Rule 24-2-50.2 - Staffing and ObservationA. Agency providers providing Level 2-WM: Ambulatory Withdrawal Management with Extended On-Site Monitoring is withdrawal management combined with a PHP program in which the person must first be evaluated by a physician before admission. The physician creates a set of standing orders based on objective and subjective signs and symptoms by which a nurse administers medication, if required, to manage withdrawal symptoms. The person must see the nurse each day prior to the start of the PHP program until withdrawal is completed. Risks and benefits of this level of WM:1. Risks for this level of withdrawal management are more psychosocial, related ASAM Dimension 4 Readiness to change, ASAM Dimension 5 Relapse, Continued Use and Continued Problem Potential, Dimension 6, Recovery Environment. (a) Benefits for this level of withdrawal cost-savings over inpatient detox; and(b) Many people who complete detoxification do not enter continued treatment for their SUD. They are likely to return to drinking or using again, require detoxification again, and repeat the cycle; escalating costs and reduce opportunity for recovery.B. Agency providers providing Level 3.2-WM: Clinically Managed Residential Withdrawal Management Services must provide a level of services designed to assist people in a safe manner through withdrawal without the need for on-site medical and nursing personnel. Services must contain the following:1. Appropriately credentialed personnel who are trained to provide physician approved protocols and recognize signs and symptoms of alcohol and drug intoxication, withdrawal, and appropriate monitoring of those conditions. Employees must:(a) Observe and supervise the person;(b) Determine the person's appropriate level of care; and(c) Facilitate the person's transition to continuing care.2. Twenty-four (24) hours a day medical evaluation and consultation.3. A written agreement or contract with a local hospital able to provide Medically Managed Withdrawal Management Services as defined by the ASAM.4. The employee supervising self-administered medications must be appropriately licensed or credentialed by the State of Mississippi.C. Agency providers providing Level 3.7-WM: Medically Monitored Inpatient Withdrawal Management Services. This level of Withdrawal Management most commonly occurs in conjunction with Level 3.7 Medically Monitored High Intensive Inpatient (Residential) Services. This service provides care to people whose withdrawal signs and symptoms are sufficiently severe to require 24-hour care delivered by medical professionals and RN coverage. Services must include the following: 1. Services staffed by a physician or appropriately licensed employee performing the duties as a physician under a collaborative agreement or other requirements of the Medical Practice Act.2. Physician or licensed designee must be available 24 hours a day by telephone.3. People must be assessed by a physician or licensed designee within 24 hours of admission or earlier if medically necessary.4. A RN or other licensed and credentialed nurse is available to conduct a nursing assessment on admission.5. Documentation of hourly observation of the people receiving services during the first 24 hours of the withdrawal management. Agency providers providing this service must have a written plan describing the handling of medical emergencies, which includes the roles of employees and physicians.6. Must have an interdisciplinary team of appropriately trained employees available to assess and treat the person's needs.