No. 38812 (Amendment): Rule R501-21. Outpatient Treatment Programs

(Amendment)

DAR File No.: 38812
Filed: 08/25/2014 01:31:24 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of the changes is to bring the requirements for Opioid Treatment Programs into line with best practice, reduce administrative costs, and reduce the need for changes if and when federal regulations change.

Summary of the rule or change:

This rule establishes definitions, legal requirements, staffing requirements, facility requirements health, and safety regulations for out patient treatment programs. This rule change removes specific requirements, provides flexibility, and reduces the need for future changes. The rule addresses physician training, face-to-face meetings with clients, and procedure. It brings the rule into compliance with the principles of Trauma Informed Care and the current accreditation requirements of both the Commission on Accreditation of Health Care Facilities and the Joint Commission on Accreditation of Health Care Facilities.

State statutory or constitutional authorization for this rule:

• Section 62A-2-106
• Section 62A-2-101

Anticipated cost or savings to:

the state budget:

This rule establishes requirements and regulations for outpatient programs. It will have no impact on state government and will not affect the budget.

local governments:

This rule establishes requirements and regulations for outpatient programs. It will have no impact on local government and will not have any affect on the budget.

small businesses:

This amendment will create a savings for small businesses and is being made at their request. While no specific cost saving has been computed, it will provide the saving to agencies by reducing physician costs by removing face-to-face requirements and reduce time required by clinical and support staff to observe all urine sample draws.

persons other than small businesses, businesses, or local governmental entities:

The amendments to this rule affect only the programs providing Opioid Outpatient Replacement Treatment. This will create a savings to them due to change of requirements. This rule will not impact local government or other persons.

Compliance costs for affected persons:

This amendment will reduce costs and improve patient care by reducing time for patients desiring or needing changes in doses by removing the requirement for a face-to-face visit with a physician to cover information already provided.

Comments by the department head on the fiscal impact the rule may have on businesses:

The fiscal impact this rule will have on businesses is a cost savings. There is no impact on state or local government.

Ann Williamson, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Human Services
Administration, Administrative Services, Licensing
195 N 1950 W 1ST FLR
SALT LAKE CITY, UT 84116

Direct questions regarding this rule to:

• Julene Jones at the above address, by phone at 801-538-4521, by FAX at 801-538-3942, or by Internet E-mail at [e-mail]
• Jeff Harris at the above address, by phone at 801-538-4236, by FAX at 801-538-4553, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/15/2014

This rule may become effective on:

10/22/2014

Authorized by:

Diane Moore, Director

RULE TEXT

R501. Human Services, Administration, Administrative Services, Licensing.

R501-21. Outpatient Treatment Programs.

R501-21-1. Authority.

Pursuant to Section 62A-2-101 et seq., the Office of Licensing, shall license outpatient treatment programs according to the following rules.

 

R501-21-2. Purpose.

Outpatient treatment programs shall serve consumers who require less structure than offered in day treatment or residential treatment programs. Consumers are provided treatment as often as determined and noted in the treatment plan.

 

R501-21-3. Definition.

Outpatient treatment program means individual, family, or group therapy or counseling designed to improve and enhance social or psychological functioning for those whose physical and emotional status allows them to continue functioning in their usual living environment in accordance with Subsection 62A-2-101(12).

 

R501-21-4. Administration.

A. In addition to the following rules, all Outpatient Treatment Programs shall comply with R501-2, Core Standards.

B. A current list of enrollment of all registered consumers shall be on-site at all times.

 

R501-21-5. Staffing.

Professional staff shall include at least one of the following individuals who has received training in the specific area listed below:

A. Mental Health

1. a licensed physician, or

2. a licensed psychologist, or

3. a licensed mental health therapist, or

4. a licensed advanced practice registered nurse-psychiatric mental health nurse specialist.

5. If unlicensed staff are used, they shall not supervise clinical programs. Unlicensed staff shall be trained to work with psychiatric consumers and be supervised by a licensed clinical professional.

B. Substance Abuse

1. a licensed physician, or

2. a licensed psychologist, or

3. a licensed mental health therapist, or

4. a licensed advanced practice registered nurse-psychiatric mental health nurse specialist.

5. A licensed substance abuse counselor or unlicensed staff who work with substance abusers shall be supervised by a licensed clinical professional.

6. Opioid outpatient treatment programs shall have a licensed physician who is an American Society of Addiction Medicine certified physician or who can document specific training in methadone treatment for opioid addictions or who can document specific training or experience in methadone treatment for opioid addictions. Physicians prescribing buprenorphine must show proof of completion of [8 hour ]federally required physician training.

C. Children and Youth

1. a licensed psychiatrist, or

2. a licensed psychologist, or

3. a licensed mental health therapist, or

4. a licensed advanced practice registered nurse-psychiatric mental health nurse specialist.

5. If the following individuals are used they shall not supervise clinical programs: A person with a graduate degree in counseling, psychiatric nursing, marriage and family therapy, social work or psychology who is working toward a clinical license, and has been approved by the Division of Occupational and Professional Licensing for the appropriate supervision, or a second year graduate student training for one of the above degrees.

D. Domestic Violence

1. a licensed psychiatrist, or

2. a licensed psychologist, or

3. a licensed clinical social worker, or

4. a licensed marriage and family therapist, or

5. a licensed professional counselor, or

6. a licensed advanced practice registered nurse-psychiatric mental health nurse specialist, or

7. a person with a graduate degree in counseling, psychiatric nursing, marriage and family therapy, social work or psychology who is working toward a clinical license, and has been approved by the Division of Occupational and Professional Licensing for the appropriate supervision, or

8. a second year graduate student in training for one of the above degrees, or

9. a licensed social services worker with at least three years of continual, full time, related experience, when practicing under the direction and supervision of a licensed clinical professional.

10. Individuals from categories 7. and 8. above shall not supervise clinical programs. Individuals in category i. above shall not supervise clinical programs, and may only co-facilitate group therapy sessions with a person qualified per paragraphs 1. through 6. above.

 

R501-21-6. Direct Service.

A. Treatment plans shall be developed based on assessment and evaluation of individual consumer needs. The treatment may be consultive and may include medication management.

B. Treatment plans shall be reviewed and signed by a licensed clinical professional as frequently as determined in the treatment plan.

C. Except for Domestic Violence, individual, group, couple, or family counseling sessions shall be provided to the consumer as frequently as determined in the treatment plan. In the consumer's record and in the progress notes, the date of the session and the provider shall be documented. Treatment sessions may be provided less frequently than once a month if approved by the clinical supervisor and justified in the consumer record.

D. Domestic violence treatment programs shall comply with generally accepted practices in the current domestic violence literature and the following requirements:

1. Maintain and document cooperative working relationships with domestic violence shelters, treatment programs, referring agencies, custodial parents when the consumer is a minor and local domestic violence coalitions. If the consumer is a perpetrator, contact with victims, current partner, and the criminal justice referring agencies is also required, as appropriate.

2. Treatment sessions for each perpetrator, not including orientation and assessment interviews, shall be provided for at least one hour per week for a minimum of sixteen weeks. Treatment sessions for children and victims shall offer a minimum of 10 sessions for each consumer not including intake or orientation.

3. Staff to Consumer Ratio:

a. The staff to consumer ratio in adult treatment groups shall be one to eight for a one hour long group or one to ten for an hour and a half long group. The maximum group size shall not exceed sixteen.

b. Child victim or child witness groups shall have a ratio of one staff to eight children when the consumers are under twelve years of age, and a one staff to ten children ratio when the consumers are twelve years of age or older.

c. When any consumer enters a treatment program the staff shall conduct an in-depth, face to face interview and assessment to determine the consumer's clinical profile and treatment needs. For perpetrator consumers, additional information shall be obtained from the police incident report, perpetrator's criminal history, prior treatment providers, and the victim. When appropriate, additional information for child consumers shall be obtained from parents, prior treatment providers, schools and Child Protective Services. When any of the above information cannot be obtained the reason shall be documented. The assessment shall include the following:

1) a profile of the frequency, severity and duration of the domestic violence behavior, which includes a summary of psychological violence,

2) documentation of any homicidal, suicidal ideation and intentions as well as abusive behavior toward children,

3) a clinical diagnosis and a referral for evaluation to determine the need for medication if indicated,

4) documentation of safety planning when the consumer is an adult victim, child victim, or child witness, and that they have contact with the perpetrator. For victims who choose not to become treatment consumers, safety planning shall be addressed when they are contacted, and

5) documentation that appropriate measures have been taken to protect children from harm.

4. Consumers deemed appropriate for a domestic violence treatment program shall have an individualized treatment plan, which addresses all relevant treatment issues. Consumers who are not deemed appropriate for domestic violence programs shall be referred to the appropriate resource, with the reasons for referral documented and notification given to the referring agency. Domestic violence counseling shall be provided when appropriate, concurrently with or after other necessary treatment.

5. Conjoint or group therapy sessions with victims and perpetrators together or with both co-perpetrators shall not be provided until a comprehensive assessment has been completed to determine that the violence has stopped and that conjoint treatment is appropriate. The perpetrator must complete a minimum of 12 domestic violence treatment sessions prior to implementing conjoint therapy.

6. A written procedure shall be implemented to facilitate the following in an efficient and timely manner:

a. entry of the court ordered defendant into treatment,

b. notification of consumer compliance, participation or completion,

c. disposition of non-compliant consumers,

d. notification of the recurrence of violence, and

e. notification of factors which may exacerbate an individual's potential for violence.

7. Comply with the "Duty to Warn," Section 78B-3-502.

8. Document specialized training in domestic violence assessment and treatment practices including 24 hours of pre-service training within the last two years and 16 hours of training annually thereafter for all individuals providing treatment services.

9. Clinical supervision for treatment staff who are not clinically licensed shall consist of a minimum of an hour a week to discuss clinical dynamics of cases.

E. Opioid outpatient treatment programs shall:

1. Admit consumers to the program and dispense medications only after the completion of a face to face visit with a licensed practitioner having authority to prescribe controlled substances who confirms the opioid dependence. A licensed practitioner having authority to prescribe controlled substances must [conduct a face to face visit for]approve every subsequent dose increase prior to the change.

2. Assure all consumers see the physician at least once yearly.

3. Require all consumers admitted to the program to participate in random, [observed ]drug testing. Drug testing will be performed by the program minimally, 2 times per month for the first 3 months of treatment, and monthly thereafter, except for a consumer whose lack of progress shall require more frequent drug testing for a longer period of time.

4. Require consumers to participate in counseling sessions at least 1 hour per week for the first 90 days. Upon successful completion of this phase of treatment, consumers shall be required to participate in counseling 2 hours per month for the next 6 months. Upon successful completion of 9 months of treatment, consumers shall be seen at least monthly thereafter until discharge. Exceptions to this requirement must be approved in writing by the Division of Substance Abuse and Mental Health.

5. Maintain a staff to consumer ratio of:

a. 1 counselor to every 50 consumers.

b. 1 hour of physician time at the program site each month for every 10 consumers enrolled.

c. 1 FTE nurse to dispense medications for every 150 consumers dosing on an average daily basis.

6. Comply with R523-21-1 Rules Governing Methadone Providers.

 

R501-21-7. Physical Environment.

A. The program shall provide written documentation of compliance with the following:

1. local zoning ordinances,

2. local business license requirements,

3. local building codes,

4. local fire safety regulations, and

5. local health codes.

B. Building and Grounds

1. The program shall ensure that the appearance and cleanliness of the building and grounds are maintained.

2. The program shall take reasonable measures to ensure a safe physical environment for consumers and staff.

 

R501-21-8. Physical Facility.

A. Space shall be provided for private and group counseling sessions.

B. The program shall have storage for the following:

1. locked storage for medications, and

2. locked storage for hazardous chemicals and materials, according to the direction of the local fire authorities.

C. Equipment

1. Furniture and equipment shall be of sufficient quantity, variety, and quality to meet program and consumer plans.

2. All furniture and equipment shall be maintained in a clean and safe condition.

D. Bathrooms

1. Bathrooms shall accommodate physically disabled consumers.

2. Each bathroom shall be maintained in good operating order and be properly equipped with toilet paper, towels, and soap.

3. Bathrooms shall be ventilated by mechanical means or equipped with a screened window that opens.

 

KEY: human services, licensing, outpatient treatment programs

Date of Enactment or Last Substantive Amendment: [January 24, 2011]2014

Notice of Continuation: April 5, 2010

Authorizing, and Implemented or Interpreted Law: 62A-2-101 et seq.

 

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