The patient has a history of alcohol dependence and was admitted to medically supervised withdrawal services. The patient was receiving treatment for alcohol use disorder with a recommended level of care of medically supervised withdrawal. The patient was reported to have an initial Clinical Institute Withdrawal Assessment (CIWA) score of 17. The health plan's determination is upheld.

The current module of Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) was used with medically managed or medically supervised detoxification as the current level of care. There had not been changes in the patient's status that would require a higher level of care. There was no evidence that withdrawal symptoms continued to require 24-hour medical oversight in a hospital setting due to serious or life-threatening complications. Clinical documentation does not establish that the withdrawal continued to require 24-hour medical supervision, stabilization, and regular vital sign monitoring that should have been managed in a supervised setting. Based on the answers to these questions, the patient did not meet criteria for continued inpatient care.
The patient had experienced improvement in withdrawal symptoms during the authorized days. By the dates of service and question, the patient did not have any distressing withdrawal symptoms, and the clinical documentation does not establish that the inpatient level of care continued to be necessary.
The patient could have been safely and effectively treated at a lower level of care.