Ala. Admin. Code r. 580-9-44-.19 - Level II-D: Ambulatory Detoxification With Extended On-site Monitoring
(1) Rule
Compliance. Each Level II-D Ambulatory 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 II-D Ambulatory Detoxification Program it provides, as according to Rule
580-9-44-.13 and the following
specifications:
1. Location. The entity shall
specifically identify and describe the setting in which Level II-D Ambulatory
Detoxification with 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 meets the DMH facility
certification standards.
2.
Admission Criteria: The entity shall develop, maintain and document
implementation of written criteria for admission to its Level II-D Ambulatory
Detoxification With Extended On-Site Monitoring Program, in compliance with the
requirements of Rule
580-9-44-.13(9)
and the following specifications:
(i) The
entity's admission criteria shall specify the target population for the Level
II-D program, which shall include, at a minimum, individuals who:
(I) Have been assessed as being at moderate
risk of severe withdrawal syndrome outside of the program setting.
(II) Are free of severe, unstabilized
physical and psychiatric complications.
(III) Who do not have adequate family or
other service systems in place to support an outpatient detoxification
process.
(ii) The entity
shall provide written documentation in individual case records that each client
admitted to receive Level II-D Ambulatory Detoxification with Extended On-Site
Monitoring Services meets:
(I) The diagnostic
criteria for Substance Induced Disorder as defined in 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 II-D Ambulatory 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 II-D Ambulatory Detoxification Program shall document the
capacity to provide the following core services:
(I) Placement assessment.
(II) Individual counseling.
(III) Group counseling.
(IV) Psychoeducation.
(V) Family counseling.
(VI) Medical and somatic services.
(VII) Medication administration.
(VIII) Medication monitoring.
(IX) Alcohol and/or drug
screening/testing.
(X) 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. The entity's Level II-D
program shall, at a minimum, consist of the following components:
(i) Completion of a comprehensive medical
history and physical examination of the client at admission.
(ii) 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 (e.g., SAMHSA,
ASAM, American Academy of Addiction Psychology).
(I) Level II-D Ambulatory Detoxification
Programs that utilize benzodiazepines in the detoxification protocol:
I. Shall have written protocols and
procedures to show that all doses or amounts of benzodiazepines are carefully
monitored and are slowly reduced as appropriate.
II. 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.
(iii) On-site physician and/or nurse
monitoring, assessment and management of signs and symptoms of intoxication and
withdrawal.
(iv) Medication
administration and monitoring services including specific procedures for
pregnant women.
(v) Ongoing Intake
Interview Examination.
(vi) Direct
affiliation with other levels of care.
5. Documentation: Level II-D Ambulatory
Detoxification Programs shall provide the following:
(i) Documentation of each
clinical/therapeutic intervention provided.
(ii) Daily assessment of progress including
response to medication, which also notes any treatment changes.
(iii) Monitoring of vital signs each day the
client is on site.
(iv) The use of
detoxification rating scale tables and flow sheets.
(v) Physician review of all
services.
6. Support
Systems. The Level II-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)
Transportation.
(v) Twenty-four
(24) hour access to emergency medical services.
7. Program Personnel: Each Level II-D
Ambulatory 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 II-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 induced disorders.
The medical director shall be responsible for admission, diagnosis, medication
management and client care.
(ii)
Nursing Services Director: The Level II-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.
(I)
There shall be a Registered Nurse or Licensed Practical Nurse on site during
all hours of the Level II-D Program's operation.
(v) Clinical staff providing services shall
have access to a full-time clinical director.
(vi) 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.
(vii) The entity shall
maintain an adequate number of physicians, nurses, counselors and case managers
to sustain the Level II-D Ambulatory Detoxification Outpatient Program as
delineated in its program operational procedures.
(viii) The entity shall maintain an adequate
number of administrative support personnel to sustain the program's
administrative functions.
8. Training. The entity shall provide written
documentation that all Level II-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 II-D Services are provided in
regularly scheduled sessions and that:
(i) The
entity has the demonstrated capacity to provide a structured program of
clinical services for a minimum of nine (9) hours per week.
(ii) The frequency and amount of Level II-D
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 II-D Program varies 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 II-D Program. 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.
(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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