New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-A - Former Office of Alcohol and Drug Abuse Prevention
Chapter He-A 300 - CERTIFICATION AND OPERATION OF ALCOHOL AND OTHER DRUG DISORDER TREATMENT PROGRAMS
Part He-A 304 - CERTIFICATION AND OPERATIONAL REQUIREMENTS FOR OPIOID TREATMENT PROGRAMS
Section He-A 304.28 - Client Discharge and Transfer
Universal Citation: NH Admin Rules He-A 304.28
Current through Register No. 40, October 3, 2024
(a) A client shall be discharged from an OTP for the following reasons:
(1) Program completion or transfer based on
changes in the client's functioning relative to ASAM Criteria (2013), available
as noted in Appendix A; or
(2)
Program termination, including:
a.
Administrative discharge;
b. The
client left the program before completion against advice of treatment staff;
and
c. The client is inaccessible,
such as the client has been jailed or hospitalized.
(b) An OTP may administratively discharge a client from a treatment program only if:
(1) The client's behavior on OTP premises is
abusive, violent, or illegal;
(2)
The client repeatedly causes disruption to the community or to the OTP and
fails to change their behavior subsequent to written notice of the required
behavior change;
(3) The client
fails to pay fees within 5 business days after being informed in writing and
counseled regarding financial responsibility and possible sanctions including
discharge;
(4) The client has had
unexcused absences on 3 consecutive medication days, and the medical director,
after a reevaluation of the client, has determined that administrative
discharge is warranted;
(5)
Clinical staff documents therapeutic reasons for discharge, including but not
limited to:
a. The client becoming unwilling
to participate in achieving their treatment goals; or
b. The client continuing to use alcohol or
other drugs in a manner that poses a risk to either the client's physical
well-being or public safety;
(6) The client is non-compliant with
prescription medications; or
(7)
The client violates OTP rules in a manner that is consistent with the OTP's
progressive discipline policy.
(c) If a client is administratively discharged due to financial reasons in (b) (2) above, the OTP shall provide medically supervised withdrawal in accordance with (d) below, regardless of the client's ability to pay.
(d) If a client is being administratively discharged for any reason, they shall have the opportunity to participate in medically supervised withdrawal as follows:
(1) The OTP shall maintain the client with a
dose adequate to alleviate all withdrawal symptoms;
(2) The OTP shall establish client dosing
based on individual need, as detailed in the client's treatment plan;
(3) The OTP shall provide flexible dosage
tapering at the client's request;
(4) The OTP shall develop a detoxification
schedule with daily dosage reductions of not more than 10 percent of the
original dose;
(5) The OTP shall
conduct daily observation of the client, monitoring for withdrawal
symptoms;
(6)
Methadone/buprenorphine shall be administered daily; and
(7) Take-home medications shall not be
allowed during medically supervised withdrawal.
(e) Clients may transfer between OTPs subject to the following:
(1) When a client
transferring to a program has received a medical examination within 3 months
prior to admission, the OTP shall not conduct a new medical examination unless
requested by the licensed practitioner;
(2) The OTP to which a client transfers shall
include copies of the previous medical examination in the client's record
within 30 days of admission;
(3)
Upon receipt of an appropriately executed release of information, an OTP shall
provide to the receiving OTP the client's clinical record, including
attendance, dosage, previous 3 drug screens, and all pertinent medical
information, even if the client still has an outstanding financial
balance;
(4) Clients who have
qualified for unsupervised take home doses at their previous
methadone/buprenorphine opiate treatment program shall continue to receive
unsupervised take home doses at the same level, not to exceed 6 take home doses
per week, as long as the receiving OTP has verified the client's compliance in
his or her previous program;
(5)
When transferring a client, the counselor shall:
a. Complete a progress note on the client's
treatment and progress towards treatment goals, to be included in the client's
record; and
b. Update the client
evaluation and treatment plan; and
(6) When transferring a client to another
treatment program, the current OTP shall forward copies of the following
information to the receiving OTP, only after a release of confidential
information is signed by the client:
a. The
discharge summary in (f) below;
b.
Client demographic information, including the client's name, date of birth,
address, telephone number, and the last 4 digits of his or her Social Security
number; and
c. A diagnostic
assessment statement and other assessment information, including:
1. TB test results;
2. A record of the client's treatment
history; and
3. Documentation of
any court-mandated or OTP-recommended follow-up treatment.
(f) In all cases of client discharge or transfer, the counselor shall complete a narrative discharge summary, including, at a minimum:
(1) The dates of admission and discharge or
transfer;
(2) The client's
psychosocial substance use history and legal history;
(3) A summary of the client's progress toward
treatment goals in all ASAM Criteria (2013), available as noted in Appendix A,
domains;
(4) The reason for
discharge or transfer;
(5) The
client's DSM-5 diagnosis and summary, to include other assessment testing
completed during treatment;
(6) A
summary of the client's physical condition at the time of discharge or
transfer;
(7) A continuing care
plan, as applicable, including all ASAM Criteria (2013), available as noted in
Appendix A, domains; and
(8) The
dated signature of the counselor completing the summary.
(g) The discharge summary shall be completed no later than 7 days following a client's discharge or transfer from the OTP.
(h) The counselor shall meet with the client at the time of discharge or transfer to establish a continuing care plan that:
(1) Includes recommendations
for continuing care in all ASAM Criteria (2013), available as noted in Appendix
A, domains;
(2) Addresses the use
of community based support groups; and
(3) Assists the client in making contact with
other agencies or services.
(i) The counselor shall document in the client record if and why the meeting in (h) could not take place.
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