Current through Register Vol. XLI, No. 38, September 20, 2024
29.1. Delivery of patient care and treatment
interventions shall be based on the needs identified in the individualized
treatment plan of care.
29.2.
Within 30 days after admission of a patient, the MAT program shall develop a
more comprehensive individualized treatment plan of care and attach it to the
patient's chart no later than five days after the plan is developed. The
individualized treatment plan of care shall be developed pursuant to the
guidelines and protocols established by the American Society of Addiction
Medicine (ASAM), the Center for Substance Abuse Treatment (CSAT) and the
National Institute on Drug Abuse (NIDA), the American Association for the
Treatment of Opioid Dependence (AATOD), or such other nationally recognized
authority approved by the Secretary. The individualized treatment plan of care
shall include a recovery model based upon the approved guidelines and
protocols.
29.3. The individualized
treatment plan of care shall be reviewed by the program physician, primary
counselor and patient at least every 90 days and documented in the patient
record. Reviews shall address each of the objectives identified on the initial
plan of care; document all treatment, counseling, medications and other
services rendered to the patient; and document the patient's progress. A
revised plan of care may be implemented with each review. If a new plan of care
is not implemented, the reasons for such decision should documented in the
patient's record. Paper and electronic plans of care, including all reviews and
updates, must be acknowledged by the patient.
29.4. The initial and quarterly
individualized treatment plans of care shall be developed by the patient, the
program physician and primary counselor, with input as appropriate from other
health care providers. The individualized treatment plan of care shall be
drafted to meet the specific needs of the patient. After the individualized
treatment plan of care is developed and approved by the patient, the plan of
care shall be placed in the patient's chart within five days of development.
The patient shall receive a copy of all of his or her individualized treatment
plans of care.
29.5. All
individualized treatment plans of care shall include, at a minimum:
29.5.a. Documentation of the patient's
diagnoses; the proposed medical treatment and counseling; medication dosages
and administration;
29.5.b. A
requirement that the patient regularly attend and participate in the MAT
program, both medical and counseling aspects, as determined necessary by the
staff and patient;
29.5.c. The
identification of triggers for misuse of substances;
29.5.d. The development and use of coping
strategies for each trigger;
29.5.e. The development of a detailed relapse
prevention plan;
29.5.f. Meaningful
follow-up on any identified behavioral health issues;
29.5.g. Follow-up medical or physical issues
as necessary;
29.5.h. A vocational
evaluation, formal or informal;
29.5.i. A plan to achieve financial stability
and independence;
29.5.j. A
requirement that the patient abstain from use of illicit substances, abuse of
prescription substances or other substances of abuse;
29.5.k. Documentation of other individual or
familial issues as relevant and appropriate and the proposed means of
addressing such issues;
29.5.l. The
success of the patient's treatment, initiatives and goals;
29.5.m. A description of services and their
frequency to be provided for the patient and primarily directed to achieve the
expected goals and outcomes;
29.5.n. The results from initial, monthly and
random drug tests; and
29.5.o. Such
other information as recommended by the guidelines and recovery model utilized
for the patient.
29.6.
The individualized treatment plan of care shall reflect the patient's current
physical health condition and whether the patient requires other health care
services. MAT programs without primary care services onsite shall refer
patients for appropriate laboratory tests and additional medical treatment and
follow up on the results.
29.7.
Each MAT program shall provide opportunities for family involvement in the
therapy provided to each patient and document such involvement in the
individualized treatment plans of care.
29.8. The medical staff shall conduct careful
discussions with the patient regarding the patient's continued desire to remain
in the MAT program on a maintenance schedule of medication and document such
discussions in the patient's chart and individualized plans of care.
29.8.a. MAT programs shall make every effort
to retain patients in treatment as long as clinically appropriate and medically
necessary in accordance with approved national guidelines and acceptable to the
patient.
29.8.b. At the time of the
quarterly review, the patient shall again be presented with the option of
participating in alternative treatment, such as medically-supervised
withdrawal. The patient shall sign and date a statement indicating whether he
or she wishes to participate in an alternative form of treatment or remain
within the program in an ongoing recovery-oriented maintenance format. The
statement shall be included with the patient's individualized treatment plan of
care.
29.8.c. If the patient
chooses the option of participating in alternative treatment, the
individualized treatment plan of care shall include a consent form signed by
the patient acknowledging that under the detoxification protocol the strength
of maintenance doses of medication-assisted treatment medication should
decrease over time and that the participant is required to work toward a
recovery-oriented lifestyle.
29.8.d. A patient in good standing with the
program, as defined by policy, has the right to continue to stay in the
program. At no time should such a patient feel pressured to enter a program of
withdrawal over his or her objections.
29.8.e. If a patient wishes to enter
medically-supervised withdrawal, the individualized treatment plan of care
shall reflect that choice.
29.8.f.
If at any time a patient in good standing wishes to re-enter a maintenance
program, the patient may do so in consultation with the primary counselor and
medical staff.
29.9. With
the patient's permission, the MAT program shall obtain complete medical records
from other health care providers, including counselors, and maintain the
records in the patient's chart and the individualized treatment plan of
care.
29.10. Coordination of Care
Agreement.
29.10.a. The coordination of care
agreement shall be signed by the patient, program physician and primary
counselor. If a change of program physician or primary counselor takes place, a
new agreement must be signed.
29.10.b. The coordination of care agreement
shall be reviewed and updated at least annually. If the coordination of care
agreement is reviewed, but not updated, the review shall be documented in the
patient's record.
29.10.c. The
coordination of care agreement shall include the following:
29.10.c.1. An authorization allowing
communication between the program physician and primary counselor so that the
patient may receive comprehensive and quality medication-assisted
treatment;
29.10.c.2. The name and
contact information for the program physician and primary counselor;
29.10.c.3. The categories of records which
may be shared;
29.10.c.4. A summary
of treatment and goals, diagnoses and services to be received onsite or by
referral;
29.10.c.5. Current
medications being prescribed, including dosage, frequency and
delivery;
29.10.c.6. Date and
prescription history for medication-assisted treatment medications;
and
29.10.c.7. Estimated length of
treatment.
29.10.d. The
coordination of care agreement will be provided in a form prescribed and made
available by the Secretary.
