(1) Patient placement criteria shall address the following:
(a) Persons who have recently received chemical dependency inpatient services and require a moderately structured living arrangement shall be admitted to this component. This level of care provides a transitional phase, which includes at least 5 contact hours per week in a supervised setting where vocational rehabilitation, occupational training, education or employment are encouraged.
(b) Persons needing detoxification shall not be admitted or retained but shall be referred or transferred to an approved chemical dependency detoxification program or licensed hospital. Persons manifesting signs and symptoms of a condition that warrants acute medical care shall not be admitted but shall be referred to a licensed hospital.
(c) Dimensional admission criteria must demonstrate compliance with the preceding descriptions and encompass the dimensions delineated in ARM 37.27.120(1 ) ( j) ( i ) through (vii) .
(d) Continued stay criteria shall be based on the above criteria to justify continuance at this level of care or transfer to a more or less restrictive treatment environment. A continued stay/utilization review must be documented at least once, preferably at 6 weeks.
(e) Discharge criteria shall be based on previous dimensional criteria to demonstrate successful completion of treatment or justification for an extension or transfer. Note: The alcohol and drug abuse division will develop sample criteria for this component.
(2) Intermediate care services shall include:
(a) Admission and screening services in accordance with admission criteria.
( b ) Twenty-four hour, 7-day a week supervision in a non-medical community-based residential treatment program.
(c) Medical history and personal observation. Since clients are only accepted from inpatient care, it is assumed that an adequate medical evaluation has been performed and the results have been forwarded and included in the client's file.
(d) Two sessions of group therapy per week, consistent with the client's individual treatment plan. Group therapy hours may include structured group dynamics, group educational experiences, group step work or other interpersonal group processes. Regular alcoholics anonymous meetings are not considered as group therapy hours.
(e) Two sessions per month of documented individual counseling with certified or eligible counseling staff.
(f) Other supportive services as deemed necessary by the program.
(g) Periodic assessment by certified or eligible counseling staff.
(h) Encouragement to participate in alcoholics anonymous or with support groups.
(i) Efforts toward vocational rehabilitation, occupational training, education and/or job placement.
(j) Social and recreational activities.
(k) Family counseling services, as appropriate.
(l) Referral, discharge and follow-up services that ensure continuity of care after discharge.
(m) Transportation services as appropriate.
(3) Staff requirements:
(a) Staff shall consist of a director, certified or eligible chemical dependency counselor(s) and house manager(s) .
(b) A minimum of one staff member shall be on duty for admitting, treating and discharging purposes on a 24-hour, 7-day a week basis. A senior resident may be utilized for relief coverage if definite criteria for senior resident status has been established. Criteria must include a minimum of 3 months abstinence, record of progress, evidence of increased responsibility, and training.
(4) The program shall develop policies and procedures to address the previously listed services, staffing requirements and the criteria in ARM 37.27.115.
(5) Residential requirements for the intermediate component shall include:
(a) Facility license from the department of public health and human services or, if under 8 beds, an acceptable fire, life and safety sign-off by appropriate officials.
(b) Adequate food service which includes a 30-day menu and a week's food supply.
(c) Availability of articles necessary for personal hygiene.
(d) Documented availability of a licensed physician for referral and emergencies.
(e) Access to medical/surgical, dental and psychiatric care.
(f) Medical policies and procedures which include: care of residents with minor acute illnesses, medical emergencies, dangerous behavior, cardiopulmonary resuscitation (CPR) , care of residents having convulsions, and first aid. Since clients are only accepted from an inpatient component, it is assumed they will have received an adequate medical evaluation and the results forwarded and included in the client's file. Therefore, this component will only be required to take a medical history, make personal observations and check for medications.
(g) Medication control which ensures the handling, storing and administration of medications within the facility according to federal and state regulations. Note: Only a registered nurse or licensed practical nurse may administer medications, otherwise the self-administration system must be utilized.
(h) A safe, protective environment.
(i) Client admission register which designates the date of admission, date of discharge and discharge and referral notes.
(6) Client recordkeeping and reporting requirements specific to the intermediate component shall include:
(a) ADIS admission/discharge form.
(b) Date of admission.
(c) Admission note/utilization review, which justifies the admission to this level of care based on compliance with dimensional/admission criteria.
(d) Biopsychosocial assessment.
(e) Dimensional admission criteria checklist.
(f) Medical history and documentation that a medical evaluation occurred at the inpatient care program.
(g) Documentation of all supportive service contacts.
(h) Individualized treatment plan which is reviewed and updated monthly and responds to ARM 37.27.120(g) .
(i) Progress notes shall be written at a minimum of once per week and respond to ARM 37.27.120(h) .
(j) Continued stay/utilization review note which justifies continuation of intermediate care or transfer based on dimensional criteria.
(k) Discharge summary that includes an account of the client's response to treatment which reviews the treatment plan and documents the client's progress in accomplishing the treatment goals and an aftercare plan.
(7) Program effectiveness and quality assurance efforts which include individual case review, quality assurance program and utilization review.
(a) Individual case review is a procedure for monitoring a client's progress and is designed to ensure the adequacy and appropriateness of services provided to that client and shall:
(i) Be designed to ensure that the care provided for clients is evaluated and updated monthly, according to the needs of each client.
(ii) Be accomplished through weekly staff meetings and/or staff reviews. All involved treatment staff must participate.
(iii) Insure that a staffing or review note is developed at the staff review and inserted in the progress notes. Corresponding updates and/or revisions to the treatment plan shall be documented on the plan a minimum of once per month.
(b) Program effectiveness: review is a process of using patient placement criteria to evaluate the necessity and appropriateness of allocated services and resources to ensure that the program's services are necessary, cost efficient and effectively utilized. Utilization and effectiveness reviews shall:
(i) Utilize patient placement criteria to justify the necessity of admission, continued stay, transfer, discharge at timely intervals, and document via a utilization review note.
(ii) Be designed to achieve cost efficiency, increase effective utilization of the program's services, and ensure the necessity of services provided.
(iii) Ensure the collection, analysis and utilization of information which demonstrates program effectiveness. This shall include, but not be limited to, completion of goals and objectives, bed utilization, length of stay, completion ratios, employment and/or vocational/educational placements and follow-up data.