Ala. Admin. Code r. 580-9-44-.16 - Level I-D: Ambulatory Detoxification Without Extended On-Site Monitoring
(1) Rule
Compliance. Each Level I-D Detoxification Program shall comply with the
following rules and the rules specified in this chapter.
(a) Program Description: The entity shall
develop, maintain and implement a written program description that defines the
Level I-D Ambulatory Detoxification without Extended On-site Monitoring Program
it provides to include the following specifications:
1. Location: The entity shall specifically
identify and describe the setting in which Level I-D Ambulatory Detoxification
without Extended On-Site Monitoring Services shall be provided. Services may be
provided in any appropriate setting that protects the client's right to
privacy, confidentiality, safety and including but not limited to, a general
healthcare facility, a physician's office or an addiction or mental health
treatment facility as pre-authorized by DMH.
2. Admission Criteria: The entity shall
develop, maintain and document implementation of written criteria for admission
to its Level I-D Ambulatory Detoxification without Extended On-Site Monitoring
Program and the following specifications:
(i)
The entity's admission criteria shall specify the target population for the
Level I-D Program, which shall include, at a minimum, individuals:
(I) Experiencing mild withdrawal or at risk
of experiencing withdrawal from alcohol and/or other drugs at a level of
assessed severity appropriate for outpatient care.
(II) Who have adequate systems in place to
support outpatient detoxification process.
(ii) The entity shall provide written
documentation in individual case records that each client admitted to receive
Level I-D Ambulatory Detoxification without Extended On-Site Monitoring
Services meets:
(I) The diagnostic criteria
for a Substance Induced Disorder as defined in the most recent edition of the
Diagnostic and Statistical Manual of Mental Disorders.
(II) The dimensional criteria for admission
to this level of care as defined in the ASAM
PPC-2R.
3. Core
Services: Each Level I-D Detoxification Program shall demonstrate the capacity
to provide a basic level of skilled treatment services appropriate to the needs
of its clientele.
(i) At a minimum, the Level
I-D Ambulatory Detoxification Program shall document the capacity to provide
the following core services:
(I) Placement
assessment.
(II) Individual
counseling.
(III)
Psychoeducation.
(IV) Family
counseling.
(V) Peer
support.
(VI) Medication
administration.
(VII) Medication
monitoring.
(VIII) Alcohol and/or
drug screening/testing.
(IX) Case
management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV.
Monitoring.
4. Therapeutic Component Implementation. The
entity shall document implementation of medical and other clinical services
organized to enhance the client's understanding of addiction, support
completion of the detoxification process and initiate transfer to an
appropriate level of care for continued treatment.
(i) Service strategies for each Level I-D
Detoxification Program shall include, at a minimum:
(I) Implementation of individualized
counseling plan strategies.
(II)
Completion of a comprehensive medical history and physical examination of the
client at admission.
(III)
Protocols and/or standing orders, established by the entity's medical director
for management of detoxification from each major drug category of abused drugs
that are consistent with guidelines published by nationally recognized
organizations, including but not limited to, Substance Abuse and Mental Health
Services Administration (SAMHSA), American Society of Addiction Medicine
(ASAM), the American Psychiatric Association, and the American Academy of
Addiction Psychology.
I. Level I-D Ambulatory
Detoxification Programs that utilize Benzodiazepines in the detoxification
protocol:
A. Shall have written protocols and
procedures to show that all doses or amounts of benzodiazepines are carefully
monitored and are slowly reduced as appropriate.
B. Shall have written longer-term
detoxification protocols and procedures that adhere to general principles of
management including clear indications of benzodiazepine dependence, clear
intermediate treatment goals and strategies, regular review and methods to
prevent diversion from the plan.
(IV) Individual ongoing assessment services,
including, but not limited to:
I. Physical
examination by a physician, physician assistant or nurse
practitioner.
II. Human services
need assessment by a case manager.
(V) Medication administration and monitoring
services including specific procedures for pregnant women.
(VI) Motivational enhancement
therapy.
(VII) Direct affiliation
with other levels of care.
5. Documentation: In addition to meeting the
requirements an individualized progress note shall be recorded for each
respective service provided in Level I-D:
(i)
Daily assessment of progress, including response to medication, which also
notes any treatment regimen changes.
(ii) Regular and frequent monitoring of vital
signs.
(iii) The use of
detoxification rating scale tables and flow sheets.
(iv) Physician review of all
services.
6. Support
Systems. The Level I-D Ambulatory Detoxification Program shall develop,
maintain and document implementation of written policies and procedures
utilized to provide client access to support services on site or through
consultation or referral, which shall minimally include:
(i) Specialized clinical consultation for
biomedical, emotional, behavioral and cognitive problems.
(ii) Appropriate laboratory and toxicology
testing.
(iii) Psychological and
psychiatric services.
(iv)
Twenty-four (24) hour access to emergency services.
(v) Transportation.
7. Program Personnel. Each Level I-D
Detoxification Program shall employ an adequate number of qualified individuals
to provide personalized care for its clientele and to meet the program's goals
and objectives.
(i) Medical Director: The
Level I-D Detoxification Program shall have a medical director who is a
physician licensed to practice in the State of Alabama, with a minimum of one
(1) year experience treating persons with substance use disorders. The medical
director shall be responsible for admission, diagnosis, medication management
and client care.
(ii) Nursing
Services Director: The Level I-D Program shall have a nursing services director
who shall be a Registered Nurse licensed according to Alabama law with training
and work experience in behavioral health.
(iii) Nursing Personnel: The entity shall
have an adequate number of Alabama licensed nurses to assure that the
administration of medications during Level I-D Services complies with
applicable state and federal regulations.
(iv) Case Manager Coordinator: The entity
shall have a case manager coordinator who shall be available to the Level I-D
Program on at least a 50% Full-time Equivalent (FTE) basis and shall, at a
minimum:
(I) Have a Bachelor's Degree in a
behavioral science, at least two (2) years case management experience relative
to substance use disorders, and completed DMH/Mental Illness and Substance
Abuse Services Division approved case management training.
(II) Supervise and delegate responsibilities
to case managers working in the Level I-D Program.
(III) Ensure the availability of
person-centered case management services to facilitate Level I-D clients'
transition into ongoing treatment and recovery.
(IV) Each client shall be assigned to a case
manager for care management.
(V)
All direct care personnel shall have the qualifications, as a qualified
paraprofessional, to provide the specific services delineated in the entity's
program description for this level of care.
8. Training. The entity shall provide written
documentation that all Level I-D Program personnel satisfy the competency and
training requirements as specified in Rule
580-9-44-.02(3).
9. Service Intensity. The entity shall
document in the clinical record that Level I-D Services are provided in
regularly scheduled sessions and that the frequency and amount of these
services are established on the basis of the unique needs of each client
served.
10. Length of Service. The
entity shall provide written documentation in the clinical record that the
duration of treatment in a Level I-D Program shall vary as determined by the
client's assessed needs and that the client continues in treatment until:
(i) Withdrawal signs and symptoms are
sufficiently resolved; or
(ii)
Withdrawal signs and symptoms have failed to respond to treatment and have
intensified warranting a transfer to a more intense level of care; or
(iii) The client is otherwise unable to
complete detoxification at this level of care.
11. Service Availability: The entity shall
provide written documentation describing the process utilized to establish the
hours of service availability for its Level I-D Ambulatory Detoxification
Programs. At a minimum, this process shall:
(i) Include consideration of the needs of the
target population, including work, school and parenting
responsibilities.
(ii) Include
consideration of transportation accessibility.
(iii) Not be based solely on standard eight
(8) to five (5), Monday through Friday office
hours.
Notes
Author: Substance Abuse Services Division
Statutory Authority: Code of Ala. 1975, ยง 22-50-11.
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