Rehab Levels and Costs

When comparing outpatient and residential rehab options, families often face confusion over different program types and costs. The key differences are not in the treatment itself, but in the number of hours spent per week and the level of supervision.

Levels of Care and What Each Means

Outpatient treatment (ASAM Level 1) usually means less than 9 hours of structured therapy per week for adults, or less than 6 hours for adolescents. This could involve individual counseling sessions, group therapy, or other structured treatment 1-2 times per week, while the patient continues living at home.

Intensive outpatient programs, or IOPs, are a more structured form of outpatient treatment, with visits often every day. ASAM level 2.1 IOPs require 9 to 19 hours of services per week for adults, and at least 6 hours per week for adolescents. IOP is a step up in intensity from regular outpatient treatment, but it still allows patients to live at home and may attend school or work

Partial hospitalization, or PHP, is an even higher level of outpatient care. Clinically intensive PHP programs can provide 20 or more hours of programming each week, which fills much of a patient’s day. This high level of outpatient care is for people who need daily monitoring in a structured setting, but do not need 24-hour residential supervision.

Residential, or inpatient rehab refers to programs staffed 24 hours a day to provide 24-hour treatment in a residential setting. It can require prior authorization from insurance, and involves more supervision and hours than any outpatient care.

Cost and Insurance: What is Known, What is Not

Quantifying the cost of treatment is difficult, especially because many services are covered by insurance, or available from federally supported facilities.

However, ASAM's guidelines on reimbursable services do shed some light on the difference between levels of care. Medicaid.gov’s ASAM resource guide describes PHP as a 20-hour program for patients who need daily monitoring to manage their treatment without 24-hour care, and this staffed day program is distinguishable from Level 2.1 IOP.

Residential programs differ from lower-intensive care because they provide treatment and supervision 24 hours a day, 7 days a week.

How to Find a Licensed Program

Finding a program licensed by the right authority is an important first step. Because of the seriousness of substance use disorder, both outpatient and residential treatment must be provided by a credentialed, licensed facility. The main federal directory is SAMHSA.gov's treatment finder, at FindTreatment.gov, FindTreatment.gov. The FindTreatment.gov is one of the several key tools for locating a treatment program. It provides a tool to search a variety of treatment programs, and also has specific contact information for each program. SAMHSA's helpline is another comprehensive source. The SAMHSA helpline is a free, confidential service open 24 hours a day. It's accessible in both English and Spanish. To call SAMHSA's helpline, dial 1-800-662-HELP (4357) or TTY 1-800-487-4889.

When Higher-Intensity Care is Considered

To establish medical necessity, a credible authority (such as a physician or licensed counselor) must confirm that the appropriate level of care is medically necessary. Medicaid.gov's ASAM resource guide says that PHP is considered appropriate for people who need daily monitoring.

Residential care is an even higher intensity. SAMHSA categorizes ASAM level 3 residential treatment as care available in a living facility, where patients have access to 24-hour care, including both help and supervision.

What to Say Next: Verify Coverage Before Enrolling

When considering any treatment option, insurance coverage is a key factor. Before enrolling in any program, it's important to confirm the coverage. This includes verifying that the program is both licensed and in-network, and if there are any additional costs. At the same time, it is very important to confirm the program's classification as an ASAM level 1, 2.1, 2.5, or 3.

Some programs may require additional authorization from your insurance company, such as prior authorization for partial hospitalization. To contact SAMHSA's helpline, call 1-800-662-HELP (4357) or TTY 1-800-487-4889.