W. Va. Code R. § 69-11-35

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

Section 69-11-35 - Special Populations

35.1. Concurrent Alcohol and Polysubstance Abuse.

35.1.a. Each MAT program shall address abuse of alcohol and other non-opioid substances within the context of the medication-assisted therapy effort.

35.1.b. The MAT program shall ensure that its staff is fully trained and knowledgeable regarding current effective strategies for treating alcohol, cocaine, and other drug abuse.

35.1.c. Ongoing polysubstance use is not a reason for discharge unless the patient refuses recommended, more intensive levels of care. The interdisciplinary team shall consider the patient's condition and address the situation from a clinical perspective and in accordance with guidelines and protocols from approved authorities.

35.1.d. Each MAT program shall have a policy regarding treatment of co-morbid disorders such as psychiatric and medical disorders. The goal of the treatment shall be to provide treatment for these disorders in as seamless a fashion as possible, maximizing patient convenience and compliance with appointments and recommendations. The program shall develop interagency agreements whenever possible to ensure smooth referral processes and interchange of information.

35.2. Behavioral Health Needs.

35.2.a. Each MAT programs shall ensure that patients with behavioral health needs are identified through the evaluation process and referred for appropriate treatment.

35.2.b. At all phases of treatment, the MAT program shall monitor patients during detoxification withdrawal and recovery for indications of symptoms of behavioral illness.

35.2.c. Each MAT program shall establish linkages with licensed behavioral health providers in the community.

35.2.d. Each MAT program may provide psychotropic medication management onsite by appropriately trained medical professionals. Individualized treatment plans of care shall describe the goals of psychotropic medication management, which shall be reviewed regularly. The patient's chart and individualized treatment plan of care shall document regular contact with the prescribing physician or physician extender, or both, for the distinct purpose of monitoring prescribed psychotropic medications.

35.3. HIV Patients.

35.3.a. The MAT program shall educate all patients regarding HIV/AIDS, testing procedures, confidentiality, reporting, follow-up care, safer sex, social responsibilities and sharing of intravenous equipment.

35.3.b. The program shall establish linkages with HIV/AIDS treatment programs in the community.

35.4. Chronic Pain Patients.

35.4.a. Each MAT program shall ensure that physicians practicing at the facility are knowledgeable in the treatment and management of substance use disorder in a context of chronic pain and pain management. The program may not prohibit a patient diagnosed with chronic pain from receiving medication for either maintenance or withdrawal in a program setting.

35.4.b. Each MAT program shall ensure continuity of care and communication between programs or physicians regarding patients receiving treatment in both a MAT program and a facility or physician's office for purposes of pain management, with the patient's written permission. If a patient refuses permission for the two entities to communicate and coordinate care, the program shall document refusal and may make clinically appropriate decisions regarding take-home medication privileges and continuation in treatment.

35.5. Pregnant Patients.

35.5.a. Pregnant women seeking and needing treatment shall be enrolled in the MAT program and provided treatment in accordance with guidelines and protocols from approved authorities.

35.5.b. The MAT program shall ensure that every pregnant patient has the opportunity for prenatal care, either onsite or by referral. If the arrangement is by referral, the program shall have agreements in place, including informed consent procedures, which ensure exchange of pertinent clinical information regarding compliance with the recommended plan of medical care.

35.5.c. If not available elsewhere, the program shall offer basic instruction on maternal, physical and dietary care as part of its counseling services and document the provision of the services in the clinical record.

35.5.d. With respect to pharmacotherapy for opioid addicted pregnant women in medication-assisted therapy, the program shall ensure that:

35.5.d.1. Maintenance treatment dosage levels shall be maintained at the lowest possible dosage level that is a medically appropriate therapeutic dose as determined by the medical director or program physician taking the pregnancy into account.

35.5.d.2. The initial medication-assisted treatment dose for a newly admitted pregnant patient and the subsequent induction and maintenance dosing strategy reflect the same effective dosing protocols used for all other patients;

35.5.d.3. The dose is monitored carefully, moving rapidly to supply increased or split dose if it becomes necessary; and

35.5.d.4. If a pregnant patient elects to withdraw from medication-assisted treatment, that withdrawal is not initiated by the program before 14 weeks and after 32 weeks' gestation; perform regular fetal assessments as appropriate for fetal age and require that withdrawal is supervised by a physician experienced in substance use disorder medicine.

35.5.e. The MAT program shall ensure appropriate referral for follow-up and primary care for the mother and infant.

35.5.f. If a pregnant patient is discharged, the MAT program shall identify the physician to whom the patient is being discharged and this information shall be retained in the clinical record.

35.5.g. The program shall offer onsite parenting education and training to all male and female patients who are parents or shall refer interested patients to appropriate alternative services for training. Any referral shall be documented in the patient's record.

35.5.h. The program shall offer reproductive health education to all patients and appropriate referrals for contraceptive services as necessary.

35.6. Criminal Justice.

Each MAT program shall establish agreements and develop and implement procedures to coordinate with agents of the criminal justice system on behalf of patients insofar as permitted by patient confidentiality requirements.

W. Va. Code R. § 69-11-35