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

(a) Non-hospital detoxification - admission of clients to a chemical dependency detoxification component shall be limited to persons who need detoxification services with 24-hour supervision and do not manifest signs and symptoms of a condition which warrants acute care and treatment in a hospital. Persons shall demonstrate at least one of the following: a significant likelihood of the development of a withdrawal syndrome; previous history of having failed at attempts at outpatient withdrawal; the presence of a medical condition serious enough to warrant inpatient (not hospital) management and/or isolated medical symptoms of concern as identified by a licensed physician. Services are provided in a non-hospital approved chemical dependency program.

(b) Hospital detoxification - Admission to this level of care is designated for persons requiring a hospital setting due to acute intoxication, unconsciousness, withdrawal of significance, other physical conditions related to the patient's chemical dependency. An acute care hospital license is required for this service, not an approval designation.

(c) Dimensional admission criteria shall address ARM 37.27.120(1) (j) (i) (ii) and (iii) .

(d) Continued stay criteria shall be based on ARM 37.27.120(1) (j) (i) (ii) and (iii) and justify an extension if detoxification lasts over 3 days.

(e) Discharge criteria shall be based on ARM 37.27.120(1) (j) (i) (ii) and (iii) and demonstrate successful completion of this level of care or transfer.

(2) Detoxification services shall include:

(a) Admission and screening services in accordance with dimensional admission criteria to substantiate the appropriateness of treatment.

(b) A safe and protective environment.

(c) Protection from the development of life threatening mental and physical symptoms that may ensue when a habitual and excessive drinker or drug abuser abruptly terminates his drinking or drug usage.

(d) Twenty-four hour, 7-day a week supervision.

(e) Medical screening which includes medical history, vital signs, screening for a diversity of medical/surgical conditions, emotional problems, contagious disease, vermin infestation, observation of client's emotional behavior and physical discomfort. If the client is found to be totally incapacitated by alcohol or drugs he/she shall be examined by a licensed physician.

(f) Counseling services designed to facilitate motivation of the person to accept referral into a continuum of care.

(g) Transportation services as appropriate.

(h) Referral, discharge and follow-up services that ensure continuity of care after discharge.

(3) Staff requirements:

(a) At least one registered nurse for supervision of medical screening.

(b) All detoxification staff shall be knowledgeable about medical conditions, skilled in observation and eliciting information pertinent to assessment of a health problem and competent to recognize significant signs and symptoms of illness or trauma. In addition, staff shall possess a valid and current red cross card or certificate for first aid cardiopulmonary resuscitation or the equivalent.

(c) A minimum of one staff member on duty for admitting, treating and discharging purposes.

(d) Adequate staff to guarantee care as defined in this section.

(4) The program shall develop policies and procedures to address the previously listed services, staff requirements and the criteria in ARM 37.27.115.

(5) Residential requirements for detoxification (emergency care) component shall include:

(a) A facility license from the department of public health and human services or, if under 8 beds, a 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 or contract for food services. Also juice and snacks must be available.

(c) Availability of articles necessary for personal hygiene.

(d) Documented availability of a licensed physician for referral, emergencies and consultation with the staff nurse.

(e) An affiliation agreement with a licensed hospital and access to medical, surgical, dental and psychiatric care.

(f) Medical policies and procedures including: approval by a licensed physician, medical screening, care of residents with minor acute illnesses, medical emergencies, first aid, dangerous behavior, cardiopulmonary resuscitation, and care of residents having convulsions.

(g) Policies and procedures on medication control which address the handling, storing and administration of medications within the facility according to federal and state regulations. Note: Only a registered nurse or a licensed practical nurse may administer medications, otherwise the self-administration system must be utilized.

(h) Client admission register which designates date of admission, date of discharge, discharge and referral note.

(6) Client recordkeeping and reporting requirements specific to the detoxification component shall include:

(a) ADIS admission/discharge forms.

(b) Date of admission.

(c) Admission/utilization review note, which justifies the admission to this level of care based on compliance with dimensional admission criteria.

(d) Social history.

(e) Documentation of a medical screening which includes vital signs.

(f) Documentation of all supportive services contacts.

(g) Individualized treatment plan which is reviewed and updated daily and includes an aftercare plan. The plan shall meet the requirements of ARM 37.27.120(g) .

(h) Progress notes written for every 8-hour shift and meeting the requirements of ARM 37.27.120(h) .

(i) A discharge summary that includes a description of the client's physical condition and status of recommended referral.

(7) Program effectiveness and quality assurance efforts including individual case review and utilization reviews.

(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 for clients is evaluated and updated according to the needs of each individual.

(ii) Be accomplished through daily staffing. Appropriate treatment staff must participate.

(iii) Ensure a staffing note is developed at the staffing meeting and inserted in the progress notes. An aftercare plan shall be formulated, reviewed and documented.

(b) Utilization and 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 admissions, continued stay, transfer and 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) Address under-utilization and inefficient scheduling as well as over-utilization of the program's resources.

(iv) Ensure methods for identifying utilization related problems which include bed utilization, length of stay, recidivism, supportive services, effectiveness of an aftercare plan based on verification of referrals for a continuum of care, as well as utilization of the findings of related quality assurance activities and all relevant documentation.

(v) Be conducted at least quarterly.

History: Sec. 53-24-204 and 53-24-208, MCA; IMP, Sec. 53-24-208, MCA; NEW, 1981 MAR p. 1899, Eff. 1/1/82; AMD, 1983 MAR p. 1463, Eff. 10/14/83; AMD, 1985 MAR p. 1768, Eff. 11/15/85; AMD, 1987 MAR p. 2383, Eff. 12/25/87; AMD, 1992 MAR p. 1477, Eff. 7/17/92; TRANS, from DOC, 1998 MAR p. 1502.

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