W. Va. Code R. § 69-12-29
Current through Register Vol. XLI, No. 50, December 13, 2024
Section 69-12-29 - Special Populations29.1. Concurrent Alcohol and Polysubstance Abuse. 29.1.1. Each OBMAT program shall address, where appropriate, misuse of alcohol and other non-opioid substances within the context of the medication-assisted therapy effort.29.1.2. The OBMAT program shall ensure that its staff is fully trained and knowledgeable regarding current effective strategies for treating alcohol, illicit drug use, and other drug misuse.29.1.3. Ongoing polysubstance use is not a reason for discharge unless the patient refuses recommended treatment. 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.29.1.4. Each OBMAT program shall have a policy regarding treatment of comorbid 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.29.2. Behavioral Health Needs. 29.2.1. Each OBMAT program shall ensure that patients with behavioral health needs are identified through the evaluation process and referred for appropriate treatment.29.2.2. At all phases of treatment, the OBMAT program shall monitor patients during medical withdrawal and recovery for symptoms of behavioral illness.29.2.3. Each OBMAT program shall establish linkages with licensed behavioral health providers in the community or in the program's facility.29.2.4. Each OBMAT 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 plan of care or treatment strategy shall document regular contact with the prescribing physician or physician extender, or both, for the distinct purpose of monitoring prescribed psychotropic medications if such medications are prescribed.29.3. HIV Patients.29.3.1. The OBMAT program shall educate all patients regarding HIV/AIDS, testing procedures, confidentiality, reporting, follow-up care, safer sex, social responsibilities and sharing of intravenous equipment.29.3.2. The program shall establish linkages with HIV/AIDS treatment programs in the community.29.4. Chronic Pain Patients.29.4.1. Each OBMAT program shall ensure that physicians practicing at the facility are knowledgeable in the treatment and management of substance use disorder in the 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.29.4.2. Each OBMAT program shall ensure continuity of care and communication between programs or physicians regarding patients receiving treatment in both an OBMAT 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 continuation in treatment.29.5. Pregnant Patients. 29.5.1. Pregnant women seeking and needing treatment shall be enrolled in the OBMAT program and provided treatment in accordance with guidelines and protocols from approved authorities.29.5.2. The OBMAT program shall ensure referrals for every pregnant patient who does not have an obstetrical provider. Care for the pregnant patient with a substance use disorder should be co-managed by the OBMAT program and the patient's obstetrical provider. The OBMAT program shall have agreements in place with the patient's obstetrical provider, including informed consent procedures that ensure exchange of pertinent clinical information regarding compliance with the recommended plan of medical care.29.5.3. With respect to pharmacotherapy for pregnant women with active opioid use disorder in medication-assisted therapy, the program shall ensure that: 29.5.3.a. Maintenance medication levels shall be maintained at the lowest possible dosage level that is a medically therapeutic dose as determined by the medical director or program physician taking the pregnancy into account.29.5.3.b. 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;29.5.3.c. The dose is monitored carefully to supply increased or split dose if it becomes necessary; and29.5.3.d. If a pregnant patient elects to withdraw from medication-assisted treatment against medical advice, the program shall inform the patient of the risks of withdrawal to the patient and the effects on the pregnancy.29.5.4. The OBMAT program shall document referral for follow-up and primary care for the mother and infant.29.5.5. If a pregnant patient is discharged, the OBMAT program shall identify the physician to whom the patient is being discharged. If a provider is not available, a referral shall be made to a Comprehensive Behavioral Health Center. Information regarding discharge for any reason, including an inability to refer, shall be retained in the clinical record.W. Va. Code R. § 69-12-29