N.H. Admin. Code § He-P 826.16

Current through Register No. 45, November 7, 2024

Section He-P 826.16 - Required Services

(a) The licensee shall provide administrative services that include the appointment of a full-time, on-site administrator who:

(1) Is responsible for the day-to-day operations of the SUD-RTF;

(2) Meets the requirements of He-P 826.18(i) and (j); and

(3) Designates, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence. The alternate administrator shall not be required to meet the requirements of He-P 826.18(i) .

(b) The clinical services director or designee shall be available for consultation at all times any client is present at the SUD-RTF.

(c) At the time of application for admission, the licensee shall provide the client a written copy of the clientele service agreement pursuant to RSA 161-J:4.

(d) In addition to (c) above, at the time of admission, the licensee shall provide a written copy to the client and the guardian, agent, or surrogate decision-maker, if any, or personal representative, and receive written verification of receipt for the following:

(1) An admissions contract including the following information:

a. The basic daily, weekly, or monthly fee;

b. A list of the core services required by He-P 826.16(e) that are covered by the basic fee;

c. Information regarding the timing and frequency of cost of care increases;

d. The time period covered by the admissions contract;

e. The SUD-RTF's house rules;

f. The grounds for immediate termination of the agreement, pursuant to RSA 151:21, V;

g. The SUD-RTF's responsibility for client discharge planning;

h. Information regarding nursing, other health care services, or supplies not provided in the core services, to include:

1. The availability of services;

2. The SUD-RTF's responsibility for arranging services; and

3. The fee and payment for services, if known;

i. The licensee's policies and procedures regarding:

1. Arranging for the provision of transportation;

2. Arranging for the provision of third party services, such as a cable television;

3. Acting as a billing agent for third party services;

4. Handling of client funds pursuant to RSA 151:24 and He-P 826.14(ac); and

5. Storage and loss of the client's personal property;

j. The licensee's medication management services; and

k. The list of grooming and personal hygiene supplies provided by the SUD-RTF as part of the basic daily, weekly, or monthly rate;

(2) A copy of the most current version of the patients' bill of rights under RSA 151: 21 and the SUD-RTF's policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(3) The SUD-RTF's policy and procedure for handling reports of abuse, neglect, or exploitation which shall be in accordance with RSA 161-F:46 and RSA 169-C:29; and

(4) Information on advanced directives.

(e) The licensee shall provide the following core services:

(1) Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight regarding:

a. The clients' functioning, safety, and whereabouts; and

b. The clients' health status, including the provision of intervention as necessary or required;

(2) Emergency response and crisis intervention;

(3) Assistance with taking and ordering medications as needed;

(4) Provide nutritious meals and snacks in accordance with He-P 826.20 unless the client chooses other options according to their admission agreement;

(5) Housekeeping, laundry, and maintenance services in accordance with the admission agreement;

(6) The availability of activities, for which the facility shall make reasonable accommodation for clients with disabilities, including television, radio, internet, games, newspapers, visitors, and music, designed to sustain and promote physical, intellectual, social, and spiritual well-being of all clients in accordance with the admission agreement;

(7) Assistance in arranging medical and dental appointments, which shall include assistance in arranging transportation to and from such appointments and reminding the clients of the appointments;

(8) Supervision of clients when required to offset cognitive deficits that may pose a risk to self or others if the client is not supervised; and

(9) Provide referral to, and assistance in accessing, medication-assisted SUD treatment, either on site or off site, when clinically appropriate.

(f) The licensee shall provide access to the following services:

(1) A screening and assessment interview conducted or supervised by a licensed counselor to determine:

a. That the client meets the requirements for treatment of a substance use disorder; and

b. A determination of the appropriate ASAM level of care needed.

(2) If the interview in (1) above indicates a need for a clinical evaluation, the clinical evaluation shall be conducted by a licensed counselor in accordance with "TAP 21: Addiction Counseling Competencies," (2017 revision) available as listed in Appendix A using an evidenced based evaluation tool and addressing all ASAM domains to determine:

a. If the client meets diagnostic criteria as indicated in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, Text Revision) (DSM-5) (May 2013 edition), available as listed in Appendix A, for a substance use disorder or other comorbid disorders and formally documents the DSM-5 diagnosis(es) in client record;

b. The appropriate initial level of care for the client based on ASAM criteria; and

c. Areas to be addressed in the treatment plan;

(3) If the clinical evaluation detailed in (2) above was completed by a licensed counselor from a referring agency, the licensee should accept that clinical evaluation as satisfaction of (2) above; and

(4) Behavioral health services on-site or through referral.

(g) The SUD-RTF shall perform an evaluation of each client's needs and develop a treatment plan upon admission or within 24 hours following admission as described in (h) below.

(h) Individual treatment plans shall contain, at a minimum, the following elements:

(1) Goals, objectives, and interventions written in terms that are specific, measurable, attainable, realistic, and timely;

(2) Identifies the client's clinical needs, treatment goals, and objectives;

(3) Identifies the client's strengths and resources for achieving goals and objectives in (1) above;

(4) Defines the strategy for providing services to meet those needs, goals, and objectives;

(5) Identifies referral to outside providers for the purpose of achieving a specific goal or objective when the service cannot be delivered by the treatment program;

(6) Provides the criteria for terminating specific interventions;

(7) Includes specification and description of the indicators to be used to assess the client's progress;

(8) Documentation of participation by the client in the treatment planning process or the reason why the client did not participate;

(9) Signatures of the client and the counselor agreeing to the treatment plan, or if applicable, documentation of the client's refusal to sign the treatment plan; and

(10) Identifies the client's discharge goals.

(i) Treatment plans shall be updated weekly based on any changes in any ASAM domain or client status.

(j) Treatment plan updates shall include:

(1) Documentation of the degree to which the client is meeting treatment plan goals and objectives;

(2) Modification of existing goals or addition of new goals based on changes in the clients functioning relative to ASAM domains and treatment goals and objectives;

(3) The counselor's evaluation of whether or not the client needs to move to a different level of care based on changes in functioning in any ASAM domain and documentation of the reasons for this evaluation; and

(4) The signature of the client and the counselor agreeing to the updated treatment plan, or if applicable, documentation of the client's refusal to sign the treatment plan.

(k) In addition to the individualized treatment planning in (h) above, all providers shall provide client education on:

(1) Substance use disorders;

(2) Relapse prevention;

(3) Infectious diseases associated with injection drug use, including but not limited to, HIV, hepatitis, and tuberculosis (TB);

(4) Sexually transmitted diseases;

(5) Emotional, physical, and sexual abuse;

(6) Nicotine use disorder and cessation options; and

(7) The impact of drug and alcohol use during pregnancy, risks to the fetus, and the importance of informing medical practitioners of drug and alcohol use during pregnancy.

(l) When group education and counseling are provided as part of the treatment program, the provider shall:

(1) Maintain an outline of each educational and group therapy session provided;

(2) Limit clinical groups to no more than 12 individuals with one licensed counselor present and no more than 16 individuals when that licensed counselor is joined by a CRSW or second licensed counselor; and

(3) Limit recovery support groups to include no more than 8 individuals with one CRSW present and no more than 12 individuals when that CRSW is joined by a second CRSW.

(m) All client activities and services shall be documented in accordance with "TAP 21: Addiction Counseling Competencies," 2017 revision, available as listed in Appendix A.

(n) At the time of a client's admission, the licensee shall ensure that orders from a licensed practitioner are obtained for medications, and that special dietary requirements are documented.

(o) The licensee shall have each client obtain a health examination by a licensed practitioner within 30 days prior to admission or within 72 hours following admission to the SUD-RTF.

(p) The health examination in (o) above shall include:

(1) Diagnoses, if any;

(2) The medical history;

(3) Medical findings, including the presence or absence of communicable disease;

(4) Vital signs;

(5) Prescribed and over-the-counter medications;

(6) Allergies; and

(7) Dietary needs.

(q) The licensee shall maintain a daily shift change log which documents such things as client behavior and significant events that a subsequent shift should be made aware of.

(r) When a client refuses care or services that could result in a threat to their recovery, health, safety, or well-being, or that of others, the licensee or their designee shall:

(1) Inform the client and guardian, agent, or surrogate decision-maker, if any, of the potential results of their refusal;

(2) Notify the licensed practitioner of the client's refusal of care; and

(3) Document in the client's record the refusal of care and the client's reason for the refusal if known.

(s) The licensee shall maintain an information data sheet in the client's record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to another medical facility.

(t) The information data sheet in (s) above shall include:

(1) Full name and the name the client prefers, if different;

(2) Name, address, and telephone number of the client's next of kin, guardian, agent, or surrogate decision-maker, if any;

(3) Diagnosis;

(4) Medications, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advanced directives; and

(10) Any other pertinent information not specified in (1) -(9) above.

N.H. Admin. Code § He-P 826.16

Derived From Volume XXXVIII Number 45, Filed November 8, 2018, Proposed by #12658, Effective 11/1/2018, Expires 11/1/2028.