ASAM Criteria, 4th Edition® Feature: User Guide

The BestNotes ASAM Criteria, 4th Edition® level of care workflow tool helps providers efficiently document and align clinical level of care decisions with ASAM’s 4th Edition criteria—directly within the EHR. It supports consistent, compliant use of ASAM standards while encouraging reference to the official ASAM Criteria for comprehensive clinical guidance.

Access

The ASAM Criteria, 4th Edition® feature is permission-enabled. The cost for this feature is $2 per authorized user per month for the ASAM Criteria, 4th Edition® digital license.

Permissions required

1. Navigate to Settings.
2. Click on Security.
3. Select Permission Groups in the dropdown.
4. You may add this permission to any existing permission group OR create a new permission group.
5. Select Complete ASAM Criteria, 4th Edition® permission within the Clinical permissions.
6. Click Save.
7. Users affected by this permission adjustment will need to log off and log back on to see the new access.

Using the feature

NOTE: This feature is intended for use by providers who have completed training from ASAM Criteria, 4th Edition®.

The ASAM Criteria, 4th Edition® has five core dimensions that have admissions criteria associated with them.

1. Navigate through dimensions: Continue through each dimension and subdimension, matching the patient’s presenting status.
2. Select criteria: As the provider, click the criteria button and select the criteria statement that matches the patient’s presenting experience.
3. Add narrative and dimensional drivers: 
   • Include a narrative for the dimension/subdimension
   • Any narrative included and marked as a "dimensional driver" will become eligible for treatment plan inclusion
4. Record relevant measures (if applicable): At each subdimension level, you can record a relevant measure as applicable. Examples include a CIWA or COWS score or any other outcome measure to support your narrative. 
5. Risk rating: As criteria are selected, a corresponding risk rating is generated, which measures can be recorded, or none at all.

Determining Level of Care (Dimensions 1-5)

After completing Dimension 5 and all its subdimensions:

1. Review recommended level of care: Click Edit to view the ASAM Criteria recommended level of care.
2. Make selection: Identify the highest recommended level of care and click the correct radio button.
3. Optional indications: Recovery Residence, Prompt Medical Evaluation, or MOUD Continuation 
4. Click Update.

Dimension 6: Person Centered Considerations

Dimension 6 is a mandatory step in the process, but it does not have any criteria rules associated with it.

1. Answer the question:"Is the patient willing to attend the criteria recommended level of care?"
   • If Yes, follow-up questions may be hidden.
   • If No, you will need to answer follow-up questions.
2. Barriers to care: If selected, you can type in any identified barriers to care, such as transportation, employment, or childcare.
3. Record patient preferences: Record any patient preferences expressed in the text box.
4. Readiness for change: Record the patient’s readiness for change/stage of change (e.g., Action stage).
5. Relevant measures: You can record a relevant measure in relation to Dimension 6.

Summary of Placement Decisions

This section is where your organization records the level of care you have decided is appropriate for the patient. The decision is made by your clinical team, not by ASAM. This should only be set upon intake and should not be changed except at time of transition/discharge to record a level of care change. 

1. Select actual level of care: Use the drop-down to select the actual level of care the patient is being placed.
2. If the selected level of care differs from the criteria's recommendation, select from the available lists:
   • Reason for the difference between ASAM Criteria recommendation and placement
   • Anticipated consequence(s) of level of care adjustment
3. Click Save.

ASAM Criteria, 4th Edition® in a Comprehensive Diagnostic Assessment (CDA)

When completing a CDA for a patient who has already been assessed, the latest ASAM criteria data is shown in a quick view.

1. Re-assessment (if needed): If the current data is not accurate or needs adjustment, click Re-assessment.
2. Review recommended level of care: If any changes are made to the criteria, click Edit and review the recommended level of care to see if your changes have resulted in a change to the ASAM criteria recommended level of care. To complete the re-assessment, click Update.

The ASAM criteria history card within the patient’s chart will show the assessment and the re-assessment as updates are made.

ASAM Criteria, 4th Edition® in a Master Treatment Plan (MTP)

When completing an MTP, the latest results for the patient’s ASAM criteria are shown, and you are able to make adjustments if a re-assessment is needed. 

ASAM Criteria, 4th Edition® in a Treatment Plan Review

During a treatment plan review, if treatment plan content is resolved or improved, it will likely lead to a level of care change.

The level of care review is an additional step during the treatment plan review. 

1. After finishing the treatment plan content (goals, objectives, interventions).
2. Click Edit to review the level of care review.
3. Indicate if the patient is appropriately placed in the correct level of care.
4. Click Update.

A reminder for "Re-assessment indicated" will appear, along with a place for free-form notes (e.g., "scheduled transition with patient").

ASAM Criteria, 4th Edition® in a Transition Discharge Summary

The level of care review in the transition discharge summary will show the current level of care, and if the criteria is supporting a less intense level of care. If re-assessment indicated, the reminder will be present.

1. Complete the re-assessment to determine the correct level of care.
   • Update dimensional drivers and criteria for the patient as appropriate.
2. Review the highest level of care the ASAM criteria is recommending.
3. Record the new recommended level of care, click Update.
4. Dimension 6: Adjust the actual placement of the patient.
   • Ask the questions of Dimension 6 (e.g., if the patient is willing to attend the new level of care).
   • Record the Summary of Placement Decisions. 
5. Click Save and Sign & Complete.

Afterward, update the patient's episodes and programs to reflect the transition, potentially discharging them from the higher level of care program and adding them to the new, lower level of care program. Program settings can have an associated level of care. 

ASAM 4 criteria history card within Clinical tab

In the Clinical tab on the ASAM4 criteria history card, a summary view of the findings is available for providers to see the results at a glance. Click on the episode to expand and see historical data of each assessment and re-assessment.  The card will also include the completion status, who completed it, date, criteria set, and placement decision.

Quick Tips and Best Practices

• Select the criteria statement that best matches the patient’s presenting status 
• Use narrative to support clinical reasoning and continuity
• Mark dimensional drivers intentionally 
• After re-assessments, always review the recommended level of care
• Use ASAM Criteria, 4th Edition® History to track changes over time