Current through Register Vol. 63, No. 9, September 1, 2024
In addition to any other requirements described in these rules
and applicable statutes, programs approved to render Medically Monitored
Inpatient Withdrawal Management Services, ASAM Level of Care 3.7-WM to
adolescents or adults must, at a minimum, meet and maintain documentation
demonstrating ongoing compliance with each of the following
requirements:
(1) Render a planned and
structured regimen of 24-hour professionally directed services delivered by
medical treatment staff that include evaluation, observation, medical
monitoring, and withdrawal management in an inpatient setting, under a defined
set of physician approved and monitored medical procedures and
protocols.
(2) Patients must meet
the following ASAM dimensional assessment criteria required for placement in
ASAM Level of Care 3.7-WM:
(a) The patient is
experiencing signs and symptoms of severe withdrawal or there is evidence,
based on history or other relevant factors, that severe withdrawal syndrome is
imminent;
(b) The severe withdrawal
syndrome is assessed as manageable at this level of care; and
(c) The patient scores within a defined range
on CIWA-Ar, COWs or other assessment metric for the drug(s) identified for
withdrawal management services and meets physician-defined protocol for
admission at this Level of Care.
(3) Medical services must include:
(a) A LMP onsite daily to render medical
assessments, provide monitoring of care and further evaluation;
(b) A Medical treatment staff onsite and
readily available 24 hours a day, 7 days per week, to oversee the monitoring of
the patient's progress and medication administration on an hourly basis, or as
needed; and
(c) Medical staff must
have access to specialized clinical consultation and supervision for
biomedical, emotional, or behavioral issues related to intoxication and
withdrawal management.
(4) Starting April 1, 2024 the following
standards are in effect: ASAM Level 3.7-WM Programs must maintain a 24-hour,
daily minimum of on-site medical staffing as follows:
(a) Minimum licensed nurse staffing:
(A) A medical treatment staff must be on each
shift 24 hours per day;
(B) An LNP
must serve as the licensed charge nurse for no less than eight consecutive
hours between the start of day shift and the end of evening shift, seven days a
week; and
(C) Section (4)(e) of
this rule may be variance by the Division. The request for variance must comply
with OAR 415-012-0090 and must be reviewed annually. The variance shall be
considered by the Division if the program attests that:
(i) The program has been unable to recruit
appropriate personnel despite diligent efforts, including offering wages at the
community prevailing rate for withdrawal management facilities;
(ii) The variance does not endanger the
health or safety of patients; and
(iii) An RN or physician is available and
obligated to immediately respond to telephone calls from the program and
respond on-site when medically necessary.
(b) Minimum Certified Nursing Assistant
(nursing assistant) staffing ratios:
(A) Day
shift: 1 nursing assistant per 8 patients;
(B) Evening shift: 1 nursing assistant per 10
patients; and
(C) Night shift: 1
nursing assistant per 16 patients.
(c) At a minimum, one additional medical
treatment staff must be onsite and readily available 24 hours per day:
(A) When the census is between 9-20;
and
(B) For each additional 10
patients or part thereof when the census is 21 or higher.
(d) Providers are responsible for assuring
appropriate staffing and must increase the number of medical treatment staff
present beyond the minimum levels set forth above, as necessary to safely
monitor and treat patients. Providers must consider patient acuity and medical
treatment staff responsibilities when determining the appropriate levels of
additional staffing.
(5)
The following staffing standards are in effect until March 31, 2024:
(a) ASAM Level 3.7-WM Programs must be
staffed by:
(A) LMPs who are available 24
hours a day by telephone, available to assess the patient within 24 hours of
admission, or earlier, (if medically necessary), and available to provide on
-site monitoring of care and further evaluation on a daily basis;
(B) A licensed and credentialed nurse must be
available to conduct a nursing assessment upon admission and to oversee the
monitoring of the patient's progress and medication administration on an hourly
basis, if needed;
(C) Appropriately
licensed and credentialed staff must be available to administer medications in
accordance with physician orders; and
(D) The level of nursing care must be
appropriate to the severity of patient needs.
(b) The Program must maintain a minimum ratio
of paid full-time staff to bed capacity as follows:
(A) 1 through 8 beds - 1 staff person on
duty;
(B) 9 through 18 beds - 2
staff persons on duty;
(C) 19
through 30 beds - 3 staff persons on duty;
(D) 31 beds and above - One additional staff
person beyond the three staff required above for each additional 15 beds or
part thereof.
(c) The
Program's written staffing plan must address the provision of appropriate and
adequate staff coverage during emergency and high demand situations.
(d) The Program must provide a minimum of one
hour per month of personal clinical supervision and consultation for each staff
person and volunteer who is responsible for the delivery of treatment services.
The clinical supervision must relate to the individual's skill level with the
objective of assisting staff and volunteers to increase their treatment skills
and quality of services to individuals.
(6) Adolescent ASAM Level of Care 3.7-WM
Withdrawal Management Services are a version of Medically Monitored Inpatient
Withdrawal Management, ASAM Level of Care 3.7-WM services, designed
specifically for adolescents. When licensed as such, in addition to all
requirements for Medically Monitored Inpatient Withdrawal Management, ASAM
Level of Care 3.7-WM, programs must, at a minimum, meet and maintain
documentation demonstrating ongoing compliance with each of the following
requirements:
(a) Medical protocols developed
by a physician knowledgeable in withdrawal management and preferably
knowledgeable about adolescent development and medicine;
(b) LMPs monitor the delivery of procedures
and protocols;
(c) Adolescents
placed at this level of care must be experiencing withdrawal signs and symptoms
that are moderate to severe and thus require 24-hour medical inpatient
care;
(d) Identification of when an
adolescent requires a higher level of care and facilitation of the transfer to
that level of care; and
(e) Medical
services must include:
(A) Provision of
24-hour per day, 7-days per week access to LMP consultation;
(B) Availability for 24-hour per day, 7-days
per week LMP evaluation of adolescents; and
(C) 24-hour per day, 7-days per week medical
monitoring of the safety and outcome of the withdrawal management services;
and
(D) Medical treatment staff
provide 24-hour per day, 7-days per week organized, on-site services that
include medical supervision, observation and treatment.
Statutory/Other Authority: ORS
413.042 & ORS
430.256
Statutes/Other Implemented: ORS
430.306 & ORS
430.345-430.375
