment have failed or the client is unable to make behavior changes without the
support of a structured environment; or has a history of compulsive, relapse-prone
chronicity or organic-related difficulties as a result of the client's abuse of alcohol or other
drugs;
e. Be in imminent danger of relapse with dangerous emotional, behavioral, or cognitive
consequences because of limited coping skills to address relapse triggers and cravings;

or because the client is unable to consistently address the substance dependence
disorder in spite of understanding it and is at risk in a less structured level of care or
without staff support to maintain engagement while transitioning to life in the community;
or because of other issues such as postponing immediate gratification and these issues
are being addressed concurrently in a level II program; and
f. Require a twenty-four-hour supportive setting because the client is at moderately high
risk of physical, sexual, or emotional abuse; or is assessed as being unable to achieve or
maintain sobriety at a less intensive level of care because substance use in the client's
recovery environment is so endemic; or lacks social contacts or has inappropriate social
contacts that jeopardize recovery; or is unlikely to recover because of continued
exposure to school, work, or living environment and insufficient resources and skills to
maintain an adequate level of functioning; or is in danger of victimization by another; and
is able to cope for limited periods of time outside of the twenty-four-hour structure to
pursue clinical, vocational, educational, and community activities.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
