(A) Opioid treatment programs
shall
are to
provide
, at a minimum, the following services:
(1)
The
general
General services, SUD case
management services, and crisis intervention services pursuant to Chapter
5122-29 of the Administrative Code.
(2)
Vocational
rehabilitation, education and employment services for patients who either
request these services or who have been determined by the program staff to be
in need of these services
Adequate medical,
counseling, vocational, educational, employment, and other screening,
assessment, and treatment services to meet patient needs.
(B) Opioid treatment programs will
provide adequate medical, counseling, vocational,
educational, employment, and other assessment and treatment
ensure that the services
, and the
specified in
paragraph (A) of this rule are made available in a combination and frequency
that is tailored to each individual patient based on an individualized
assessment and the patient care plan that was created after shared decision
making between the patient and the patient's medical team. The program
sponsor will document
that these services are fully
and reasonably available to all patients
this
availability in each patient's record.
All services will
are to be provided on-site at the opioid treatment program
with the exception of
except that vocational services, educational services,
and employment services may be provided off-site.
All
A program
sponsor may enter into a written agreement with any of the following to provide
a service specified in paragraph (A)(1) of this rule to patients of the
OTP:
other services may be provided by a
community mental health services or addiction services provider certified for
the residential and withdrawal management substance use disorder services as
defined in rule 5122-29-09 of the Administrative Code as long as the person is
receiving that service, or a state correctional facility. The program sponsor,
at their discretion, will enter into formal, documented agreements with private
or public agencies, organizations, practitioners, or institutions to provide
these services to patients enrolled in the opioid treatment
program.
(1)
A class one residential facility, hospital,
correctional facility, or nursing facility, when that facility or hospital is
certified to provide the particular service under section
5119.36 of the Revsied Code or
the staff member of that facility or hospital providing the particular service
is an individual described in division (B) of section
5119.35 of the Revised
Code.
(2)
A community addiction services provider or community
mental health services provider certified to provide that particular service
under section 5119.36 of the Revised
Code.
(3)
An individual described in division (B) of section
5119.35 of the Revised
Code.
(C) Services
are allowed to be provided through telehealth pursuant to agency 5122 of the
Administrative Code pertaining to telehealth, and these services are to be
documented in accordance with agency rules. Telehealth services including
induction of any form of medication assisted treatment will only be allowed in
accordance with federal and state standards.
(D) Services provided through medication
units are subject to rule
5122-40-15 of the Administrative
Code.
(E) Upon admission, each
patient shall receive the following information both written and verbally:
(1) Signs and symptoms of overdose
and
; when,
where, and how to seek emergency assistance; and education on the use of overdose reversal
drugs;
(2) An explanation of
the medication, including:
(a) Medication
administration;
(b) Potential drug
interactions;
(c) Medical issues
related to detoxification
withdrawal management from opioid treatment
medications;
(d) Characteristics of
the medications administered or prescribed by the program;
(e) Drug safety issues;
(f) Dispensing procedures and dosage
restrictions; and,
(g) Side
effects of medications administered or prescribed by the program.
(3) An explanation of alternative
methods that are available for treatment of opioid addiction, whether offered
by the program or not, and the potential benefits, risks and costs of each
treatment; and
(4) A formal agreement of informed consent to
be signed by the patient and a copy retained by him or her.
(F) Every person admitted to a
opioid treatment program
shall
is to receive program orientation within two weeks of
admission. The orientation
shall
is to be made verbally at the earliest opportunity at
which the patient is stable and capable of understanding and retaining the
information presented. Orientation
shall
is to include
the following:
(1) An explanation of the
patient's rights and right to file a grievance and applicable appeal
procedures, in accordance with rule
5122-26-18 of the Administrative
Code;
(2) An explanation of the
services and activities provided by the opioid treatment program, including:
(a) Expectations and rules;
(b) Hours of operation;
(c) Access to crisis services;
(d) Confidentiality policy;
(e) Toxicological screening and random
testing policies;
(f)
Administrative withdrawal criteria, pursuant to rule
5122-40-14 of the Administrative
Code;
(g) Interventions; and,
(h)
Various discharge criteria.
(3) An explanation about obtaining reports
from the prescription drug monitoring program database;
, how the reports
are used to treat and monitor the patient, and
the requirement that the reports be maintained in the patient files;
(4) An explanation of any and all financial
obligations of the patient; all fees charged by the opioid treatment program;
and any financial arrangements for services provided by the opioid treatment
program;
(5) Familiarization with
the opioid treatment programs
program's facility and premises;
(6) Provision of a
naloxone kit
an overdose
reversal medication kit approved by the United States food and drug
administration, including the nasal atomizer or other device furnished by
the opioid treatment program
, or a
prescription for such kit.
(a) The opioid
treatment program shall
is to provide instruction on the kits use including,
but not limited to, recognizing the signs and symptoms of overdose and calling
911 in overdose situations.
(b) The
opioid treatment program shall
is to provide a new naloxone kit or prescription upon expiration or use
of the old kit.
(c) The opioid
treatment program shall
is to be exempt from this requirement for one year if
the client refuses the naloxone kit or
already has a naloxone kit.
(G) Documentation that
the patient has completed the orientation training and received the written
information required in paragraphs (E) and (F) of this rule, shall
is to be
completed and signed by the program and the patient and maintained in the
patient's chart.
(H) Each opioid
treatment program
shall
is to make available substance use disorder
counseling, individual or group, to every patient as is clinically necessary.
(1)
The ratio of
full-time equivalent individual counselors to patients shall be no greater than
one to sixty-five.
All patients will be
assigned a primary counselor. The primary counselor will be individually
determined by the specific needs of the patient and allow patients access to
their primary counselor if more frequent contact is merited by need or is
requested by the patient.
(2)
Counselor to patient ratios shall
The primary counselor is to:
be individually determined by the specific needs of
the patient and allow patients access to their primary counselor if more
frequent contact is merited by need or is requested by the patient.
(a)
Allow the program
to provide adequate psychosocial assessments, treatment planning, and
individualized counseling; and
(b)
Allow for
regularly scheduled, documented individual counseling sessions.
(3)
Counseling sessions are to be offered according to generally
accepted best practices and, except as provided in paragraph (H)(4) of this
rule, be available to the patient:
(a)
At least weekly during the first ninety days of
treatment, for at least fifty minutes in duration.
(b)
Thereafter,
counseling duration and frequency should be established by the counselor in
collaboration with the patient and documented in the treatment plan, with
consideration given to the ability of the patient to participate, recovery
status, treatment engagement, and laboratory results.
(4)
Exceptions to frequency of counselor to patient contact are
to be clinically justified and documented in the client record. Justification
will be based on the patient's choice for quantity, frequency, and the reason
patient is unable to participate in counseling sessions as described in
paragraph (H)(3) of this rule.
(5)
Medication is not
to be interrupted or made dependent upon completion of counseling as outlined
in paragraph (H)(3) of this rule.
(3) The counselor caseload
shall:
(a) Allow the program to provide
adequate psychosocial assessments, treatment planning and individualized
counseling; and,
(b) Allow for regularly scheduled,
documented individual counseling sessions.
(4) Counseling sessions shall be
provided according to generally accepted best practices and shall be
offered:
(a) At least weekly during the first
ninety days of treatment, for at least fifty minutes in
duration.
(b) Thereafter, counseling duration
and frequency should be established by the counselor in collaboration with the
patient and documented in the treatment plan, with consideration given to the
ability of the patient to participate, recovery status, treatment engagement,
and laboratory results.
(5) Exceptions to frequency of
counselor to patient contact shall be clinically justified and documented in
client record.
