(A) Opioid treatment programs may voluntarily
establish medication units with the appropriate licensure from the Ohio
department of mental health and addiction services, the United States drug
enforcement agency, the substance abuse and mental health services agency, and
the
state of Ohio board of pharmacy. Medication
units will be associated with a single primary opioid treatment program or hub
that will oversee their operations.
Non-mobile
medication units are stationary brick-and mortar facilities, and mobile
medication units are vehicles that may provide health care services
traditionally performed at brick-and-mortar opioid treatment programs. All
medication units will be licensed and located
. Any medication unit, regardless of whether it is
non-mobile or mobile, will be licensed in accordance with section
5119.37 of the Revised Code
and located in accordance with any state and local
zoning restrictions that apply to the primary opioid treatment programs with
which the medication unit is associated. All required services that are
unable to be performed at the medication unit will be performed by the primary
opioid treatment program.
(B) Non-mobile medication units may
be located no further than ninety miles from the primary opioid treatment
program in the following venues:
(1) Homeless shelters, jails,
prisons, or county or local boards of public health;
(2) Federally qualified health
centers;
(3) Providers certified to provide
ASAM level three residential substance use disorder services in accordance with
rule 5122-29-09 of the Administrative Code;
(4) Appalachian counties, as defined
by https://www.arc.gov/appalachian_region/CountiesinAppalachia.asp. These
medication units may be opened no closer than forty-five miles and no further
than ninety miles from the primary opioid treatment program;
or,
(5) Counties with under sixty
thousand residents.
(C)(B) Mobile medication
units may
only be located in
:
areas that are greater
than five miles from the nearest opioid treatment program.
(1) Appalachian counties, as defined
by
https://www.arc.gov/appalachian_region/CountiesinAppalachia.asp.
(2) Counties with under sixty
thousand residents; or,
(3) Areas that are greater than five
miles from the nearest opioid treatment program.
(D)(C)
Medication units will provide the following services:
(1) Administering and dispensing medications
for opioid use disorder treatment;
(2) Collecting samples for drug testing or
analysis; and
(3) Dispensing
or personally furnishing of take-home
medications.
(E)(D) Medication units
may provide the following services if they provide appropriate privacy and
adequate space:
(1) Intake/initial
psychosocial and appropriate medical assessments with a full physical
examination to be completed or provided within fourteen days of admission;
and,
(2) Initiation of methadone, buprenorphine,
or naltrexone after an appropriate medical assessment has been performed.
Initiation of methadone will be performed in-person by a qualified healthcare professional
and monitored following appropriate medical practices.
(F)(E)
Medication units may also provide telecounseling services if they provide
appropriate privacy and adequate space with appropriately credentialed staff in
accordance with all federal and state regulation. Telecounseling services may
include individual or group sessions. Medication units that choose to provide
telecounseling will:
(1) Provide
telecounseling services with appropriate application of clinical judgment to
best meet patient treatment needs;
(2) Be in compliance with paragraphs (H)(3)
and (H)(4) of rule
5122-40-09 of the Administrative
Code; and
,
(3) Ensure that every patient has a
designated
program counselor
, as described in
42 C.F.R.
8.12(f)(5)(i), who is
the primary contact for behavioral health treatment and care coordination.
While the patient may utilize other counselors for emergencies, all counseling,
including telecounseling, will be handled by the
primary counselor
program
counselor.
All patients, whether seen in
person or via telehealth, count equally toward the staffing ratio specified in
paragraph (F)(1) of rule 5122-40-09 of the Administrative Code, and
opioid
Opioid treatment programs will
maintain clear and accurate caseload records for auditing purposes.
(G)(F) The primary opioid
treatment program is responsible for keeping all of the documentation on each
patient, which may be readily accessed through electronic means by medication
units. Original paper records generated by the medication unit will be
transferred to the primary treatment program after they are
generated.
(H)(G) The medical
director will maintain authority over the medical aspects of treatment offered
by mobile and non-mobile medication units.
(1) The medical director will not be
expected to be present at either type of medication unit a specified number of
hours, however, the medical director will attend and document weekly calls with
staff from each medication unit that reviews the clinical care of patients at
each medication unit.
(2) The medical director will visit
each non-mobile medication unit at least:
(a) Once per month;
and
(b) After any patient death that is
determined to be the result of an overdose.
(H)
Each mobile and
non-mobile medication unit is to have a program director who, with respect to
operation of the medication unit, is to exercise the same responsibilities that
individual has under paragraph (C) of rule
5122-40-05 of the Administrative
Code.
(I) Non-mobile
medication units will obtain their supply of approved controlled substances
directly from the manufacturer or wholesalers and maintain their inventory in
accordance with applicable state and federal regulations.
(J) All medication units will participate in
the central registry system to prevent clients from dosing at multiple opioid
treatment programs and to ensure medication unit compliance with rule
5122-40-08 of the Administrative
Code. Central registry verification can be performed either at the primary
opioid treatment program or the medication unit but need not be done more than
once per patient enrollment.
(K) If
an opioid treatment program voluntarily decides to close the operation of a
medication unit, it will notify the Ohio department of mental health and
addiction services, the United States drug enforcement agency, the substance
abuse and mental health services agency, and the Ohio board of pharmacy at
least ninety days before the planned closure of the program. The opioid
treatment program will present a plan to transfer existing patients to similar
opioid treatment programs or other suitable treatment programs at the time of
the notification.
