440 IAC 10-4-13 - OTP staff positions
Authority: IC 12-23-1-6; IC 12-23-18
Affected: IC 12-23-18; IC 25-22.5-2; IC 25-23-1; IC 25-23.6; IC 25-27.5; IC 25-33
Sec. 13.
(a) Each
OTP shall employ qualified individuals to fill the staff functions in this
section.
(b) An OTP shall have a
medical director who shall meet the following requirements:
(1) The medical director shall have the
following qualifications:
(A) Be licensed as a
physician in Indiana.
(B) Meet at
least one (1) of the following requirements:
(i) Have a minimum of one (1) year's
experience as a physician in an OTP.
(ii) Be employed as a medical director of an
OTP as of the effective date of this article.
(iii) Within one (1) year of the date of
hiring, obtain ten (10) hours of training in opioid addiction
treatment.
(2)
Within thirty (30) days of the date of hiring, the medical director shall have
or obtain admitting privileges at one (1) local hospital.
(3) The responsibilities of the medical
director include, but are not limited to, the following:
(A) Ensuring that all medical protocols are:
(i) in writing; and
(ii) reviewed and approved by appropriate
program officials on an annual basis.
(B) Ensuring that the manner in which medical
functions may be delegated to other staff is clearly articulated in the
protocols.
(C) Ensuring that
individuals seeking admission to the OTP meet the admission criteria in 42 CFR
Part 8 and in section 15 of this rule.
(D) Establishing clinical standards for the
following:
(i) The induction of treatment
medication for a patient upon admission.
(ii) The titration of a patient on treatment
medication.
(iii) The tapering of a
patient off of a treatment medication.
(E) Ensuring the following:
(i) Patients admitted to the OTP shall have a
complete physical examination.
(ii)
The results of the physical examination shall be documented in the patient's
record.
(iii) Referrals are made
for identified services not provided by the OTP.
(F) Ensuring the following:
(i) All patients voluntarily choose
maintenance opioid addiction treatment.
(ii) All relevant facts concerning the use of
a treatment medication are clearly and adequately explained to the
patient.
(iii) Each patient
provides written informed consent to treatment.
(G) Ensuring the signing or countersigning
and dating of all medical orders as required by federal or state law.
(H) Ensuring that each patient's dose of
treatment medication is appropriate for the patient's needs.
(I) Ensuring that appropriate laboratory
tests or studies have been performed and reviewed.
(J) Ensuring that a justification is recorded
in the patient's record for the following:
(i)
Reducing the frequency of visits to the program for observed medication
ingestion.
(ii) The prescribing of
medication to address other problems.
(iii) Approving a patient's receipt of
unsupervised doses of opioid treatment medication.
(iv) Approving exception requests for
patients' unsupervised doses of opioid treatment
medication.
(K) Ensuring
that treatment plans are:
(i) reviewed at
least every six (6) months; and
(ii) signed or countersigned and dated when
reviewed.
(L) Ensuring
that a clinical evaluation of a patient is conducted within ten (10) days of
any positive drug screening.
(M)
Ensuring that a face-to-face clinical evaluation of the patient's progress in
treatment is conducted at least every six (6) months regarding the patient's
need for the following:
(i) Continuing
maintenance treatment with treatment medication.
(ii) A medication reduction
protocol.
(N) Ensuring
the administering of all medical services provided by the program, including an
annual physical examination, which must include an assessment of risks or
benefits of moving to other approved opioid treatment medications.
(O) Ensuring that the program complies with
all federal, state, and local statutes, ordinances, and regulations regarding
the treatment of opioid addiction.
(P) Ensuring that the core principle of OTP
treatment is to work with each patient as follows:
(i) To arrive at the clinically appropriate
dose of medication.
(ii) To
eliminate the use of treatment medication as clinically
appropriate.
(Q) When
either the patient or the OTP determines that the reduction and elimination of
treatment medication is in the best interest of the patient or the OTP,
ensuring supervision as follows:
(i) To
alleviate adverse effects incidental to withdrawal from medication.
(ii) To bring the individual to
recovery.
(c) An OTP shall have a program physician,
who may also be the medical director. A program physician shall meet the
following requirements:
(1) All program
physicians shall:
(A) be licensed in the
state of Indiana; and
(B) work
under the supervision of the medical director.
(2) Program physicians who are not the
medical director are responsible for OTP medical services as delegated by the
medical director.
(3) Each OTP
shall have one (1) program physician physically present in the facility for a
minimum of one (1) full-time equivalent of forty (40) hours per week for every
one thousand (1,000) enrolled patients; provided, however, that except for
services required under this rule to be performed by a physician, fifty percent
(50%) of the services of a program physician may be performed by an authorized
health care professional.
(d) An OTP shall have a program director who
meets the following requirements:
(1) The
program director shall have at least one (1) of the following qualifications:
(A) One (1) year of work experience providing
services to individuals with addiction problems.
(B) A minimum of a bachelor's
degree.
(C) Three (3) years of work
experience in administration or personnel supervision in human
services.
(D) A division-approved
credential in addiction counseling under 440 IAC 4.4.
(2) The program director is responsible for
the following:
(A) The:
(i) day-to-day operations of the OTP;
and
(ii) delivery of treatment
services.
(B) The
supervision of OTP staff.
(C)
Managing all other functions delegated by the medical
director.
(e)
An OTP shall have nurses that meet the following requirements:
(1) All nurses are required to maintain
appropriate licenses to perform delegated and assigned nursing
functions.
(2) A nurse qualified by
education, training, and experience shall do the following:
(A) Supervise the administering of medication
to OTP patients.
(B) Perform other
functions delegated by the medical director or a program physician.
(3) A registered nurse or licensed
practical nurse may administer opioid treatment medication only under the
following circumstances:
(A) When acting as
the agent of a practitioner licensed under state law and registered under the
appropriate state and federal laws to administer opioid treatment
medication.
(B) When supervised by,
and under the order of, a practitioner licensed under state law and registered
under the appropriate state and federal laws to administer opioid treatment
medication.
(4) An OTP
shall employ one (1) nurse for a minimum of one (1) full-time equivalent of
forty (40) hours per week for every two hundred (200) enrolled
patients.
(f) An OTP
shall have counselors that meet the following requirements:
(1) An OTP counselor shall be qualified by
education, training, or experience to do the following:
(A) Assess the psychological and sociological
background of patients.
(B)
Contribute to the appropriate treatment plan for the patient.
(C) Monitor patient progress toward
identified treatment goals.
(2) OTP counselors shall be provided an
orientation to opioid addiction treatment, including the diversion control
plan. The orientation shall be documented in the counselor's personnel record
and shall meet the following requirements:
(A) Be for not less than four (4) hours prior
to assuming counseling duties for counseling staff lacking experience in opioid
addiction treatment.
(B) Be for a
minimum of one (1) hour prior to assuming counseling duties for counseling
staff experienced in opioid addiction treatment.
(3) Counselors shall be credentialed as any
of the following:
(A) A licensed clinical
social worker ( IC
25-23.6-5).
(B) A licensed mental health counselor ( IC
25-23.6-8.5).
(C) A licensed marriage and family therapist
( IC 25-23.6-8).
(D) A licensed clinical addiction counselor (
IC 25-23.6-10.5).
(E) A psychologist ( IC 25-33).
(F) A physician ( IC
25-22.5-2).
(G) A physician assistant ( IC 25-27.5), a
nurse practitioner ( IC
25-23-1), or a clinical nurse
specialist ( IC
25-23-1).
(H) An individual credentialed in addictions
counseling by a nationally recognized credentialing body approved by the
division.
(4) A counselor
who lacks a credential shall obtain a credential listed in subdivision (3)
within three (3) years of the effective date of this article.
(5) Counselors are responsible for providing
counseling, educational, and referral services to enrolled patients and their
families as defined by OTP protocols. Counseling services shall include
individual, group, and family counseling.
(6) An OTP shall employ one (1) full-time
counselor for a minimum of forty (40) hours per week for every fifty-five (55)
enrolled patients.
(g) An
OTP shall have a clinical supervisor that meets the following requirements:
(1) A clinical supervisor shall have either
of the following qualifications:
(A) Have a
division-approved credential under subsection (f)(3).
(B) Be licensed by the state in any of the
following:
(i) Social work ( IC
25-23.6-5).
(ii) Marriage and family therapy ( IC
25-23.6-8).
(iii) Mental health counseling ( IC
25-23.6-8.5).
(2) A
clinical supervisor shall have a minimum of three (3) years of experience in
providing addiction treatment services.
(3) A clinical supervisor is responsible for
supervising the work of the counselors.
(4) For every ten (10) counselors or portion
thereof, an OTP shall employ the proportionate equivalent of one (1) full-time
clinical supervisor for a minimum of forty (40) hours per week.
(5) A clinical supervisor may carry a patient
caseload proportionate to the number of counselors
supervised.
Notes
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