Current through Register Vol. 46, No. 39, September 25, 2024
(a) Services
applicable to all levels of care. Medically supervised withdrawal services
provide assessment, medical supervision of intoxication and withdrawal
conditions, pharmacological services, individual and group counseling, level of
care determination, and referral to other appropriate services.
(b)Screening, linkages and
referral.
(1) All providers of
withdrawal and stabilization services must provide onsite medical, mental
health and substance use disorder services as well as screening, linkages and
referral to other specialized providers of physical and behavioral health
services if such services cannot be provided by the withdrawal and
stabilization program.
(2) All
providers must develop referral sources and keep updated lists of regional
programs which provide treatment and recovery services at all levels of
care.
(3) All providers must
provide screening and referral for specialized physical conditions and/or
mental health conditions.
(4) All
providers shall provide overdose prevention education and naloxone education
and training to a patient or prospective patient, and their significant
other(s), in accordance with guidance issued by the Office. Providers shall
make a naloxone kit or prescription available to all patients or prospective
patients and develop a safety plan with the patient as
needed.
(c)Policies and procedures.
The program governing authority must approve written policies, procedures and
methods governing the provision of services in compliance with Office
regulations and guidance, including a description of each service provided.
Such policies and procedures must include, at a minimum, the following:
(1) procedures and specific criteria for
admission, retention, level of care transition(s), referrals and
discharge;
(2) level of care
determinations utilizing a tool approved by OASAS to determine the appropriate
level of care, treatment/recovery plans, and placement services;
(3) staffing for sufficient coverage and task
designation; at least 50% of all clinical staff must be qualified health
professionals as defined in Part 800 of this Title;
(4) the provision of medical services,
including screening and referral for associated physical conditions;
(5) the provision of mental health services,
including the use of OASAS approved, validated screening instruments for
co-occurring mental health conditions and behavioral health risks, including
suicide risk, and referral for associated mental health conditions;
(6) the provision of evidence-based SUD
treatment services that are person-centered, strength-based and
trauma-informed;
(7) procedures for
the coordination of care with other service providers including transfers,
emergency care and transport;
(8) a
schedule of fees for services rendered;
(9) infection control procedures;
(10) cooperative agreements with other SUD
treatment service providers or other providers of services that a patient may
need;
(11) compliance with other
requirements of applicable local, state, and federal laws and regulations,
OASAS guidance documents and standards of care regarding, but not limited to:
(i) education, counseling, prevention and
treatment of transmissible infections, including tuberculosis, viral hepatitis,
sexually transmitted infections and HIV; regarding HIV, such education,
counseling, prevention and treatment shall include condom use, testing, pre-
and postexposure prophylaxis and treatment;
(ii) the use toxicology tests consistent with
OASAS guidance;
(iii) medication
and the use of medication for addiction treatment;
(iv) medication policies must ensure the
appropriate continuation of medically appropriate and lawfully prescribed
medication(s) taken by the patient prior to admission;
(12) record keeping procedures which ensure
that documentation is accurate, timely, prepared by appropriate staff, and in
conformance with state and federal confidentially rules including 42 CFR Part
2;
(13) utilization review and
quality improvement. All programs must have a utilization review process, a
quality improvement process, and a written plan that identifies key performance
measures;
(14) medical and nursing
procedures consistent with professional practice;
(15) pharmacological services including
storage and dispensing of medication pursuant to applicable state and federal
regulations;
(16) laboratory testing
protocols, including alcohol screening and toxicology tests, such as breath
tests and urine screening;
(17)
toxicology policy;
(18) incident
reporting and review in accordance with this Title; and
(19) screening of patients and visitors and
the disposal of any items that create an unsafe environment;
(i) programs must implement policies and
procedures to prevent and address the presence of items that create an unsafe
environment in a manner that is trauma-informed, person-centered, respectful of
patient and visitor dignity, and that reasonably balances the well-being and
the health and safety of all patients in the
program.
(d)
Medical Protocols for Withdrawal Management.
(1) Providers of withdrawal management and
stabilization services must develop and implement written withdrawal management
and stabilization protocols that are consistent with the following criteria, in
accordance with guidance from the Office:
(i)
objective monitoring;
(ii)
safety;
(iii) involvement of
medical professionals;
(iv)
stabilization on medication for addiction treatment;
(v) patient comfort;
(vi) level of care assessment; and
(vii) transition to continued care.
(2) Providers of withdrawal
management and stabilization services must obtain and maintain approval of
medical protocols for withdrawal management from the OASAS Chief Medical
Officer (CMO) or CMO designee by attesting that their protocols meet the
criteria identified herein and in guidance issued by the Office when seeking
new certification for, or continued operation of, withdrawal management and
stabilization services.
(i) Medical protocols
are subject to review at any time by OASAS.
(ii) Medical protocols not in compliance with
this Chapter and guidance issued by the Office and/or do not meet the standard
of care for withdrawal management and stabilization services may result in
corrective and/or disciplinary action in accordance with this
Title.
(e)
Co-location. Substance use disorder withdrawal and
stabilization services may be co located with other substance use disorder
services to ensure improved coordination of care and linkage.
(f)
Capacity. Capacity
approved by the Office may not be exceeded at any time except with written
permission from the Office.
(g) Emergency medical kit.
Each program shall maintain an emergency medical kit in accordance with the
provisions of Part 800 and applicable guidance.
(h)
Admission requirements for all
programs.
(1) Admission shall be
based upon a diagnosis of substance use disorder pursuant to the most recent
edition of either the Diagnostic and Statistical Manual of the American
Psychiatric Association, or the International Classification of
Diseases.
(2) A level of care
determination must be made using the OASAS level of care assessment tool as
defined in Part 800 of this Title and documented in the patient
record.
(3) The admission
assessment or decision to admit must include identification of initial services
needed until the development of the treatment/recovery plan.
(4) An individual who presents to the
withdrawal and stabilization service seeking or having been referred for
treatment or assessment shall have an initial determination made and documented
in a written record by a qualified health professional, or other clinical staff
under the supervision of a qualified health professional, which states that:
(i) the individual appears to be in need of
withdrawal and stabilization services; and
(ii) the individual appears to be free of
serious transmissible infections that could be transmitted through ordinary
contact; and
(iii) the individual
appears not to need acute hospital care, acute psychiatric care, or other
intensive services which cannot be provided in conjunction with withdrawal and
stabilization services or which would prevent them from participating in
substance use disorder treatment.
(5) Each person admitted to the withdrawal
and stabilization service must receive a medical evaluation as soon as
possible, but no later than the first twenty-four (24) hours.
(6) Decision to admit, notice to patient.
(i) If determined appropriate for withdrawal
and stabilization services, the patient shall be admitted, consistent with Part
815 of this Title.
(ii) The
decision to admit a patient must be made by a clinical staff member who is a
qualified health professional and must be documented by the dated signature
(physical or electronic) of the qualified health professional working within
their scope of practice and include the basis for admitting the
patient;
(iii) there must be a
notation in the patient record that the patient received a copy of the
withdrawal and stabilization service's rules and regulations, including
patient's rights, a summary of federal confidentiality requirements, and a
statement that such rules were discussed with the patient and the patient
indicated that they understood them;
(iv) all patients shall be informed that
admission is voluntary and that a patient shall be free to discharge themselves
from the service at any time, provided however, this provision shall not
preclude or prohibit attempts to persuade a patient to remain in the service in
their own best interest.
(a) For prospective
or admitted patients under an external mandate, the potential consequences for
premature discharge must be explained, including that the external mandate does
not alter the voluntary nature of admission, continued treatment, and
toxicology screening.
(b) Any
patient who desires to leave the service should be offered a physical
examination as soon as possible by medical personnel of the service.
(7) If the medical
personnel determine upon examination that such patient does not pose a danger
to themselves or other persons because they are not incapacitated by a
substance(s) to a degree that they may endanger themselves or other persons, or
that there is no need for medical or psychiatric intervention, the patient and
their family/significant other shall receive the following prior to leaving the
program:
(i) education about the medical
consequences of untreated substance(s) withdrawal.
(ii) instructions for obtaining emergency
medical care for substance(s) withdrawal, should such care be
necessary;
(iii) prescriptions for
all medications, including medications for addiction treatments for substance
use disorder(s);
(iv) referrals to
ensure ongoing access to medications, including medication for addiction
treatment for substance use disorder(s); and
(v) overdose prevention education, naloxone
education and training, and a naloxone kit or prescription regardless of
substance use disorder diagnosis.
(a) the
patient record must document that the patient, and their family/significant
other(s) were provided education about the medical consequences of untreated
substance(s) withdrawal, instructions for obtaining emergency medical care for
substance(s) withdrawal, prescriptions and/or other arrangements to ensure
access to medications, including medication for addiction treatment for
substance use disorder(s), and overdose prevention education, naloxone
education and training, and a naloxone kit or prescription consistent with this
Part.
(b) The patient record must
document the reasons why education about the medical consequences of untreated
substance(s) withdrawal, instructions for obtaining emergency medical care for
substance(s) withdrawal, prescriptions and/or other arrangements to ensure
access to medications, including medication for addiction treatment for
substance use disorder(s), and overdose prevention education, naloxone
education and training, and a naloxone kit or prescription were not offered, if
the program is unable to provide these services or if the patient declines
these services.
(8) If an individual does not meet admission
criteria for the withdrawal and stabilization service, a referral to a service
that can meet the individual's treatment needs must be made, unless the
individual is already receiving substance use disorder services from another
provider. Individuals who do not meet admission criteria shall be informed of
the reason.
(9) The admission
assessment or decision to admit shall contain a statement documenting the
individual is appropriate for this level of care, identify the assignment of a
named clinical staff member with the responsibility to provide orientation to
the individual, and include a preliminary schedule of activities, therapies and
interventions.
(i)Initial assessment.
(1) Except as otherwise provided in
paragraph (2) of this subdivision, an initial assessment must be conducted by a
clinical staff member.
(2) The
initial assessment must be completed within twenty-four (24) hours of admission
and shall include whatever relevant information is necessary to develop an
individualized, person-centered, interdisciplinary treatment/recovery plan. The
initial assessment shall comprise of a written report of findings and
conclusions and shall include the names of any staff or other persons
participating in the assessment.
(3) The initial assessment shall include:
(i) the patient's identifying and emergency
contact information; and
(ii) the
patient's history and recent use of substances, substance use disorder
treatment history, medical history, psychiatric history, high risk behaviors,
mental status, living arrangements, level of self-sufficiency, supports, and
barriers to treatment services; and
(iii) any information concerning a medical or
psychological condition that may affect communication or other functioning;
and
(iv) transmissible infection
risk assessment (HIV, tuberculosis, viral hepatitis, sexual transmitted
infections, and other transmissible infections).
(4) If the patient had previously been
admitted to the same service within thirty (30) days of the current admission,
the previous assessment may be utilized, provided that such documentation has
been reviewed and determined to be current and accurate.
(5) Except for patients admitted to a
medically supervised outpatient service, no patient may be continued in the
withdrawal and stabilization service longer than seven (7) days after admission
unless there is a reasonable probability that discharge criteria will be met
within an additional seven (7) days. Current evidence must document a level of
instability requiring continued stay for adjustment of medication or attainment
of a level of stability to enable functioning outside a structured setting; and
one of the following:
(i) there is medical
evidence of moderate to severe organ damage related to substance use;
or
(ii) the patient is pregnant and
continued stay is necessary to ensure stabilization and/or complete referral to
continuing treatment; or
(iii) there
is evidence of other medical complications warranting continued care in a
withdrawal and stabilization service.
(6)
Medical History and Physical
Examination.
(i) A medical history
shall be taken, and a physical examination performed by a physician, physician
assistant, or nurse practitioner within twenty-four (24) hours of admission.
The physical examination will include but shall not be limited to the
investigation of, and if appropriate, screenings for transmissible infections;
pulmonary, cardiac or liver abnormalities; and physical and/or psychological
conditions or limitations which may require special services or attention
during treatment. The physical examination shall also include the following
laboratory tests:
(a) complete blood count
and differential;
(b) routine and
microscopic urinalysis, as clinically indicated, and in accordance with
guidance from the Office;
(c) if
medically or clinically indicated, urine toxicology test;
(d) blood-based tuberculosis test;
(1) an intradermal PPD may be given in those
circumstances when a blood-based tuberculosis test cannot be performed; this
test is given and interpreted by the medical staff unless the patient is known
to be PPD positive;
(e)
pregnancy test for persons of child-bearing potential; or
(f) any other tests the examining physician,
physician assistant, nurse practitioner or other medical staff member deems to
be necessary, including, but not limited to, an ECG or a chest
X-ray.
(ii) If a medical
history has been taken and a physical examination has been performed within the
last twenty-four (24) hours, the existing medical history and physical
examination documentation, including the results of laboratory and other
diagnostic tests, for the patient may be used to comply with the requirements
of this Part, provided that such documentation has been reviewed and determined
to be current and accurate.
(a) A focused
medical history shall be taken and/or physical examination shall be performed
and/or laboratory tests and other diagnostic tests shall be ordered if the
examining physician or other medical staff determine that elements of the
existing medical history and/or physical examination and/or the results of
laboratory and other diagnostic tests require reevaluation based on the
clinical judgment of the examining physician or other medical staff.
(b) A focused medical history and/or physical
examination shall be performed and/or laboratory, and other diagnostic tests
shall be ordered if the patient has a physical complaint(s) that was not
addressed in the existing medical history and /or physical examination, and/or
the patient has a new physical complaint(s) that has developed since the
existing medical history was taken and existing physical examination was
performed.
(iii) Patient
records shall include a summary of the results of the physical examination,
laboratory test, and other diagnostic tests and shall also demonstrate that
appropriate medical care, including psychiatric care, is recommended to any
patient whose health status indicates the need for such
care.
(j)Initial Services
(1) The initial assessment shall include an
identification of initial withdrawal and stabilization intervention services
needed, and schedules of individual and group counseling to address the needed
services until the development of the treatment/recovery plan. The initial
services shall be based on the withdrawal protocols that may be needed as well
as the goals the patient identifies for treatment.
(2)
Medication for Addiction
Treatment (MAT) for Substance Use Disorder (SUD)
(i) The program shall maintain a patient with
substance use disorder on approved medication, including those federal Food and
Drug Administration (FDA) approved medications to treat substance use disorder,
if deemed clinically appropriate and in collaboration with the patient's
existing provider, and with patient consent, in accordance with federal and
state rules and guidance issued by the Office. The program shall document such
contact with the existing program or practitioner prescribing such
medications.
(ii) To facilitate
access to full opioid agonist medication for patients who are maintained on
such medication at the time of admission or who choose to start such medication
during admission, the program shall develop a formal agreement with at least
one Opioid Treatment Program (OTP) certified by the Office to facilitate
patient access to full opioid agonist medication, if clinically appropriate.
Such agreements shall address the program and the OTPs responsibilities to
facilitate patient access to such medication in accordance with guidance issued
by the Office.
(iii) The program
shall provide FDA approved medications to treat substance use disorder to an
existing patient or prospective patient seeking admission to an Office
certified program in accordance with all federal and state rules and guidance
issued by the Office.
(iv) The
program shall provide education to an existing patient or prospective patient
with substance use disorder about approved medications for the treatment of
substance use disorder if the patient is not already taking such medications,
including the benefits and risks.The program shall document such discussion and
the outcome of such discussion, including a patient's preference for or refusal
of medication, in the patients record.
(v) The program shall ensure that the
patient's discharge plan includes an appointment with a treatment provider or
program that can continue the medication post-discharge.
(3) Psychosocial Treatment Requirements.
(i) Group and individual psychosocial
treatment modalities must be offered.
(ii) These interventions must be
evidenced-based, trauma-informed, personcentered, and individualized to the
needs of the patient per the clinical assessment, in accordance with guidance
and standards from the Office.
(k) Treatment/recovery plan.
(1) Each patient must have a written person-centered
treatment/recovery plan developed by the clinical staff person with primary
responsibility for the patient, in collaboration with the patient and anyone
identified by the patient as supportive to recovery goals. The treatment plan
begins with the assessment incorporated into the patient record and is
regularly updated with progress notes. The plan must be completed within
twenty-four (24) hours of admission and shall be based on the initial
assessment conducted. The plan shall:
(i) be
developed by the responsible clinical staff member(s), in collaboration with
the patient and anyone identified by the patient as supportive to recovery and
signed and dated by all parties when completed and agreed upon;
(ii) provide goals for the outcome of
treatment, the protocols to be followed for medical withdrawal and the clinical
care services to be provided;
(iii)
be updated as appropriate and as required by the level of care should
additional problems requiring immediate treatment be identified;
(iv) reflect coordination of medical,
psychiatric, substance use care, and/or the provision of other services
provided concurrently either directly or through a secondary
provider;
(v) be incorporated in
the patient's case record along with written orders, prescriptions and the
provision of withdrawal and stabilization services; and
(vi) include provisions for prenatal care for
all patients who are pregnant. If a pregnant patient refuses or does not obtain
such care, the provider must have the patient acknowledge in writing that
prenatal care was offered, recommended, and refused. The program should also
offer to develop a plan of safe care with the patient and anyone identified by
the patient and such offer should be noted in the patient
record.
(2)
Continuing review of treatment/recovery plan. The clinical
staff shall ensure that all treatment is provided in accordance with the
individual treatment/recovery plan. The treatment/recovery plan must be
reviewed through the ongoing assessment process and regular progress notes.
Revisions to the treatment/recovery plan shall be reflected in the patient's
progress notes, signed and dated by the responsible clinical staff.
(3) Progress Notes. Progress notes are
intended to document the patient's clinical status. Such progress notes shall
provide a chronology of all significant withdrawal, stabilization and SUD
services delivered to the patient, their progress related to the initial
services or the goals established in the treatment/recovery plan and be
sufficient to delineate the course and results of treatments/services. Service
delivery should be documented in the patient record through regular progress
notes that include, unless otherwise indicated, the type, content, duration,
and outcome of each treatment/service delivered to or on behalf of a patient,
described and verified as follows:
(i) be
written, signed (physically or electronically) and dated by the clinical staff
member or another clinical staff member familiar with the patient's
care.
(ii) record the relationship
to the patient to the patient's developing treatment goals described in the
treatment/recovery plan; and
(ii)
include, as appropriate and relevant, any recommendations, communications, or
determinations for initial, continued, or revised patient goals and/or
treatment; and
(iv) include all
individual, medical, and psychiatric contacts for the purpose of assessing,
diagnosing, or treating the patient.
(v) Unless additional requirements apply to
specific levels of withdrawal and stabilization services, progress notes shall
be documented no less often than once per shift for the first five (5) days and
no less often than once per day thereafter.
(vi) If a patient's condition necessitates
more frequent documentation, the appropriate staff must document the provision
of those services and/or care in the patient's progress notes.
(vii) The program's multidisciplinary team,
as defined in Part 800 of this Title, shall meet on a regularly scheduled basis
for the purpose of reviewing a sample of cases for the purpose of clinical
monitoring of practice. This meeting shall be documented as to date,
attendance, cases reviewed and recommendations.
(l)
Discharge and planning for level
of care transitions.
(1) Discharge
and planning for level of care transition shall commence upon admission and
shall be considered part of the treatment/recovery planning process. The plan
for discharge or level of care transition shall be developed by the clinical
staff member(s) with primary responsibility for the patient in collaboration
with the patient and anyone identified by the patient as supportive to
recovery. Planning must provide a framework for a long-term, patient-driven
treatment/recovery plan and link the patient to appropriate level of care
transition services to support the plan; and include detailed information on
referral and plan specifics. No patient shall be discharged until the plan is
complete and identifies a staff member assigned to follow up on referrals.
Documentation detailing why a discharge or level of care transition plan was
not provided to the patient must be placed in the medical record, if the
patient did not receive a plan.
(2)
Discharge and/or level of care transitions should occur when:
(i) the patient meets criteria documented by
the OASAS level of care determination protocol for an alternate level of care
and has been medically withdrawn from a substance(s) they are physiologically
dependent on, has been stabilized on a medication(s) for addiction treatment if
such treatment(s) were initiated during admission, has co-occurring medical
and/or psychiatric symptoms that have been stabilized, and has developed a
discharge or level of care transition plan;
(ii) the patient and the medical and clinical
staff agree that the patient has received maximum benefit from the withdrawal
and stabilization services provided by the program; or
(iii) the patient does not adhere to the
program's written behavioral standards, provided that the patient is offered a
referral and connection to another treatment program.
(a) discharge for behavioral reasons with a
referral and connection to another treatment program shall only occur after the
program has utilized behavioral interventions to help the patient manage their
behavior in a less disruptive manner and discharge must be consistent with the
provisions of Part 815 of this Title.
(3) The plan shall include, but not be
limited to at least the following:
(i) an
evaluation of the patient's living arrangement, level of self-sufficiency and
available support systems;
(ii)
identification of substance use disorder treatment and other services the
patient will need after discharge including alternative medical and mental
health providers; and
(iii) a list
of current medications.
(a) A member of the
clinical and medical staff who participated in preparing the plan, and the
patient, shall sign and date the plan upon its completion. Except for medically
monitored withdrawal and stabilization services, the program physician shall
also sign and date the plan.
(b)
The plan shall be discussed with the patient, given to the patient upon
discharge and with appropriate patient consent, the plan, including level of
care transition planning, shall be forwarded to any subsequent service
providers. The patient and their family/significant other(s) shall be offered
overdose prevention education, naloxone education and training, and a naloxone
kit or prescription.
(c) For a
patient transitioning directly from a withdrawal and stabilization service to
another service within the same facility, a transfer plan may take the place of
a discharge plan. To ensure sufficient information is available to the new
service, a transfer plan must include information about the patient's immediate
needs, medical and psychiatric diagnoses, medications and plan for meeting
those needs.
(m)
Patient records.
(1) Providers must keep individual patient
records for each patient admitted. These records must include, at a minimum,
all information and documentation required in this Part, including but not
limited to:
(i) identifying information about
the patient and their family;
(ii)
the source of referral, date of commencing service, and names of clinical staff
who have primary responsibility for the patient's care;
(iii) a notation that the patient received a
copy of the program's rules and regulations, including patient's rights
consistent with Part 815 of this Title and a summary of the federal
confidentially requirements, that such rules and regulations were discussed
with the patient, including their ability to designate individuals to be
notified in case of an emergency, and that the patient indicated they
understood them;
(iv) the admission
diagnosis, including substance-related, medical, and psychiatric diagnoses in
official nomenclature with associated diagnostic codes in the most recent
version of the Diagnostic and Statistical Manual (DSM) or the International
Classification of Diseases (ICD);
(v) any clinical and non-clinical
documentation or determination applicable to the delivery of withdrawal and
stabilization treatment services for a patient and/or supporting the patient's
evolving recovery treatment/recovery plan;
(vi) the individual treatment/recovery plan
and all reviews and updates thereto through progress notes;
(vii) reports of all assessments performed,
including findings and conclusions;
(viii) reports of all examinations performed,
including but not limited to X-rays and/or other imaging studies, clinical
laboratory tests, clinical psychological tests, electroencephalograms, and
psychometric tests
(ix)
documentation of public health education and screening with regard to
tuberculosis, sexually transmitted infections, hepatitis, and HIV prevention
and harm reduction.
(x) summaries
of case conferences, and special consultations held.
(xi) dated and signed prescriptions or orders
for all medications with notation of termination dates;
(xii) documentation that the patient, and
their family/significant other(s), were offered overdose prevention education,
naloxone education and training and a naloxone kit or prescription;
(xiii) documentation should include, if
applicable, the reasons why overdose prevention education, naloxone education
and training, and/or a naloxone kit or prescription were not offered or the
reasons why the patient declined overdose prevention, naloxone education and
training and/or a naloxone kit or prescription.
(xiv) the discharge plan;
(xv) any other documents or information
regarding the patient's condition, treatment, and results of treatment;
and
(xvi) signed forms consenting
to treatment and for obtaining or releasing confidential information in
accordance with 42 Code of Federal Regulations Part 2 or other applicable
law.
(2) Patient records
shall be maintained, shared with other clinical staff involved in the treatment
of a patient and with professional staff or other providers involved in the
care of such patient, and released in accordance with state and federal laws
and regulations governing confidentiality.
(n)
Staffing.
(1) Staff may be either specifically assigned to the
withdrawal and stabilization service or may be part of the staff of the
facility within which the service is located, provided that:
(i) they have specific training in the
diagnosis and treatment of substance use disorder, including person-centered,
trauma-informed principles; and
(ii)
the service identifies and documents the percentage of time each shared staff
member is assigned to each service.
(2) A withdrawal and stabilization service
shall have regular, scheduled, and documented training made available in the
following subject areas, or as determined by the Office:
(i) diagnosing substance use disorder and
other addictive disorders;
(ii)
signs and symptoms of withdrawal from all classes of substances;
(iii) complications of withdrawal from all
classes of substances;
(iv) public
health education and screening with regard to tuberculosis, sexually
transmitted infections, viral hepatitis, and HIV prevention and harm reduction,
and,
(v) certification in
cardiopulmonary resuscitation from the American Red Cross, the American Heart
Association or an equivalent nationally recognized organization within one year
of hire, to be renewed as needed.
(3) Each service shall have a qualified
individual designated as the Health Coordinator to ensure the provision of
education, risk reduction, counseling and referral services to all patients
regarding HIV, tuberculosis, viral hepatitis, sexually transmitted infections,
and other transmissible infections.
(4) Clinical staff shall have primary
responsibility for implementing the treatment/recovery plan.
(5) Medical staff shall have primary
responsibility for coordinating medical care including, but not limited to,
physical examination, prescription, dispensing, and/or administration of
medications, observation of symptoms, and vital signs and the provision of
nursing care.
(6) Additional
staffing requirements specific to the type of withdrawal and stabilization
service provided pursuant to applicable sections of this
Part.