Sec.17-226d-7. Treatment and rehabilitation program requirements for specific modalities

(a) Residential medical detoxification programs

(1) Services provided

Each residential medical detoxification program shall provide the following services:

(A) medical management of the detoxification process from alcohol or drugs or both;

(B) medical and psycho-social assessments of the needs of each client admitted to the program;

(C) referral of all clients to ongoing treatment for whom the assessment has indicated the desirability of continuing participation in the treatment process; and,

(D) motivational counseling to encourage continuing client participation in the treatment process; and,

(E) knowledge about and access to self-help groups.

(2) Additional admission criteria

In addition to the requirements of section 17-226d-6 (a) each residential medical detoxification program shall require that each person admitted to the program shall:

(A) be an alcohol or drug dependent person who is intoxicated by drugs or alcohol at the time of admission;

(B) be at risk of experiencing serious medical complications without medical monitoring of the detoxification process; and,

(C) be likely to require the administration of medications or other services by medical personnel under the supervision of a licensed physician, in order to reduce or eliminate the effects of withdrawal from alcohol or drugs on the body.

(3) Hours of operation

Each residential medical detoxification program shall operate 24 hours per day, seven days a week. Each residential medical alcohol detoxification program shall accept for admission at all times, persons who meet the program admission criteria and for whom space is available.

(4) Length of stay

Clients may remain in residential medical detoxification programs no longer than 5 days for alcohol detoxification and 14 days for drug detoxification unless there is a statement signed by a physician in the client's record stating why it is necessary for the particular client to remain in the program for a longer period of time.

(5) Staffing

(A) Each residential medical detoxification program shall have a licensed physician on the staff or under contract who shall be responsible for supervising all medical services provided by the program. The program shall specify the physician's duties in writing and shall maintain written records of the number of hours and specific functions performed by the physician for the program.

(B) A minimum of one licensed nurse shall be on duty at all times.

(C) A minimum of one paid staff person shall be on duty at all times in addition to the nurse required by subsection (B).

(D) There shall be a client to staff ratio at all times no greater than one staff person on duty for each 10 clients in residence.

(6) Medical services

In addition to the requirements of section 17-226d-6 (j) each residential medical detoxification program shall provide the following medical services:

(A) Medical screening by a physician, nurse or physician's assistant at the time of admission for each client to exclude clients who have any serious injury or other medical condition requiring referral to a hospital; and,

(B) Each client admitted to a residential medical detoxification program shall be examined by a physician within 24 hours after admission unless the client was examined by a physician immediately before admission pursuant to the requirements of 17-226d-6 (j) (5) and orders were written by the examining physician.

(b) Social-setting alcohol detoxification

(1) Services provided

Each social-setting alcohol detoxification program shall provide the following services:

(A) counseling and other supportive non-medical services to clients who are experiencing physical withdrawal from alcohol;

(B) continual observation of clients during the withdrawal process;

(C) motivational counseling to encourage continuing client participation in the treatment process;

(D) referral to ongoing participation in the treatment process; and,

(E) knowledge about the access to self-help groups

(2) Additional admission criteria

In addition to admission criteria developed pursuant to the requirements of 17-226d-6 (a), each social-setting alcohol detoxification program shall formulate admission criteria which ensure that:

(A) Each client admitted to the program has been observed and evaluated by staff trained to determine whether the client is eligible for admission to a social-setting alcohol detoxification program.

(B) Clients shall not be admitted to the program who:

(i) are unconscious or have obvious life threatening medical conditions, such clients shall be sent directly to a hospital;

(ii) exhibit symptoms of dual addiction or psychotic behavior, or have had a heart attack within 6 months shall be referred to an appropriate medical facility.

(C) Clients who exhibit or state that they have any of the following symptoms shall be sent to a hospital emergency room for immediate screening and must have a written medical clearance, signed by a licensed physician before they can be admitted to the program:

(i) a blood alcohol level of .3 or greater;

(ii) severe abdominal pain;

(iii) irregularities in skin color;

(iv) chest pain, vomiting or passing blood; or,

(v) evidence of recent traumatic injury.

(3) Hours of operation

Each program shall operate 24 hours per day, 7 days per week and shall accept admissions at anytime.

(4) Length of stay

Clients may remain in a social-setting alcohol detoxification program no longer than 5 days unless there is a statement signed by a certified alcoholism counselor in the client record stating why it is necessary for the particular client to remain in the program for a longer period of time.

(5) Staffing

(A) All professional staff employed by the program shall be trained in first aid and cardiopulmonary resuscitation and shall have additional training from a physician to recognize the onset of medical problems associated with withdrawal from alcohol.

(B) There shall be at least two paid staff persons on duty at all times.

(C) There shall be a client to staff ratio at all times no greater than one staff person on duty for each 10 clients in residence.

(6) Medical care agreements

Each program shall have a written agreement with one or more licensed physicians to provide staff training as required by subsection (5) (A) of this section.

(c) Residential programs

(1) Residential programs shall provide residential accommodations and meals and one or more of the following services to clients:

(A) Intensive services shall at a minimum include:

(i) a short term program of up to 30 days duration;

(ii) daily group and/or individual counseling sessions, alcohol education, and knowledge about, and access to, self-help groups.

(B) Long term treatment and rehabilitation services shall at a minimum include:

(i) daily group and, or individual counseling;

(ii) a minimum of 20 hours per week of treatment which may include activities such as individual, group or family counseling, lectures, discussions or films;

(iii) knowledge about and access to self help groups.

(C) Intermediate services which shall, at a minimum include:

(i) a program of more than 30 days duration;

(ii) counseling on an individual and/or group basis at least 3 days per week;

(iii) introduction to self-help groups;

(iv) assistance in finding and retaining gainful employment or entering an educational or vocational training program;

(v) a minimum of 3 hours of counseling per week for each client for the first 30 days treatment and a minimum of one counseling session per week thereafter.

(2) Additional admission criteria

In addition to admission criteria developed pursuant to the requirements of 17-226d-6 (a), residential programs shall not admit:

(A) any person in need of detoxification from alcohol or drugs;

(B) any person who would be an appropriate candidate for outpatient or day/evening treatment.

(C) any person for intermediate services for whom gainful employment is not a reasonable expectation as determined by the initial assessment.

(3) Hours of operation

Each residential program shall operate seven days a week, 24 hours per day.

(4) Medical services

Each residential program shall arrange for the provision of medical services for illness or injury which occur during the course of the client's stay in the program. The program may provide such services through a staff physician or through a contract or contracts with licensed physicians, clinics or hospitals.

(5) Staffing

A paid staff person shall be physically present overnight and shall have ready access to back up clinical staff at each residential program.

(d) Day/evening programs

(1) Services offered

Each day/evening treatment program shall, at a minimum provide the following services to its clients:

(A) a short term non-residential program operating a minimum of 5 hours a day, 5 days a week if a daytime program or a minimum of 3 hours an evening 3 evenings a week if an evening program;

(B) a planned program of activities including substance abuse education and an introduction to the concept of self-help groups;

(C) daily individual, group or family counseling each day the program is in operation;

(D) a minimum of fifty percent of each client's time at the program shall be spent in individual, group or family counseling sessions and other activities such as lectures, discussions or films.

(e) Outpatient programs

(1) Services offered

Each program shall provide the following minimum services:

(A) individual, family or group counseling on an outpatient basis;

(B) a minimum of one counseling session per client per week except when the client record includes an explanation why less frequent counseling is appropriate, however, any client who receives less than one counseling session within a 30 day period shall be discharged from the program; and,

(C) knowledge about and access to self-help groups.

(2) Hours of operation

Each outpatient program shall operate at least 5 days a week, eight hours a day. Each program shall be open at least one evening a week or two hours a week outside of the hours of 9:00 a.m. to 5:00 p.m. to accommodate the needs of clients who work during the day.

(3) Medical services

Each outpatient program which dispenses prescription drugs as part of their planned treatment regimen shall:

(A) employ a medical director who shall be responsible for overseeing the administration of all drugs to clients;

(B) give physicals in accordance with the requirements of section 17-226d-6 (1) to all clients prior to the start of drug therapy.

(f) Methadone programs

(1) Except where this section imposes other or more stringent specific requirements, any program offering methadone maintenance or methadone detoxification shall abide by the Federal Methadone Regulations, 21 CFR 291, which are hereby incorporated by reference.

(2) Admission criteria

(A) No program shall admit any person to maintenance treatment who: is less than 18 years old unless the program has documented evidence that the person has made at least two attempts at drug free treatment.

(B) A program may establish admission criteria which is more stringent than the federal requirements with the prior written approval of the State Methadone Authority.

(3) Required documentation

In addition to the requirements of subsection (i) of section 17-226d-6 each methadone program shall record the following information in the client's record:

(A) all changes in the client's medication schedule;

(B) all changes in dosage;

(C) in any case where a replacement dosage of methadone must be dispensed to a client during a single day the reasons why such replacement dosage was dispensed shall be recorded in the client's record; and,

(D) at any time the program physician orders that a urine screening or other required laboratory tests not be given the reasons for the order shall be recorded and signed by the physician.

(4) Hours of operation

(A) Inpatient programs shall be open 24 hours per day, seven days a week.

(B) Outpatient detoxification programs shall be open seven days a week.

(C) Outpatient maintenance programs shall be open a minimum of six days a week.

(5) Physicals and laboratory examinations

(A) Each program shall ensure each client has a physical examination upon admission to the program and at least annually thereafter in accordance with the requirements of section 17-226d-7 (j). The annual physical may be performed by the client's personal physician.

(B) When a client who has left the program seeks readmission less than 6 months after receiving a required physical, only a urine screening need be performed unless other tests as required by section 17-226d-6 (j) (2) are medically indicated.

(C) A client who seeks readmission more than six months after receiving a required physical shall receive a physical and all laboratory tests as required by subsection (A) of this section.

(6) Each program shall have and utilize a written procedure for dispensing methadone to clients which shall include but need not be limited to the following requirements:

(A) Subject to the exceptions listed in subsection (8) below, all methadone dispensed by the program shall be consumed on the program's premises in the presence of the program staff member who dispensed the drug.

(B) A written description of the circumstances under which a replacement dosage may be administered to a client.

(C) Whenever a program permits clients to have take home dosages of medication, the program shall warn clients of the dangers of accidental poisoning of children or other members of the client's household and shall advise clients as to the proper and safe storage of methadone in the client's home.

(D) All methadone dosages dispensed for off-premises consumption shall be dispensed in child-proof containers with a warning label.

(7) Counseling

Each methadone program shall provide a minimum of one counseling session per month for each client.

(8) Permissible off-premises consumption

Each program which allows off-premises consumption of methadone dispensed by the program shall do so in accordance with a written procedure which shall include but need not be limited to, whichever of the following circumstances are applicable to the program:

(A) Each program which operates six days a week may give each enrolled client one take-home dosage of medication each week.

(B) Each program which has a written policy and criteria permitting decreasing attendance may give any client who qualifies up to a 6 day supply of methadone no more frequently than every 7th day in accordance with the requirements of the Federal Methadone Regulations.

(C) When an enrolled client is so ill that he is unable to physically come to the program for his medication the program physician may:

(i) Authorize delivery of the medication to the client provided that either a licensed nurse or a licensed physician, accompanied by one other person employed by the program, delivers the medication.

(ii) Obtain the approval of the Federal Food and Drug Administration and the State Methadone Authority to permit a relative or other individual to pick up a single dose of medication and deliver it to the client.

(D) Holidays

(i) Each outpatient program regardless of its regular schedule may close for the holidays of Independence Day, Thanksgiving, Christmas Day and New Year's Day and may provide a single dose of take-home medication for each client enrolled in the program for each holiday.

(ii) Each outpatient maintenance program, regardless of its normal schedule may close for official state holidays other than those listed in subsection (i) above and may provide a single dose of take-home medication for each client enrolled in the program for each holiday provided the reason for the take-home dose is recorded in each client's record.

(E) Travel

(i) Each program which allows take-home medication to be dispensed for client travel shall have and utilize written criteria describing the circumstances under which such take-home doses for travel are permitted.

(ii) When a client requests take-home medication for travel which will last more than seven days but less than 15 days the program must obtain the prior written approval of the State Methadone Authority before dispensing the take-home medication.

(iii) When a client requests take-home medication for travel which will last 15 days or more the program must obtain the prior approval of both the Federal Food and Drug Administration and the State Methadone Authority before dispensing the take-home medication.

(9) Involuntary detoxification

(A) Each program shall have and utilize a written procedure for the detoxification of clients who have been expelled from the program, which procedure shall conform to the requirements of section 17-226d-11 (g).

(B) Detoxification of clients expelled from the program shall occur at the expelling program's facilities unless the client has been expelled for violent behavior or threats of violence, in which case the program is not obligated to provide detoxification, but may make a referral to another program.

(C) A program shall have no further responsibility to provide treatment to, or take any other action on behalf of, a client who has been expelled from the program and who has been offered the opportunity to contest the expulsion pursuant to the requirements of section 17-226d-11 (g) and who has rejected the program's arrangements for detoxification provided pursuant to subsections (A) and (B) of this section.

(Effective September 20, 1984)