W. Va. Code R. § 69-11-21

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 69-11-21 - Pre-Admission Assessment; Admission Criteria and Admission Process

21.1. Each MAT program shall develop, implement and maintain policies and procedures designed to ensure that patients are admitted to maintenance treatment only after assessment by qualified personnel who have determined that the person meets the qualifications for admission.

21.2. Any individual seeking admittance to the MAT program shall undergo a pre-admission initial assessment in order to determine whether the person meets the criteria for admission to a MAT program. The initial assessment, consisting of a physical assessment and an intake screening, shall be conducted by the medical director, an approved program physician or a supervised physician extender. The initial assessment shall focus on the individual's eligibility and need for treatment and shall provide indicators for initial dosage level, if required and if admission is determined appropriate. The determination of admission eligibility shall be made using accepted medical criteria such as those listed in the latest approved version of the Diagnostic and Statistical Manual for Mental Disorders.

21.3. The initial physical assessment shall include documentation of:

21.3.a. A brief physical examination;

21.3.b. The patient's immediately relevant history, including, but not limited to, determination of chronic or acute medical conditions such as diabetes, renal disease, hepatitis, sickle cell anemia, tuberculosis, human immunodeficiency virus (HIV) exposure, sexually transmitted disease, chronic cardiopulmonary disease and pregnancy;

21.3.c. A determination of currently prescribed medication or utilized over-the-counter substances;

21.3.d. An evaluation of the patient's use of other substances of abuse and alcohol;

21.3.e. Determination of current substance use disorder;

21.3.f. Determination of length of substance use disorder;

21.3.g. An initial drug test and full drug screen to identify whether the patient is using other drugs, including opiates, methadone, buprenorphine, amphetamines, cocaine, barbiturates, benzodiazepines, marijuana or other drugs or substances as determined by community standards, regional variation or clinical indication, such as carisoprodol; to determine whether the individual has a substance use disorder from another MAT program;

21.3.h. An inquiry to and report from the Controlled Substances Monitoring Program database;

21.3.i. An inquiry whether the patient is enrolled in any other MAT program;

21.3.j. Identify comorbid medical and psychiatric conditions or disorders and to determine how, when and where they will be addressed;

21.3.k. Screen for communicable diseases and address them as needed and evaluate patient's level of physical, psychological and social functioning or impairment;

21.3.l. Assess the individual's access to social supports, family, friends, employment, housing, finances and whether any legal problems exist; and

21.3.m. Determine the patient's readiness to participate in treatment.

21.4. The individual desiring admission for treatment through the use of a medication-assisted treatment medication must be at least 18 years of age. Exceptions may be made on extremely rare occasions with parental consent and by application of the treating physician to the state opioid treatment authority.

21.5. All admissions shall include documentation regarding medical necessity and program eligibility for medication-assisted treatment that includes:

21.5.a. Objective evidence, such as a positive drug test, of current physical dependence or tolerance to opioids or methadone; or

21.5.b. Objective symptoms of withdrawal, with documentation of the signs and symptoms of withdrawal, or both; or

21.5.c. Evidence from the patient of the following:

21.5.c.1. Onset of opioid physical dependence prior to admission with continuous use the greater part of the year; and

21.5.c.2. Multiple or daily self-administration of an opioid, or both.

21.6. The following behavioral signs which support the diagnosis of substance use disorder shall be discussed and documented, although none are considered required for admission:

21.6.a. Unsuccessful efforts to control use;

21.6.b. Time spent obtaining drugs or recovering from the effects of abuse;

21.6.c. Continual use despite harmful consequences;

21.6.d. Obtaining opiates illegally;

21.6.e. Inappropriate use of prescribed opiates;

21.6.f. Giving up or reducing important social, occupational or recreational activities;

21.6.g. Continuing use of the opiate despite known adverse consequences to self, family or society; and

21.6.h. One or more unsuccessful attempts at gradual removal of physical dependence on opioids or detoxification using methadone, buprenorphine or other appropriate medications.

21.7. The absence of physiological dependence should not be an exclusion criterion, and admission may be clinically justified. The initial assessment may recognize that individuals in some populations may be susceptible to relapse to substance use disorder, leading to high-risk behaviors with potentially life-threatening consequences.

21.8. After thorough review of the information acquired through the initial assessment, an individual may be admitted to the MAT program if, using accepted medical criteria, a determination is made that one or more of the following factors is met:

21.8.a. The individual has a positive drug test for either opioids or methadone;

21.8.b. There are objective symptoms of withdrawal, or both; or

21.8.c. There is objective evidence that the individual qualifies under the provisions of subsection 21.9. of this rule.

21.9. Admission to the MAT program may be allowed to the following groups with a high risk of relapse without the necessity of a positive drug test or the presence of objective symptoms:

21.9.a. The individual is a pregnant woman with a history of substance use disorder;

21.9.b. The individual is a prisoner or has been released from a correctional facility within six months;

21.9.c. The individual is a former program patient who successfully completed treatment but believes that he or she is at risk of imminent relapse; or

21.9.d. The individual has been deemed as high risk by the medical director or treating physician.

21.10. A patient enrolled in a MAT program shall not be permitted to obtain treatment in any other MAT program except in exceptional circumstances and as provided in subsection 30.14 of these rules.

21.11. The admission and initial dosing of the patient may take place only after the patient is seen by a program physician, or an experienced medical professional working within the scope of his or her license who:

21.11.a. Has consulted by telephone or in person with the program physician;

21.11.b. Is approved by the medical director; and

21.11.c. Has completed a plan of education and development.

21.12. Whenever possible, the patient shall be admitted only after observation by and an interview with the program physician. Under unusual circumstances, an experienced medical professional working within the scope of his or her license may conduct the interview and observation and obtain telephone or fax orders from the physician to initiate treatment. Any patient admitted under those circumstances must be seen by the program physician within three working days of admission for verification of appropriate admission and treatment. All unusual circumstances and their outcomes shall be reviewed by the admissions committee.

21.13. The program physician or physician extender shall review the accumulated data directly with the individual and confirm a diagnosis of substance use disorder of sufficient severity to warrant admission to the MAT program. The program physician shall document that treatment is medically necessary. The admission and initial dosing decisions ultimately rest with the medical director or the designated program physician.

21.14. The program physician shall ensure that each patient voluntarily chooses maintenance treatment and that all relevant facts concerning the use of medication-assisted treatment medications are clearly and adequately explained to the patient. The program physician shall ensure that each newly admitted patient provides informed written consent to treatment.

21.15. Every individual shall be given the opportunity to enter into a detoxification program and shall be fully informed of the protocol, goals and procedures for detoxification. The individual shall specifically consent to participation in the detoxification program in writing. The consent form shall be maintained in the patient chart and with the patient's individualized treatment plan of care.

21.16. Admission of individuals with no opioid tolerance shall require careful monitoring and documentation during the induction phase of treatment.

21.17. The physician or physician extender and patient shall each sign and date the verification that the initial assessment and review occurred and that the patient received all applicable information, policies and procedures.

21.18. Exceptions to admission policy shall be reviewed and tracked by the admissions committee and be made available to regulatory bodies.

21.19. If a patient was previously discharged from treatment at another program, the admitting MAT program with patient consent shall contact the previous MAT program or programs from treatment history.

21.20. Non-admissions. The program shall maintain written logs that identify persons who were considered for admission or initially screened for admission but were not admitted. This log shall identify the reasons why the individuals were not admitted and what referrals were made for them by the program.

21.21. Patient Transfers.

21.21.a. MAT programs shall accept patients transferring from another MAT program within the State of West Virginia, if:

21.21.a.1. The MAT program accepting a patient voluntarily transferring from another MAT program shall provide documentation that the patient's medical record and reasons for the transfer was sought from the patient's previous MAT program; and

21.21.a.2. The patient is in compliance with readmission policies for patients who have been administratively detoxified.

21.21.b. In order for the patient to transfer to another MAT program, the following requirements shall be met:

21.21.b.1. The MAT program that the patient is leaving shall forward all relevant patient records to the MAT program where the patient is transferring; and

21.21.b.2. The MAT program shall provide documentation that the patient's medical record and reason for transfer was sought from the patient's previous MAT program and shall meet the admission criteria of this rule.

21.21.c. Patients who are West Virginia residents and wish to transfer to another West Virginia-based program shall be reviewed by the new program's admission program physician or medical director on an individual basis to determine their placement on the receiving program's patient listing. The review shall determine the patient's need, program placement availability and the circumstances for the transfer request.

21.21.d. Patients who are not West Virginia residents shall transfer to a West Virginia program as a new admission in accordance with this rule.

W. Va. Code R. § 69-11-21