Section 164.153 - Staffing Pattern(A) The Licensed or Approved Provider shall designate a physician as Medical Director who shall be responsible for administering all medical services performed by the program. The Medical Director shall have documented clinical experience or 40 hours of documented continuing education credit in addiction medicine and medications for treatment of addiction, including all FDA-approved medications for treatment of opioid use disorder. The Medical Director or designee shall be responsible for: (1) Ensuring each patient receives a medical evaluation, including a medical history;(2) Ensuring appropriate laboratory studies have been performed; and(3) Establishing an individualized signs of life check protocol for each patient to be documented in the medical record.(B) The Licensed or Approved Provider shall establish a staffing pattern in sufficient numbers and positions necessary for the service type provided. Staffing pattern shall include the following positions:(1) A full-time equivalent Senior Clinician among direct service staff who shall be responsible for the clinical/educational operation of the substance use disorder service;(2) Licensed psychiatrist or licensed psychologist on staff or available through QSOAs;(3) Registered nurse, nurse practitioner, licensed practical nurse or physician assistant;(4) At least one full time counselor, recovery specialist and case management/care coordinator staff;(5) If serving pregnant women, an obstetrician/gynecologist available on staff or through a QSOA;(6) Food personnel trained in safe and sanitary food handling and preparation, as specified in 105 CMR 590.000: Minimum Sanitation Standards for Food Establishments, and 105 CMR 590.003: Management and Personnel. Food service permits, where required, shall be current and available for review by Department personnel; and(7) Sufficient staff coverage on all shifts to ensure patient needs are met. Such staffing shall include the following staffing minimums, which shall be adjusted upward to address patient acuity and programmatic need:(a) Licensed nursing staff shall be on-site for a minimum of four hours per day, seven days per week;(b) The Provider must provide, at minimum, one recovery specialist on all shifts;(c) The Provider must provide, at minimum, the full-time equivalent of 2.5 counselors to be present at the program over a 12-hour span, seven days per week;(d) The Provider must provide, at minimum, the full-time equivalent of one care coordinator to be present at the program five days per week; and(e) Any provider with a program serving persons who identify as male or female must have a plan in place ensuring at least one direct care staff person on-site who identifies as female, and one direct care staff person who identifies as male.(C) The Licensed or Approved Provider shall ensure a qualified physician is available 24 hours per day, seven days per week, on-site, through a QSOA, or by the use of telemedicine as appropriate and in the discretion of the Practitioner, to provide consultation to staff. If services are to be available through an agreement, this agreement shall be reaffirmed at a minimum every five years.Adopted by Mass Register Issue 1482, eff. 11/11/2022.