(1) Patient placement criteria shall be developed and address the following:

(a) Persons should have only minimal (if any) continuing symptoms of intoxication or withdrawal; the presence of stable physical and emotional/behavioral conditions (if any) ; a recent history of behavioral deterioration with increasing life impairment. The client requires structured outpatient counseling involving 10 to 30 hours of program contact time per week in order to provide the necessary intensity of services without an inpatient placement. The client must be sufficiently accepting of treatment and have an environment which is adequate to support recovery efforts. This level of care affords the client the opportunity to interact with the real world environment while still benefiting from a programmatic structured therapeutic milieu.

(b) Persons needing detoxification, inpatient, or intermediate care services shall be referred to an appropriate treatment program. Persons manifesting signs and symptoms of a condition that warrants acute medical care shall not be admitted but referred to a hospital.

(c) Dimensional admission criteria shall 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 developed 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 shall be documented at three weeks following admission or as needed.

(e) Discharge criteria shall be developed based on previous dimensions to demonstrate successful completion of treatment which includes 90% completion of all required sessions or justification for an extension or transfer.

(2) Intensive outpatient services shall include:

(a) Admission and screening in accordance with dimensional admission criteria which substantiate the appropriateness of treatment based on a biopsychosocial assessment corresponding to the dimensional admission criteria via utilization review. Additionally, assessments shall include at least 3 cross-referenced diagnostic/assessment tools confirming a determination of chemical dependency. This assessment must be conducted by a certified chemical dependency counselor.

(b) Structured outpatient counseling equaling 10 to 30 hours per week consistent with the individualized treatment plan. The content of this service must be similar to inpatient treatment and offer the same foundations for recovery.

(c) A minimum of 2 skilled treatment services per day at least 3 times per week. One of the skilled treatment services must be group counseling of at least 2 to 3 hours in duration. Skilled treatment services may include group counseling, individual counseling, family counseling, and educational presentations (lectures) .

(d) The structured educational series shall be presented in a logical, progressive format which contains the essential elements necessary for recovery.

(e) One session of documented individual counseling per week with a certified or eligible chemical dependency counselor.

(f) Other support services as necessary.

(g) Availability of professional consultation including medical.

(h) Direct affiliation with more intensive levels of care. This may be offered as part of the overall program or via contract/agreement.

(i) Encouragement of clients to attend A.A. twice weekly.

(j) Periodic assessment review and treatment plan update every 2 weeks.

(k) Provision of family services as appropriate.

(l) Referral, transfer, discharge, aftercare, and follow-up services that ensure a continuity of care.

(3) Staff requirements:

(a) Counseling staff shall be certified or eligible and trained in the field of chemical dependency counseling. Counselors conducting the IAP program shall demonstrate an ability to work with clients, a knowledge of the etiology of chemical dependency, and expertise in group skills.

(b) Availability of professional counseling services 24 hours per day, 7 days per week.

(c) The program shall provide sufficient staff to provide for all aspects of this service.

(d) Staff shall be familiar with community resources for referral including medical, social, vocational, mental health, spiritual, alcoholics anonymous and etc.

(4) Required policies and procedures: The program shall develop policies, procedures and plans to address the above listed services, staff requirements and criteria.

(5) Client recordkeeping and reporting requirements specific to the intensive outpatient component shall include:

(a) ADIS admission/discharge forms;

(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 and results of diagnostic tools.

(d) Biopsychosocial assessment;

(e) Dimensional admission criteria checklist;

(f) Documentation of all supportive service contacts;

(g) Individualized treatment plan, which is reviewed and updated every 2 weeks and responds to ARM 37.27.120(h) .

(h) continued stay/utilization review note which justifies continuation of IOP or transfer based on dimensional criteria;

(i) Progress notes written at a minimum of 3 times a week, reflecting required services i.e. 10 to 30 hours per week and responding to ARM 37.27.120(h) .

(j) Discharge summary that includes: compliance with dimensional criteria or transfer; an account of the clients response to treatment; a review of the treatment plan and corresponding progress; reason for discharge and aftercare plan.

(6) Program effectiveness and quality assurance shall include:

(a) Individual case review is a procedure for monitoring a client's progress and is designed to ensure the adequacy and appropriateness of the services provided to that client and shall:

(i) Be designed to ensure that the care provided to clients is evaluated and updated every month, according to the needs of each client.

(ii) Be accomplished through reviews, which all involved treatment staff attend.

(b) Utilization and effectiveness review is a process of using patient placement criteria to evaluate the necessity and appropriateness of patient placement, allocated services and resources to ensure 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 admissions, continued stay, transfer and discharge at timely intervals and document justification via a utilization review note.

(ii) Be designed to achieve cost efficiency, increase effective utilization of program's services, and ensure the necessity of services provided;

(iii) Address under-utilization and inefficient scheduling as well as over-utilization of the programs resources.

(iv) Ensure methods for identifying and monitoring utilization and effectiveness related problems including analysis of the appropriateness and necessity of admission, caseload, continued stays, recidivism, completion ratios, frequency of services, and delays in the provision of services, effectiveness of the aftercare plan based on verification of referrals and results of follow-up, as well as utilization of the findings of related quality assurance activities and all current relevant documentation.