Current through Register Vol. XLI, No. 50, December 13, 2024
Section 69-11-9 - Environment and Operations9.1. Service Operation Schedule.9.1.a. Except as otherwise provided herein, all opioid treatment programs shall be open for business seven days-per-week. The program may be closed for eight holidays and two training days per year.9.1.b. Opioid treatment programs may close on Sundays if the following criteria are met: 9.1.b.1. The program develops and implements policies and procedures that address recently inducted patients receiving services, patients not currently on a stable dose of medication, patients that present as non-compliant with program policies and procedures and their individualized treatment plan of care, and individuals who previously picked up take-home medications on Sundays, security of take-home medication doses, and health and safety of individuals receiving services;9.1.b.2. The program receives prior approval from the state opioid treatment authority for Sunday closings;9.1.b.3. Once approved, the program shall notify individuals receiving services in writing at least 30 days in advance of their intent to close on Sunday. The notice shall address the risks to the patients the security of take-home medications. All individuals shall receive an orientation addressing take-home policies and procedures, and this orientation shall be documented in the individual's record prior to receiving take-home medications; and9.1.b.4. The program shall establish procedures for emergency access to dosing information 24 hours a day, seven days-per-week, this information may be provided via an answering service or other electronic measures. Information needed includes the patient's last dosing time and date, and dose.9.1.c. Medication dispensing hours shall include at least two hours each day of operation outside normal working hours, i.e., 9:00 a.m. and after 5:00 p.m. The state opioid treatment authority may approve an alternate schedule if that schedule meets the needs of the population served by the program.9.2. Payments for services rendered may be made either by West Virginia Medicaid, private insurance, or by cash as described in 9.2.d.9.2.a. The opioid treatment program shall be eligible for, and not prohibited from, enrollment with West Virginia Medicaid and other private insurance.9.2.b. Prior to directly billing a patient for any opioid treatment, an opioid treatment program must receive either a rejection of prior authorization, or rejection of a submitted claim or a written denial from a patient's insurer or West Virginia Medicaid denying coverage for such treatment.9.2.c. The opioid treatment program shall document in the patient's record any rejection of prior authorization, rejection of a submitted claim for written denial from a patient's insurer or West Virginia Medicaid denying coverage for opioid treatment. The opioid treatment program shall also clearly document in the patient's record if the patient has no insurance or has voluntarily and with full knowledge of the financial obligations, including all treatment costs, requested a claim not be submitted to their insurer or West Virginia Medicaid. When any instance described in this section regarding direct billing and acceptance of cash payments from a patient occurs, the opioid treatment program shall clearly document in the patient's record the rationale and medical necessity for acceptance into the program.9.2.d. The opioid treatment program may directly bill and accept cash payments from a patient only after the requirements of subdivisions 9.2.a., 9.2.b. and 9.2.c. herein, have been fulfilled and documented.9.2.e. At the option of the opioid treatment program, treatment may commence prior to billing.9.3. Each opioid treatment program facility shall have: 9.3.a. Sufficient space and adequate equipment for the provisions of all services specified in the program's description of treatment services;9.3.b. Clean, safe and well-maintained patient and staff areas;9.3.c. A secure room and lockable equipment for patient records;9.3.d. Private offices or areas for individual and group therapeutic meetings, sufficient in number to address the counseling and treatment needs of the population served;9.3.e. Sanitary, secure and private dosing areas;9.3.f. Sufficient restrooms for the estimated patient population with areas for observation of specimen production, if necessary; and9.3.g. Adequate parking areas for the expected flow of traffic.9.4. The opioid treatment program facility may provide secure personnel in lobby and parking areas, either clinic staff or contracted, if the population served or clinic environment warrants such an arrangement. If contracted staff is used for security, the staff must be trained in patient confidentiality.9.5. Infection Control. 9.5.a. The opioid treatment program shall develop, implementand maintain an effective infection control program that protects the patients, their families and clinic personnel by preventing and controlling infections and communicable diseases.9.5.b. The program shall include the implementation of a nationally recognized system of infection control guidelines.9.5.c. The opioid treatment program shall have an active surveillance and education program for the prevention, early detection, control and investigation of infections and communicable diseases.9.5.d. The opioid treatment program shall designate a person or persons, with appropriate education and training, as infection control officer to develop and implement policies governing control of infections and communicable diseases for patients and personnel.9.6. Community Relations.9.6.a. The program shall develop and implement policies and procedures for community relations.9.6.b. A program shall be responsible for ensuring that its patients do not cause unnecessary disruption to the community or act in a manner that would constitute disorderly conduct or harassment by loitering on the program's property. 9.6.b.1. Each program shall provide the state opioid treatment authority and state oversight authority, when requested, with a specific plan describing the efforts it will make to avoid disruption of the community by its patients and the actions it will take to assure responsiveness to community needs. This plan shall, at a minimum: 9.6.b.2.A. Identify program personnel who will function as community relations coordinators and define the goals and procedures of the community relations plan;9.6.b.2.B. Include policies and procedures to resolve community problems, including, but not limited to, patient loitering and medication diversion, to ensure that program operations do not affect community life adversely; and9.6.b.2.C. Include policies and procedures for soliciting patient and community ideas about medication-assisted treatment, addressing community concerns and the program's presence in the community.9.6.b.3. Each program shall document community relations efforts and community contacts, including the resolution of issues identified by community members or patients.9.7. Emergency Preparedness. -- The program's emergency preparedness plan shall include, but not be limited to, the provision of the continuation of medication-assisted treatment in the event of an emergency or natural disaster.