Current through Register Vol. XLI, No. 50, December 13, 2024
Section 69-7-18 - Staffing18.1. Medical Director. 18.1.a. Each opioid treatment program shall have a designated medical director. The medical director shall be a physician licensed to practice medicine or osteopathy in the state of West Virginia and shall have either:18.1.a.1. Demonstrated experience in opioid treatment; or18.1.a.2. A written plan to attain competence in opioid treatment within a probationary time period as provided in §18.1.b herein.18.1.b. The medical director may submit a written plan to attain competence in opioid treatment to the state authority for approval at least two weeks prior to employment at an opioid treatment program. 18.1.b.1. The time frame for completion of the plan may not exceed twelve months from the date of the appointment as medical director. The physician may work as a medical director during this probationary time period, subject to the supervision and reporting requirements of this rule.18.1.b.2. During the probationary time period, the medical director shall be supervised on a regular basis by a physician licensed in this state with demonstrated competence in the field of opioid treatment.18.1.b.3. Consultation with and supervision of a medical director during the probationary time period may be provided by telephone or video conferencing and shall be documented, initialed or verified (either in ink or electronically) and dated by both the supervising physician and the supervised physician.18.1.b.4. The administrator of the opioid treatment program is responsible for maintaining documentation regarding the medical director's training and experience in a file which is current and readily available at all times. The administrator is also responsible for ensuring that the plan of development is completed within the approved time lines.18.1.b.5. The state authority may request periodic documentation of continuing education during the initial probationary period and afterward if the documentation provided at the end of that period is not satisfactory.18.1.c. The medical director shall maintain authority over the medical aspects of treatment offered by the opioid treatment program. The medical director is responsible for: 18.1.c.1. All opioid treatment decisions;18.1.c.2. Operation of all medical aspects of the treatment program;18.1.c.3. Administration and supervision of all medical services;18.1.c.4. Ensuring that the opioid treatment program is in compliance with all applicable federal, state and local laws, rules and regulations;18.1.c.5. Obtaining and maintaining his or her continuing medical education in the field of addiction on a documented and ongoing basis;18.1.c.6. Approving the basic and continuing educational programs of all staff employed by or volunteering at the opioid treatment program; and18.1.c.7. Determining the ability of the program physicians or physician extenders to work independently within the applicable scope of practice.18.2. Professional Medical Staff. 18.2.a. The opioid treatment program may employ and use program physicians, physician extenders and other health care professionals working within their scope of practice who have received sufficient education, training and experience, or any combination thereof, to enable that person to perform the assigned functions. All physicians, nurses and other licensed professional care providers must comply with the credentialing requirements of their respective professions. The opioid treatment program may only employ advanced practice registered nurses and physician's assistants as physician extenders.18.2.b. All physicians and physician extenders employed by the opioid treatment program shall be actively licensed in West Virginia and shall have: 18.2.b.1. A minimum of one year's experience in opioid treatment settings; or18.2.b.2. Active enrollment in a plan of education for obtaining competence in opioid treatment methods and addiction that is approved by the medical director. The medical director shall certify the individual's completion of the plan of education when, in the discretion of the medical director, it is satisfactorily accomplished.18.2.c. During all hours of operation, every opioid treatment program shall have an actively licensed physician on call and available for consultation with other staff members at any time.18.2.d. During all hours of operation when medication is being administered, every opioid treatment program shall have present and on duty at the facility at least one of the following actively-licensed health care professionals 18.2.d.1. Physician assistant; or18.2.d.2. Advanced practice registered nurse; or18.2.d.3. Registered nurse; or18.2.d.4. Licensed practical nurse operating within his or her scope of practice.18.2.e. Plans of Education. 18.2.e.1. Program physicians and physician extenders operating under a plan of education shall be supervised by the medical director at a frequency appropriate for the qualifications and experience of the employee.18.2.e.2. The program sponsor or the administrator of the opioid treatment program shall document when an employee undertakes a plan of education; maintain all records regarding plans of education for the professional medical staff; ensure that completion of any plan of education is documented and maintained in the personnel files; and ensure that the medical director monitors and certifies satisfactory completion of each plan of education.18.2.e.3. The medical director shall approve each plan of education and the ability of a program physician or physician extender to work independently within his or her scope of practice. The medical director shall sign an affidavit that verifies and documents an employee's successful completion of a plan of education and the medical director's approval for that person to provide services on an independent basis within his or her scope of practice. The affidavit shall be maintained in the personnel file of each professional medical staff person who has completed a plan of education.18.3. Counseling Staff. 18.3.a. Counseling through an opioid treatment program shall be provided by a program counselor, qualified by education, training or experience to assess the psychological and sociological background of patients, to contribute to the appropriate treatment plan for the patient and to monitor patient progress.18.3.b. A mental health professional or a health care professional as identified in section 18.2.d. shall be present and on duty at the opioid treatment center during all hours of operation when medication is not being administered. The opioid treatment program shall assign a primary counselor to each patient.18.3.c. Any counselor employed by an opioid treatment program shall have one or more of the following qualifications: 18.3.c.1. A bachelor's degree and either licensure or certification as a social worker, or certification as an addiction counselor; or18.3.c.2. A graduate degree with either licensure and certification in the individual's chosen field or as an addiction counselor; or18.3.c.3. Certification as an addiction counselor; or18.3.c.4. A bachelor's degree in a relevant human services field, practicing under the supervision of an advanced alcohol and drug counselor (AADC); Provided, that the individual practicing with a bachelor's degree under supervision applies for certification as an alcohol and drug counselor within three years of the date of employment as a counselor; or18.3.c.5. An advanced degree and actively working towards licensure or certification in a chosen field under the supervision of a licensed or certified professional in that field and/or under the supervision of an AADC.18.3.d. Each opioid treatment program's policy and procedures shall establish ratios of primary counselors to persons served that are adequate to allow sessions to occur as mandated and will allow persons served access to a primary counselor.18.3.e. An opioid treatment program shall employ or retain an AADC to supervise unlicensed and/or uncertified counselors in the core competencies required by an applicable certification board. At a minimum, the supervisor shall provide at least one hour of supervision per twenty hours of direct service. Supervision may be group in nature, but must consist of case consultation and discussion and/or clinical training rather than administrative oversight.18.3.f. The administrator of the opioid treatment program is responsible for documentation of supervision, which shall be available for review at all times.18.3.g. Newly employed counselors and other non-physician clinical staff without experience in a recovery-based opioid treatment program shall receive initial training lasting at least twenty hours and consisting of, at a minimum, the following: 18.3.g.1. Addiction overview;18.3.g.2. Opioid treatment, detoxification protocols, recovery models and basic pharmacology and dosing;18.3.g.3. Characteristics of the opioid dependent population;18.3.g.4. Toxicology screening and observation of sample collection;18.3.g.5. Program policy and procedure;18.3.g.6. Confrontation, de-escalation and anger management;18.3.g.7. Cultural sensitivity as necessary and appropriate;18.3.g.8. Current strategies for identifying and treating alcohol, cocaine and other drug abuse;18.3.g.9. Identification of co-occurring behavioral health or developmental disorders; and18.3.g.10. Other clinical issues as appropriate for the population served.18.3.h. An experienced counselor newly employed from another opioid treatment program may request an exemption from the mandatory initial training required by this rule. The administrator of the opioid treatment program shall document in the personnel file any exemption granted and the basis for the exemption.18.3.i. Counselors with less than one year of full time experience in the field of opioid treatment shall accompany an experienced counselor at all times for a minimum of two weeks before seeing persons served without immediate and constant supervision.18.3.j. There shall be one (1) counselor for every fifty (50) clients in the program.18.4. Unlicensed Clinical Staff and Volunteers. 18.4.a. An opioid treatment program may employ unlicensed clinical staff and utilize volunteers to assist in the operation of the program and facility. The program shall develop policies and procedures which specify the roles and responsibilities of each unlicensed employee and volunteers. Documentation of the responsibilities, training and other obligations of an unlicensed clinical staff employee or volunteer shall be included in the personnel file of the employee or volunteer. 18.4.a.1. All employees and volunteers shall be screened through criminal and protective services background checks prior to being hired or permitted on the premises of an opioid treatment program facility. No person who has a history of one or more convictions for a felony crime may be an employee or volunteer of an opioid treatment program.18.4.a.2. An opioid treatment program may apply to the secretary for a written waiver of employment restrictions on a case-by-case basis. The secretary, in his or her sole discretion, may waive any employment restriction if the circumstances appear reasonable and just.18.4.b. An opioid treatment program shall designate a supervisor for each separate service or program. A supervisor may be responsible for more than one program. All unlicensed clinical staff and volunteers shall receive regular supervision and be provided with assistance, directions for activity and support.