Section 164.208 - Staffing Pattern(A) The Licensed or Approved Provider shall designate a Medical Director who shall be responsible for administering all medical services performed by the program. The Medical Director shall have documented clinical experience with opioid-dependent, alcohol and other drug-dependent persons and medications used for treatment of addiction, including all FDA-approved medications for treatment of opioid use disorder. The Medical Director shall be responsible for: (1) Ensuring each patient receives a complete physical examination, 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) 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, advanced practice registered nurse, or physician assistant on staff and on-site during hours of operation of the service;(4) Licensed practical nurse, case aides and case management staff;(5) If serving pregnant women, an obstetrician/gynecologist available on staff or through a QSOA; and(6) Sufficient staff coverage on all shifts to ensure patient needs are met.(C)Supervision. In addition to supervision requirements set forth in 105 CMR 164.044 Training and Supervision, the Licensed or Approved Provider shall ensure supervision of nursing staff is overseen by either a registered nurse, or a Licensed Practical Nurse (LPN) or other Qualified Health Care Professional provider defined under 105 CMR 164.005 who possesses the skills and supervision experience as determined by program and/or meets the requirements under professional licensure; provided, however that the supervisor shall be educationally prepared at or above the level of the nursing staff under his or her supervision.(D) The Licensed or Approved Provider shall ensure a qualified Practitioner is available during all hours when service is provided, either on-site or through a QSOA, to provide consultation to staff. If services are to be available through an agreement, this agreement shall be reaffirmed every five years.Adopted by Mass Register Issue 1482, eff. 11/11/2022.