Current through Register Vol. 46, No. 39, September 25, 2024
(a)
Policies and procedures. The program governing authority must
approve written policies, procedures and methods governing the provision of
strength based, person centered, trauma informed services to patients in
compliance with Office regulations including a description of each service
provided and a description of evidence-based practices employed in all aspects
of service delivery including but not limited to group, individual and family
treatment. Such policies and procedures shall address, at a minimum, the
following:
(1) procedures and specific
criteria for admission, retention, transfer, referrals and discharge;
(2) level of care determinations utilizing
the OASAS level of care determination protocol, treatment/recovery plans, and
placement services;
(3) staffing,
including but not limited to, training, supervision, and use of student
interns, peers, and volunteers;
(4)
the provision of medical and psychiatric services, including screening and
referral for associated physical or mental health conditions;
(5) a schedule of fees for services
rendered;
(6) infection control
procedures;
(7) cooperative
agreements with other substance use disorder service providers and other
providers of services that the patient may need;
(8) 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 viral hepatitis, sexually
transmitted infections and HIV; regarding HIV, such education, counseling,
prevention and treatment shall include condom use, testing, pre- and
post-exposure prophylaxis and treatment;
(ii) the use of toxicology tests as
clinically appropriate; and
(iii)
medication and the use of medication for addiction treatment;
(iv) if acupuncture is provided it must be
provided in accordance with Part 830 of this Title;
(v) the use of a problem gambling screen
approved by OASAS.
(9)
record keeping procedures which ensure that documentation is accurate, timely,
prepared by appropriate staff, and in conformance with the federal
confidentiality regulations contained in 42 Code of Federal Regulations Part 2;
and
(10) 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.
(b)
Program goals. An inpatient program shall have as its goals:
(1) the improvement of functioning and
development of coping skills necessary to enable the patient to be safely,
adequately and responsibly treated in the least intensive environment;
and
(2) the development of
individualized plans to support the maintenance of recovery, attain
selfsufficiency, and improve the patient's quality of life.
(c)
Minimum services.
Inpatient programs shall provide, at a minimum, the following strength
based, person centered, trauma informed services as clinically indicated and
specified in the individualized treatment/recovery plan:
(1) trauma-informed individual and group
counseling and activities therapy. Group counseling sessions must be structured
in size and duration to maximize therapeutic benefit for each participant.
Program policies must include a process for determining group size, group
purpose, monitoring patient experience, and assessing group efficacy;
(2) skills to identify and manage craving and
urges to use, anticipate recurrent substance use, and develop a safety
plan;
(3) education about,
orientation to, and the opportunity for participation in, available and
relevant self-help groups and other forms of peer support;
(4) assessment and referral services for
patients and significant others;
(5)
HIV education, risk assessment, supportive counseling and referral:
(i) offer viral hepatitis testing; testing
may be done on site or by referral;
(ii) offer HIV testing; testing may not be
conducted without patient written informed consent except in situations
specifically authorized by law; testing may be done on site or by referral;
individuals on a regimen of pre- or post-exposure prophylaxis, must be
permitted to continue the regimen until consultation with the prescribing
professional occurs;
(6)
vocational and/or educational assessment; and
(7) medical and psychiatric
consultation.
(d)
Medication for Addiction Treatment.
(1) All programs 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.
(2) 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.
(3) 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.
(4) 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.
(5) 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.
(e)
Emergency medical kit.
Pursuant to Part 800 of this Title, all programs must maintain an emergency
medical kit at each certified or funded location; such kit must include basic
first aid and naloxone emergency overdose prevention kits sufficient to meet
the needs of the program. Programs must develop and implement a plan to have
staff trained in the prescribed use of a naloxone overdose prevention kit such
that it is available for use during all program hours of operation.
(1) All staff and patients should be notified
of the existence of the naloxone overdose prevention kit and the authorized
administering staff.
(2) Nothing in
this regulation shall preclude patients from becoming authorized in the
administration of the naloxone emergency overdose prevention kit, provided
however, the program director must be notified of the availability of any
additional authorized users.
(f)
Food and nutrition.
(1) Each facility shall provide to each
patient three (3) nutritious meals each day which furnish sufficient nutrients
and calories to meet normal needs as well as the special needs of persons in
recovery.
(2) The facility shall
have available snacks and beverages between meals.
(3) A dietician or dietetic technician acting
within their scope of practice shall provide menu planning services. Other
suitable staff shall be responsible for the procurement of food supplies and
the training and directing of food preparation and serving
personnel.
(g)
Certified capacity. The certified bed capacity of each
inpatient program shall not be exceeded at any time except with the written
approval of the Office.
(h)
Educational and child care services. Each inpatient program
which provides services to school-age youth must make arrangements to ensure
the availability of required basic educational and child care services. (i)
Medicaid. Providers seeking Medicaid reimbursement must comply with the
requirements of this Part and Part 841 of this Title.
(j)Medical emergencies. Each
inpatient program shall have written agreements with general hospitals for the
immediate transfer of patients or prospective patients in need of acute
hospital care, unless the inpatient program is co-located in a general
hospital.
(k)
Telehealth. Services may be delivered using telehealth
consistent with Part 830 of this Title.
