# Title 75 — Department of Human Services

## Article 75-09.1 — Substance Abuse Treatment Programs

## Chapter 75-09.1-03.1 — Clinically Managed Medium-Intensity Residential Care - Adolescent ASAM Level III.5

### § 75-09.1-03.1-01. Definition.

As used in this chapter, "clinically managed medium-intensity residential care" means a substance
abuse treatment program that offers continuous observation, monitoring, and treatment by allied
professional staff of individuals with significant psychological and social problems who are not
sufficiently stable to benefit from outpatient treatment no matter how intensive. Such programs include
therapeutic group homes, therapeutic communities, psychosocial model rehabilitation centers, or
extended residential rehabilitation programs. A clinically managed medium-intensity residential care
program should not treat a client who exhibits acute intoxication or withdrawal problems also known as
ASAM dimension one; biomedical conditions and complications also known as ASAM dimension two;
or emotional, behavioral, or cognitive problems also known as ASAM dimension three unless in a dual
diagnosis program also known as level III.5 that requires the availability of twenty-four-hour medical or
nursing interventions. Clinically managed medium-intensity residential care programs must provide
relatively extended, subacute treatments that aim to effect fundamental personal change for the
adolescent who has significant social and psychological problems and the goals and modalities of
treatment focus not only on the adolescent's substance use but also a holistic view that takes into
account the client's behavior, emotions, attitudes, values, learning, family, culture, lifestyle, and overall
health. A clinically managed medium-intensity residential care program is particularly suitable for
treatment of entrenched patterns of maladaptive behavior, extremes of temperament, and development
or cognitive abnormalities related to mental health symptoms or disorders.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-03.1-02. Provider criteria.

A clinically managed medium-intensity residential care program shall:
1. Offer onsite twenty-four-hour-a-day clinical staffing by licensed counselors, other clinicians,
and other allied health professionals such as counselor aides;
2. Make available specialized professional consultation; and
3. Offer the residential program no less than seven days per week with the length of stay to be
determined by a client's condition and functioning.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-03.1-03. Program criteria.

A clinically managed medium-intensity residential care program shall include:

1. Daily clinical services including a range of cognitive, behavioral, and other therapies in
individual or group therapy and psychoeducation as deemed appropriate by an assessment
and treatment plan;
2. Motivational enhancement and engagement strategies appropriate to a client's stage of
readiness to change;
3. Counseling and clinical interventions to teach a client the skills needed for daily productive
activity, prosocial behavior, and reintegration into family and community;
4. Random client drug screening to shape behavior and reinforcement treatment gains as
appropriate to a client's individual treatment plan;
5. A system for referral of a client for identified treatment needs if the service is not available in
the program;
6. Family and caregiver treatment services as deemed appropriate by an assessment and
treatment plan;
7. Educational, vocational, and informational programming adaptive to individual client needs;
and
8. Onsite staff provided or contracted onsite or offsite accredited educational services if a client
is in school; general educational development preparation if the client does not possess a high
school diploma and is no longer in school; or short-term educational services linked to home
school designed to maintain current learning.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-03.1-04. Admission criteria.

Before a clinically managed medium-intensity residential care program may admit a client, the
client must:
1. Meet diagnostic criteria for a substance-related disorder of the DSM; and
2. Meet admission criteria for clinically managed medium-intensity residential services also
known as ASAM level III.5 in each of the six ASAM dimensions. Specifically, the client:
a. Is at risk of or is experiencing subacute intoxication or withdrawal with mild to moderate
symptoms and needs containment and increased treatment intensity without frequent
access to medical or nursing services to support engagement in treatment, ability to
tolerate withdrawal, and prevention of immediate continued use;
b. Does not have a physical condition or complication impacting immediate safety and
well-being, requiring twenty-four- hour medical or nursing interventions but biomedical
conditions distract from recovery efforts and require residential supervision or continued
substance use would place a the client at risk for serious damage to physical health
because of a co-occurring biomedical condition and the resident is capable of
self-administering any prescribed medications;
c. Does not have an emotional, behavioral, or cognitive condition or complication impacting
immediate safety or well-being requiring twenty-four-hour medical or nursing
interventions unless in a dual diagnosis program but does have problems in the areas of

dangerousness or lethality; interference with addiction recovery efforts; social functioning;
ability for self-care; or course of illness;
d. Has a low readiness to change as evidenced by a lack of awareness of the need for
treatment characterized by active or passive resistance to treatment; marked difficulty
understanding the relationship between the substance use and life problems; the client
requires a structured therapy and a twenty-four-hour programmatic milieu to promote
treatment progress and recovery; or the client requires repeated, structured motivational
interventions delivered in a twenty-four-hour milieu;
e. Has a readiness to change but issues in other dimensions impair the ability to translate
this into treatment progress and recovery;
f. Has a high relapse, continued use, or continued problem potential as evidenced by the
lack of recognition of relapse triggers or the lack of commitment to continuing care; the
inability to control use of alcohol or other drugs or antisocial behavior with the attendant
probability of harm to self or others; symptoms such as drug craving; difficulty postponing
immediate gratification and other drug-seeking behaviors; or imminent danger of relapse
with dangerous emotional, behavioral, or cognitive consequences because of a crisis
situation; or
g. Has a chaotic home environment that makes recovery goals assessed as unachievable
at a less-intensive level of care as evidenced by a moderately high risk of physical,
sexual, or emotional abuse; substance use so endemic that the client is assessed as
unable to achieve or maintain recovery; a social network of regular users of alcohol or
other drugs; living with a family or other household member who is a regular user,
abuser, or dealer of alcohol or other drugs; neglect or lack of supervision; the inability to
cope, even for limited periods of time, outside of twenty-four-hour care; a living
environment characterized by criminal behavior, victimization, and other antisocial norms
and values; or the need for staff monitoring before safe transfer to a less-intensive
setting.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
