Tenn. Comp. R. & Regs. 0940-05-42-.29 - PERSONNEL AND STAFFING REQUIREMENTS

(1) A personnel record for each staff member of a Facility shall include an application for employment and/or resume and a record of any disciplinary action taken. A licensee shall maintain written records for each employee and each individual file shall include:

(a) Identifying information including name, current address, current telephone number, and emergency contact person(s).

(b) A 10-year employment history or a complete employment history if the person has not worked in 10 years.

(c) Records of educational qualifications, if applicable.

(d) Date of employment.

(e) Documentation of training and orientation of the person's duties and responsibilities.

(f) Any records relevant to the employee's performance.

(g) Evidence that any professional license required as a condition of employment is current and in good standing.

(h) Annual verification of basic skills and annual evaluation of personnel performance. Included shall be written verification that the employee has reviewed the evaluation and has had an opportunity to comment on it.

(i) Training and development activities designed to educate the staff in meeting the needs of the service recipients being served, including STD/HIV education.

(2) Tuberculosis.

(a) All new employees, including volunteers who have routine contact with service recipients, shall be tested within three business days of employment for latent tuberculosis infection utilizing the two-step Mantoux method or a single interferongama release blood assay (IGRA).

(b) Employees shall have a test for tuberculosis annually and at the time of exposure to active tuberculosis and three months after exposure. Annual tuberculosis testing of previously TST-negative employees and volunteers shall be performed by the one-step Mantoux method.

(c) Employee records shall include the date and type of annual tuberculin tests given to the employee, date of tuberculin test results, and, if applicable, date and results of chest x-ray and any drug treatment for tuberculosis.

(3) Staffing.

(a) Program Director. The governing body of each Facility shall designate in writing a program director who is responsible for the operation of the Facility and overall compliance with federal, state and local laws and regulations regarding the operation of opioid treatment programs, and for all employees including practitioners, agents, or other persons providing services at the Facility. Facilities shall notify the SOTA in writing within 10 calendar days whenever there is a change in program director.

(b) Medical Director. The governing body of each Facility shall designate in writing a medical director to be responsible for the administration of all medical services, including compliance with all federal, state and local laws and regulations regarding the medical treatment of opioid addiction. No physician may serve as medical director of more than one OTP without the prior written approval of the SOTA. Facilities shall notify the SOTA in writing within 10 calendar days whenever there is a change in medical director.

(c) Program Physician. Facilities are required to provide sufficient physician services to provide the medical treatment and oversight necessary to serve service recipient needs.

1. Physician services include, but are not limited to, performing medical history and physical exams, determining a diagnosis under current DSM criteria, determination of opioid dependence, ordering take-home privileges, discussing cases with the treatment team and issuing any emergency orders.

2. The OTP shall provide on-site prescriber services of one hour per week for every 35 service recipients. At least 12.5% of the required prescriber services per week shall be provided by a physician.

(d) Physician Assistants and Advanced Practice Nurses. Licensed physician assistants and advanced practice nurses with a certificate of fitness with privileges to write and sign prescriptions and/or issue legend drugs may perform any functions under Tennessee law or regulations.

(e) Nurses. Facilities shall ensure that adequate nursing care is provided at all times the Facility is in operation and that a nurse is present at all times medication is administered at the Facility. Facilities that do not employ a registered nurse to supervise the nursing staff shall ensure that licensed practical nurses adhere to written protocols and are properly supervised consistent with Rules Chapter 1000-02 Rules and Regulations of Licensed Practical Nurses.

(f) Counselors. There shall be sufficient group and individual counseling available to meet the needs of the service recipient population.

(4) Staff Qualifications.

(a) Medical Director. All medical directors shall be licensed to practice medicine or osteopathy in Tennessee, shall maintain their licenses in good standing and shall have the following experience and/or credentials:

1. Three years of documented experience in the provision of services to persons who are addicted to alcohol or other drugs, including at least one year of experience in the treatment of opioid addiction; or

2. Board eligibility in psychiatry and two years of documented experience in the treatment of persons who are addicted to alcohol or other drugs; or

3. Certification as an addiction medicine specialist by the American Society of Addiction Medicine (ASAM) or Board certification as an addiction medicine specialist.

(b) Waiver from Medical Director Qualifications. Facilities that are unable to secure the services of a medical director who meets the requirements of subparagraph (a) above may apply to the TDMHSAS Office of Licensure for a waiver. The TDMHSAS Office of Licensure, in consultation with the SOTA, may grant such a waiver when there is showing that:

1. The Facility has made good faith efforts to secure a qualified medical director, but has failed;

2. The Facility can secure the services of a licensed physician who is willing to serve as medical director and participate in the training plan;

3. A training plan has been developed which is acceptable to the SOTA and which consists of a combination of continuing education in addiction medicine and in-service training by a medical consultant who meets the qualifications specified in subparagraph (a) above; and

4. A medical consultant who meets the requirements of subparagraph (a) above shall be available, consistent with a training plan approved by the SOTA, to oversee the training of the medical director and the delivery of medical services at the Facility requesting the waiver.

(c) Program Physician. All Facility physicians shall be licensed to practice medicine in Tennessee, shall maintain their licenses in good standing and shall have at least one year of documented experience in the treatment of persons addicted to alcohol or other drugs.

(d) Waiver from Program Physician Qualifications. Facilities seeking to employ a program physician, in addition to the medical director, but are unable to secure the services of a program physician who meets the requirements of subparagraph (c) above may apply to the TDMHSAS Office of Licensure for a waiver. The TDMHSAS Office of Licensure, in consultation with the SOTA, may grant such a waiver when there is a showing that:

1. The Facility has made good faith efforts to secure a qualified program physician, but has failed;

2. The Facility can secure the services of a licensed physician who is willing to serve as program physician and participate in the training plan;

3. A training plan has been developed which is acceptable to the SOTA and which consists of a combination of continuing education in addiction medicine and in-service training by the Facility's medical director; and

4. The Facility employs a qualified medical director who has the experience and credentials specified in subparagraph (a) above, has completed the training program specified in subparagraph (b) above or has completed the continuing education specified in subparagraph (e) below.

(e) Current Medical Directors and Program Physicians. All physicians serving as medical director or program physicians as of the effective date of these rules who do not meet the criteria specified above will be deemed qualified provided that the Facility notifies the Office of Licensure and the SOTA in writing that within two years from the effective date of these rules the physician serving as medical director or program physician will obtain 50 hours of continuing education in addiction medicine approved by the SOTA. At least 25 hours of this continuing education shall be obtained within one year from the effective date of these rules.

(f) Nurses. All registered nurses and licensed practical nurses shall be licensed to practice in Tennessee and shall maintain their license in good standing.

(g) Counselors. All counselors shall be qualified by training, education and/or two years' experience in addiction treatment under appropriate clinical supervision in order to provide addiction counseling services. All unlicensed counselors should be encouraged to complete the process of obtaining appropriate licensure and/or certification.

(h) Program Directors. All Facility program directors shall have at least one year of supervisory or administrative experience in the field of addiction treatment.

(i) Professional Practice. All professional staff including, but not limited to, physicians, physician assistants, nurses and counselors may perform only those duties that are within the scope of their applicable professional practice acts and Tennessee licenses.

(5) Staff Training and Orientation. Prior to working with service recipients, all staff providing treatment or services shall be oriented in accordance with these rules and shall thereafter receive additional training with these rules.

(a) Orientation shall include instruction in:

1. The Facility's written policies and procedures regarding its purposes and description; service recipient rights, responsibilities, and complaints; confidentiality; and other policies and procedures that are relevant to the employee's range of duties and responsibilities;

2. The employee's assigned duties and responsibilities; and

3. Reporting service recipient progress and problems to supervisory personnel and procedures for handling medical emergencies or other incidents that affect the delivery of treatment or services.

(b) Additional training consisting of a minimum of eight clock hours of training or instruction shall be provided annually for each staff member who provides treatment or services to service recipients. Such training shall be in subjects that relate to the employee's assigned duties and responsibilities, and in subjects about current clinical practice guidelines for opioid replacement treatment. In-house training for staff may be substituted for external training with the approval of the SOTA. The following areas shall receive emphasis during training:

1. Dosage level as determined through a physician's clinical decision-making and the individual service recipient's needs;

2. Counseling;

3. Drug screens and urinalysis;

4. Phases of treatment;

5. Treating multiple substance abuse;

6. Opioid treatment during pregnancy and diseases;

7. HIV and other infectious diseases;

8. Co-morbid psychiatric conditions;

9. FDA-approved drugs for the treatment of opioid addiction, including methadone and buprenorphine;

10. Take-home medication practices;

11. Chronic pain and pain management; and

12. Referring service recipients for primary care or other specialized services.

(c) The SOTA may require facilities to attend mandatory training in addition to any other training required by these rules.

(d) Facilities shall maintain records documenting that each staff member has received the required annual training.

(6) Employee Drug Screening. Facilities shall establish and implement written policies and procedures for pre-employment and ongoing random drug screening of all Facility employees. Each sample collected shall be screened for opioids, methadone, amphetamines, cocaine, benzodiazepines, THC, and other drugs as indicated by the SOTA.

(7) A minimum of one on-duty staff member certified in cardiopulmonary resuscitation (CPR) and trained in the Abdominal Thrust Technique and First Aid shall be maintained.

Notes

Tenn. Comp. R. & Regs. 0940-05-42-.29

Original rule filed September 20, 2012; effective December 19, 2012.

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404.