Current through Register No. 40, October 3, 2024
(a) The licensee
shall provide administrative services that include the appointment of a
full-time, on-site administrator who:
(1) Is
responsible for the day-to-day operations of the SUD-RTF;
(2) Meets the requirements of He-P 826.18(i)
and (j); and
(3) Designates, in
writing, an alternate administrator who shall assume the responsibilities of
the administrator in his or her absence. The alternate administrator shall not
be required to meet the requirements of He-P 826.18(i) .
(b) The clinical services director or
designee shall be available for consultation at all times any client is present
at the SUD-RTF.
(c) At the time of
application for admission, the licensee shall provide the client a written copy
of the clientele service agreement pursuant to
RSA
161-J:4.
(d) In addition to (c) above, at the time of
admission, the licensee shall provide a written copy to the client and the
guardian, agent, or surrogate decision-maker, if any, or personal
representative, and receive written verification of receipt for the following:
(1) An admissions contract including the
following information:
a. The basic daily,
weekly, or monthly fee;
b. A list
of the core services required by He-P 826.16(e) that are covered by the basic
fee;
c. Information regarding the
timing and frequency of cost of care increases;
d. The time period covered by the admissions
contract;
e. The SUD-RTF's house
rules;
f. The grounds for immediate
termination of the agreement, pursuant to
RSA 151:21,
V;
g. The SUD-RTF's responsibility for client
discharge planning;
h. Information
regarding nursing, other health care services, or supplies not provided in the
core services, to include:
1. The availability
of services;
2. The SUD-RTF's
responsibility for arranging services; and
3. The fee and payment for services, if
known;
i. The
licensee's policies and procedures regarding:
1. Arranging for the provision of
transportation;
2. Arranging for
the provision of third party services, such as a cable television;
3. Acting as a billing agent for third party
services;
4. Handling of client
funds pursuant to
RSA 151:24
and He-P 826.14(ac); and
5. Storage
and loss of the client's personal property;
j. The licensee's medication management
services; and
k. The list of
grooming and personal hygiene supplies provided by the SUD-RTF as part of the
basic daily, weekly, or monthly rate;
(2) A copy of the most current version of the
patients' bill of rights under RSA 151: 21 and the SUD-RTF's policy and
procedure for implementing the bill of rights pursuant to
RSA 151:20,
II;
(3) The SUD-RTF's policy and procedure for
handling reports of abuse, neglect, or exploitation which shall be in
accordance with
RSA
161-F:46 and
RSA
169-C:29; and
(4) Information on advanced
directives.
(e) The
licensee shall provide the following core services:
(1) Health and safety services to minimize
the likelihood of accident or injury, with protective care and oversight
regarding:
a. The clients' functioning,
safety, and whereabouts; and
b. The
clients' health status, including the provision of intervention as necessary or
required;
(2) Emergency
response and crisis intervention;
(3) Assistance with taking and ordering
medications as needed;
(4) Provide
nutritious meals and snacks in accordance with He-P 826.20 unless the client
chooses other options according to their admission agreement;
(5) Housekeeping, laundry, and maintenance
services in accordance with the admission agreement;
(6) The availability of activities, for which
the facility shall make reasonable accommodation for clients with disabilities,
including television, radio, internet, games, newspapers, visitors, and music,
designed to sustain and promote physical, intellectual, social, and spiritual
well-being of all clients in accordance with the admission agreement;
(7) Assistance in arranging medical and
dental appointments, which shall include assistance in arranging transportation
to and from such appointments and reminding the clients of the
appointments;
(8) Supervision of
clients when required to offset cognitive deficits that may pose a risk to self
or others if the client is not supervised; and
(9) Provide referral to, and assistance in
accessing, medication-assisted SUD treatment, either on site or off site, when
clinically appropriate.
(f) The licensee shall provide access to the
following services:
(1) A screening and
assessment interview conducted or supervised by a licensed counselor to
determine:
a. That the client meets the
requirements for treatment of a substance use disorder; and
b. A determination of the appropriate ASAM
level of care needed.
(2) If the interview in (1) above indicates a
need for a clinical evaluation, the clinical evaluation shall be conducted by a
licensed counselor in accordance with "TAP 21: Addiction Counseling
Competencies," (2017 revision) available as listed in Appendix A using an
evidenced based evaluation tool and addressing all ASAM domains to determine:
a. If the client meets diagnostic criteria as
indicated in Diagnostic and Statistical Manual of Mental Disorders (Fifth
Edition, Text Revision) (DSM-5) (May 2013 edition), available as listed in
Appendix A, for a substance use disorder or other comorbid disorders and
formally documents the DSM-5 diagnosis(es) in client record;
b. The appropriate initial level of care for
the client based on ASAM criteria; and
c. Areas to be addressed in the treatment
plan;
(3) If the
clinical evaluation detailed in (2) above was completed by a licensed counselor
from a referring agency, the licensee should accept that clinical evaluation as
satisfaction of (2) above; and
(4)
Behavioral health services on-site or through referral.
(g) The SUD-RTF shall perform an evaluation
of each client's needs and develop a treatment plan upon admission or within 24
hours following admission as described in (h) below.
(h) Individual treatment plans shall contain,
at a minimum, the following elements:
(1)
Goals, objectives, and interventions written in terms that are specific,
measurable, attainable, realistic, and timely;
(2) Identifies the client's clinical needs,
treatment goals, and objectives;
(3) Identifies the client's strengths and
resources for achieving goals and objectives in (1) above;
(4) Defines the strategy for providing
services to meet those needs, goals, and objectives;
(5) Identifies referral to outside providers
for the purpose of achieving a specific goal or objective when the service
cannot be delivered by the treatment program;
(6) Provides the criteria for terminating
specific interventions;
(7)
Includes specification and description of the indicators to be used to assess
the client's progress;
(8)
Documentation of participation by the client in the treatment planning process
or the reason why the client did not participate;
(9) Signatures of the client and the
counselor agreeing to the treatment plan, or if applicable, documentation of
the client's refusal to sign the treatment plan; and
(10) Identifies the client's discharge
goals.
(i) Treatment
plans shall be updated weekly based on any changes in any ASAM domain or client
status.
(j) Treatment plan updates
shall include:
(1) Documentation of the degree
to which the client is meeting treatment plan goals and objectives;
(2) Modification of existing goals or
addition of new goals based on changes in the clients functioning relative to
ASAM domains and treatment goals and objectives;
(3) The counselor's evaluation of whether or
not the client needs to move to a different level of care based on changes in
functioning in any ASAM domain and documentation of the reasons for this
evaluation; and
(4) The signature
of the client and the counselor agreeing to the updated treatment plan, or if
applicable, documentation of the client's refusal to sign the treatment
plan.
(k) In addition to
the individualized treatment planning in (h) above, all providers shall provide
client education on:
(1) Substance use
disorders;
(2) Relapse
prevention;
(3) Infectious diseases
associated with injection drug use, including but not limited to, HIV,
hepatitis, and tuberculosis (TB);
(4) Sexually transmitted diseases;
(5) Emotional, physical, and sexual
abuse;
(6) Nicotine use disorder
and cessation options; and
(7) The
impact of drug and alcohol use during pregnancy, risks to the fetus, and the
importance of informing medical practitioners of drug and alcohol use during
pregnancy.
(l) When
group education and counseling are provided as part of the treatment program,
the provider shall:
(1) Maintain an outline of
each educational and group therapy session provided;
(2) Limit clinical groups to no more than 12
individuals with one licensed counselor present and no more than 16 individuals
when that licensed counselor is joined by a CRSW or second licensed counselor;
and
(3) Limit recovery support
groups to include no more than 8 individuals with one CRSW present and no more
than 12 individuals when that CRSW is joined by a second CRSW.
(m) All client activities and
services shall be documented in accordance with "TAP 21: Addiction Counseling
Competencies," 2017 revision, available as listed in Appendix A.
(n) At the time of a client's admission, the
licensee shall ensure that orders from a licensed practitioner are obtained for
medications, and that special dietary requirements are documented.
(o) The licensee shall have each client
obtain a health examination by a licensed practitioner within 30 days prior to
admission or within 72 hours following admission to the SUD-RTF.
(p) The health examination in (o) above shall
include:
(1) Diagnoses, if any;
(2) The medical history;
(3) Medical findings, including the presence
or absence of communicable disease;
(4) Vital signs;
(5) Prescribed and over-the-counter
medications;
(6) Allergies;
and
(7) Dietary needs.
(q) The licensee shall maintain a
daily shift change log which documents such things as client behavior and
significant events that a subsequent shift should be made aware of.
(r) When a client refuses care or services
that could result in a threat to their recovery, health, safety, or well-being,
or that of others, the licensee or their designee shall:
(1) Inform the client and guardian, agent, or
surrogate decision-maker, if any, of the potential results of their
refusal;
(2) Notify the licensed
practitioner of the client's refusal of care; and
(3) Document in the client's record the
refusal of care and the client's reason for the refusal if known.
(s) The licensee shall maintain an
information data sheet in the client's record and promptly give a copy to
emergency medical personnel in the event of an emergency transfer to another
medical facility.
(t) The
information data sheet in (s) above shall include:
(1) Full name and the name the client
prefers, if different;
(2) Name,
address, and telephone number of the client's next of kin, guardian, agent, or
surrogate decision-maker, if any;
(3) Diagnosis;
(4) Medications, including last dose taken
and when the next dose is due;
(5)
Allergies;
(6) Functional
limitations;
(7) Date of
birth;
(8) Insurance
information;
(9) Advanced
directives; and
(10) Any other
pertinent information not specified in (1) -(9) above.
