Current through Register 1536, December 6, 2024
Section 164.123 - Provision of Service(A)Admission: Prior to admitting a client into outpatient detoxification treatment, the licensee shall obtain and shall make a part of the client record a medical evaluation by a licensed physician, psychiatrist, registered nurse, nurse practitioner, physician assistant or licensed practical nurse, which confirms that the client requires outpatient detoxification services based on:(1) an assessment of the current and potential withdrawal symptoms of the client;(2) the client's need for a structured program with frequent contact in order to engage in treatment; and,(3) an assessment as to whether the community in which the client resides poses a threat to the client's abstinence.(B)Physical Examination: The licensee shall ensure that a thorough physical examination, which conforms to principles established by the American Society of Addiction Medicine, is completed for all patients within 24 hours of admission.(1) The physical examination shall include:(a) an assessment of the patient's substance use disorder;(b) tests for the presence of opiates, alcohol, benzodiazepines, cocaine and other drugs of abuse as indicated by the patient's current substance use;(c) a brief mental status exam;(d) an assessment of infectious diseases, including TB, Viral Hepatitis, and sexually transmitted diseases (STDs); pulmonary, liver, and cardiac abnormalities; dermatological and neurological sequelae of addiction; and possible concurrent surgical problems. When indicated, laboratory tests for these conditions shall be ordered. The licensee shall ensure that laboratory tests are completed by licensed facilities that comply with all applicable federal and state licensure and certification requirements.
(2) The licensee shall ensure that the patient's current prescription medications are assessed in relation to interactions with medication prescribed in the course of treatment. Prior to prescribing, dispensing or administering an approved opioid agonist medication, the licensee shall ensure that the approved medication is not contraindicated by the patient's current prescribed medications or health status.(3) For women of child-bearing age, the licensee shall include a pregnancy test in the physical examination.(4) If the examination is conducted by a qualified health care professional who is not a physician, the results of the examination and any recommendations arising from the examination shall be reviewed by the nursing supervisor prior to implementation.(5) All medical orders shall be signed by the medical director.(6) When re-admitting a patient who had been admitted within the previous three months, the timing, frequency and interval of a complete physical examination shall be subject to physician discretion, provided that no more than three months elapses between physical examinations.(C)Treatment: (1) The licensee shall provide detoxification services after determining through physical examination that such services are required.(2) Upon receiving medical clearance to participate in treatment services, the licensee shall provide each client with at least nine hours of service programming each week.(3) Treatment shall include services specified in 105 CMR 164.074: Minimum Treatment Service Requirements, and shall be provided either directly or through Qualified Service Organization agreements.