The ASAM Criteria: Transition from 3rd Edition to 4th Edition

On July 1, 2025, the Illinois Department of Human Services, Division of Substance Use Prevention and Recovery (IDHS/SUPR) will adopt the American Society of Addiction Medicine (ASAM) Criteria, 4th Edition ("4th Edition").

IDHS/SUPR believes in and supports the primary purpose of The ASAM Criteria: "to drive improvements in treatment outcomes for patients with substance use disorders and co-occurring conditions and reduce both under- and overutilization of care." The ASAM Criteria, 4th Edition, page 15, indicates that the transition to the 4th Edition will:

  • update standards of care to reflect current state of science and practice; and
  • further promote a chronic care model that supports seamless transition through a continuum of care.

We encourage you to keep your licensure contact information up to date to receive notifications about the 4th Edition implementation and upcoming training opportunities.

Below are important dates and information that will guide the successful implementation of the ASAM 4th Edition in Illinois.

Illinois Administrative Code, Part 2060

The information provided below, as well as in the chart, are based on the current Illinois Administrative Code, Part 2060. The requirements may change when Part 2060 is changed, and IDHS/SUPR will communicate these updates.

ASAM Criteria, 4th Edition Updates

As organizations are aware, updates to the ASAM Criteria include major changes in assessment and treatment planning standards and service requirements across the continuum of care. Other updates include revising language to reflect current and evolving terminology incorporating care via telehealth and promoting integration of co-occurring conditions.

Below is high-level information about the significant changes in The ASAM Criteria, 4th Edition. Substance use treatment organizations are encouraged to develop provider-specific implementation plans to update their clinical practices.

Licensure

On June 1, 2025, IDHS/SUPR will begin to issue licenses reflecting The ASAM Criteria, 4th Edition levels of care.

* Effective Date: The license will reflect an effective date of July 1, 2025.

Existing Organizations

Existing organizations will receive a new license reflecting The ASAM Criteria, 4th Edition levels of care. IDHS/SUPR will map your currently licensed 3rd Edition levels of care to the 4th Edition.

On May 31, 2025, Midwest Substance Abuse Clinic ("MSAC") is licensed for Level 1 - Outpatient that expires on April 30, 2026. On June 1, 2025, IDHS/SUPR issues Midwest Substance Abuse Clinic a new license with the 4th Edition levels of care that indicates that MSAC is licensed for Level 1.5 with an expiration date of April 30, 2026.

The chart we will use to map levels of care has been included below as a reference tool. If an organization would like to adopt a new 4th Edition level of care, you can submit an application to "Add New Services."

Compliance and Monitoring

IDHS/SUPR expects that all licensed organizations have started to implement the ASAM 4th Edition in their substance use treatment practices. Beginning July 1, 2025, IDHS/SUPR's compliance monitors will begin monitoring organizations for compliance with the ASAM 4th Edition. During these compliance reviews, the monitors will continue to offer technical assistance (TA) and provide feedback to organizations.

Medicaid Certification Alignment

IDHS/SUPR is working closely with the Illinois Department of Healthcare and Family Services (HFS) to identify changes. In November 2024, IDHS/SUPR issued a memorandum to Illinois' managed care organizations (MCOs) announcing the date of adoption, as well as seeking some clarification that will help IDHS/SUPR support organizations as they implement the ASAM 4th Edition.

Training Opportunities

IDHS/SUPR provides publications, curricula, training, and technical assistance to support the development of the SUD treatment workforce. Please remember to keep your licensure contact information up to date to ensure that you receive notifications about the 4th Edition implementation and upcoming training opportunities.

For more information about current trainings, please visit www.prevention.org. Below are the upcoming trainings related to The ASAM Criteria, 4th Edition:

Date and Time Training Link

December 18, 2024

10:30 am - 3:00 pm

The Evolution of the ASAM Criteria: What's New in the Fourth Edition Evolution of the ASAM Criteria

January 14 - 15, 2025

8:30 am - 3:00 pm

Two-Day ASAM Criteria 4th Edition Skill Building ASAM Criteria 4th Edition Skill Building January

March 18 - 19, 2025

8:30 am - 3:00 pm

Two-Day ASAM Criteria 4th Edition Skill Building ASAM Criteria 4th Edition Skill Building March

April 15, 2025

8:30 am - 3:00 pm

Individualized Service Planning with the ASAM Criteria 4th Edition Individualized Service Planning

May 5 - 6, 2025

8:30 am - 3:00 pm

Two-Day ASAM Criteria 4th Edition Skill Building ASAM Criteria 4th Edition Skill Building May

June 2 - 3, 2025

8:30 am - 3:00 pm

Two-Day ASAM Criteria 4th Edition Skill Building ASAM Criteria 4th Edition Skill Building June

The ASAM Criteria, 4th Edition General Updates

Adolescents

The first notable change is that the 4th Edition is focused on adults only. ASAM is working on a volume that will address the patient placement and treatment criteria for adolescents, intended for release in 2024. To prevent the disruption of services to this vulnerable population, SUPR will continue to accept the use of The ASAM Criteria, 3rd Edition for adolescent care.

Continuum of Care

Updates to the continuum of care include renaming and combining levels of care (LOC) with the goal of supporting the integration of both physical and mental health care.

Early Intervention

The ASAM Criteria, 4th Edition has removed Level 0.5 and renamed the service as "Early Intervention and Secondary Prevention" and reframed the service as a comprehensive response to addiction and not a part of specialty addiction treatment. However, early intervention services will still be authorized by a Level 1 license.

Substance Use Treatment Level 1

  • Level 1.0 - Long-Term Remission Monitoring: The 4th Edition added this level of care that allows for ongoing monitoring for patients in remission, including ongoing medication management services and is not tied to a specific treatment setting.
  • Level 1.5 - Outpatient Therapy: This level is consistent with the previous Level 1.0 in the 3rd Edition, and the updates focus on the delivery of outpatient counseling and psychotherapy services.
  • Level 1.7 - Medically Managed Outpatient Treatment: This new level of care is dedicated to medically monitored outpatient care, including opioid treatment programs, low-intensity ambulatory withdrawal management services, and biomedical care for patients with physical health comorbidities.

Substance Use Treatment Level 2

  • Level 2.1 and Level 2.5: These levels had no major changes.
  • Level 2.7 - Medically Managed Intensive Outpatient Treatment: This level is an outpatient level of care that includes withdrawal management and biomedical care.

Substance Use Treatment Level 3

  • Level 3.1 - Clinically Managed Low Intensity Residential Treatment: The updates require more clinical service hours per week and structured services 7 days per week.
  • Removed Levels of Care: The 4th Edition has integrated the standards for Level 3.2-WM into Level 3.5. Level 3.3 has been eliminated.
  • Level 3.5 - Clinically Managed High-Intensity Residential Treatment: This level had no major changes.
  • Level 3.7 - Medically Managed Residential Treatment: The 4th Edition combines the previous Level 3.7 and Level 3.7-WM programs and clarifies that this LOC is a residential treatment level.

The ASAM Criteria Assessment and Treatment Planning Standards

The fundamental component of the ASAM Criteria is the multidimensional biopsychosocial assessment that guides our clinicians to diagnose, recommend the appropriate level of care and develop an individualized treatment plan. The 4th Edition differentiates the intake assessment from the treatment planning assessment. Both assessments are multidimensional and consider the patient's biological, psychological, social, and cultural contexts.

Dimensions

The 4th Edition reorders the dimensions and defines key subdimensions to inform the clinician's level of care recommendation and treatment planning. The dimensions integrate the patient's readiness to change across all dimensions and establishes a new dimension - Dimension 6: Person-Centered Considerations.

Other Updates

  • Addiction Medication: Multiple updates with the intent to increase access to addiction medication in all levels of care.
  • Withdrawal Management Services: As reflected above, the 4th Edition has integrated withdrawal management services into the medically managed levels of care (i.e., Level 1.7, 2.7 and 3.7).
  • Biomedical Care: Integrates biomedical service standards into the medically managed level of care, as these levels already offer medical management and nurse monitoring.
  • Co-Occurring Capability: Promotes integrated care by embedding care standards for patients with a co-occurring mental health condition, with the expectation that all programs should be able to provide or refer individuals with mild to moderate mental health concerns.
  • Patients with Cognitive Impairments: The 4th Edition has removed Level 3.3 and embedded the treatment of cognitive impairments within each level of care in the continuum.
  • Recovery Support Services (RSS): Advocates for a recovery-oriented systems of care by including standards that identify RSS that should be available directly or through partnership at each level of care.
  • Harm Reduction: Encourages clinicians to consider harm-reduction related needs for each patient.

Transition Chart

IDHS/SUPR Levels of Care 4th Edition Overview
Level 1- Outpatient Level 1.5 - Outpatient Therapy The 4th Edition Level 1.5 is consistent with the previous 3rd Edition Level 1.
Level 2- Intensive Outpatient Level 2.1 - Intensive Outpatient Treatment No major changes
Level 2.5- Partial Hospitalization Level 2.5 - High-Intensity Outpatient Treatment No major changes
Level 3.1- Residential Extended Care Level 3.1 - Clinically Managed Low-Intensity Residential Treatment The 4th Edition Level 3.1 includes more clinical service hours and structured services 7 days per week.
Level 3.2- Withdrawal Management- Clinically Managed No longer exists 3.2 has been integrated into 3.5. Effective July 1, 2025, SUPR will no longer license or fund Level 3.2. SUPR will work directly with each organization impacted by this change.
Level 3.5- Clinically Managed High-Intensity Residential Level 3.5 - Clinically Managed Medium to High Intensity Residential Standards from Level 3.2 in the 3rd Edition are now integrated into Level 3.5 in the 4th Edition. Level 3.5 in the 4th Edition will offer clinical monitoring for withdrawal that does not require medical management.
Level 3.7- Withdrawal Management- Medically Monitored Level 3.7 - Medically Managed Residential Treatment The 4th Edition Level 3.7 clarifies that this level of care is a residential treatment level and has aligned the dimensional admission criteria based on the expectations of what a residential Level 3.7 program can safely manage.
Level 4- Medically Managed Intensive Inpatient Level 4 - Medically Managed Inpatient Treatment The 4th Edition clarifies that this level of care is not a specialty level of care, but rather the local hospital setting.
Level 4- Withdrawal Management- Medically Managed Level 4 - Medically Managed Inpatient Treatment The 4th Edition clarifies that this level of care is not a specialty level of care, but rather the local hospital setting.

Frequently Asked Questions (FAQs)

The Illinois Administrative Code Part 2060 ("Part 2060") references levels of care from The ASAM Criteria, 3rd Edition and the service descriptions do not align with The ASAM Criteria, 4th Edition.

Since Part 2060 defines the levels of care that are licensed in Illinois and the service descriptions, the transition to The ASAM Criteria, 4th Edition levels of care will be implemented by policy directive and codified upon the next Part 2060 rule revision.

Other than Smart Alerts and Newsletters, where can organizations find more information about the transition to The ASAM Criteria, 4th Edition?

We will continue to provide guidance via Smart Alerts and our monthly newsletters, as well as periodic training.

Our organization received notification from a managed care organization that they are implementing the ASAM Criteria on January 1, 2025?

The 4th Edition was released in the Fall of 2023. We highly encourage organizations to review and update clinical practices to align with the 4th Edition. As noted above, we are working closely with HFS to ensure that we are aligned in adoption and implementation of the 4th Edition. IDHS/SUPR has requested clarification from the MCOs and when received we will be able to support organizations as they implement the Criteria.

In the interim, should you have any questions, please feel free to reach out to our help desk via DHS.SUPRHelp@illinois.gov.