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(1) Patient placement criteria shall address the following:

(a) Persons requiring intensive residential care for the treatment of chemical dependency in a hospital or suitably equipped medical setting due to acute intoxication, withdrawal, other physical and/or emotional/behavioral conditions related to the patient's chemical dependency or whose chemical dependency has progressed to the point where a hospital setting is required to provide the treatment intensity necessary to address the severity of the condition. Typically, admission to this level requires a patient likely to develop a withdrawal syndrome of significance if not medically treated; and/or the presence of significant numbers of neurological and neuropsychological signs in relation to the patient's chemical dependency. The presence of significant or unstable medical disorders or physical symptoms related to deteriorated personal health concomitant to chemical dependency also warrant admission at this level.

(b) Additionally, persons requiring this level of care must exhibit at least two 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 isolated medical symptoms of concern; external mandates for inpatient treatment; a recent history of inability to function without some externally applied behavior controls; and significant denial of the severity of his/her own addiction. Environmental factors likely to prevent a patient from maintaining treatment progress merits admission to this level of treatment.

(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, at 10 to 20 days after admission.

(e) Discharge criteria shall be based on previous dimensional criteria to demonstrate successful completion of treatment or justification for an extension or transfer.

(2) Inpatient services shall include:

(a) Admission and screening services in accordance with admission criteria which substantiate the appropriateness of treatment based on a biopsychosocial assessment by a certified counselor, corresponding to the dimensional admission criteria. Additionally, determination of chemical dependency must be confirmed by the use of at least 3 cross-referenced diagnostic/assessment tools.

(b) Twenty-four hour, 7-day a week supervision in a hospital.

(c) A medical evaluation performed by a licensed physician and conducted upon admission. This shall include a medical history, physical examination and laboratory workup.

(d) Twenty to sixty hours of therapeutic contact time per week which includes at least four skilled treatment services per day for at least 5 days per week. Skilled treatment services include but are not limited to: psychotherapy, individual, group, and family counseling, structured educational presentations (lectures) , educational groups, occupational and recreational therapy.

(e) Fourteen to twenty-five hours 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 counted as group therapy hours.

(f) The structured educational series shall be presented in a logical, progressive format, which contains the essential elements for recovery. Lectures are offered 10 times per week.

(g) One session of documented individual counseling per week with certified or eligible counseling staff.

(h) Social and recreational activities.

(i) Other supportive services as deemed necessary by the program.

(j) Periodic assessment by treatment staff.

(k) Provision of a family counseling program. Preferably a structured 4 to 7 days of residential treatment.

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

(m) Transportation services as appropriate.

(3) Staff requirements:

(a) There shall be qualified staff and supporting personnel necessary for the provision of inpatient care including registered nurse, licensed practical nurse, and certified counseling staff.

(b) A licensed physician or a list of rotating physicians responsible for admissions and on-call services.

(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 inpatient care component shall include:

(a) A facility in a hospital or a suitably equipped medical setting licensed in accord with 50-5-201 , MCA. Such programs are usually located in facilities classified as institutional occupancies in chapter 10 of the 1973 edition of the life safety code (National Fire Protection Association 101.)

(b) Adequate food service which includes a 30-day menu and a week's food supply or contract for food services.

(c) Availability of articles necessary for personal hygiene.

( d ) Access to medical/surgical/dental and psychiatric care.

(e) A medical evaluation performed by a licensed physician shall be conducted upon admission. This shall include a medical history, physical examination and laboratory workup.

(f) Adequate life support systems within the unit.

(g) Availability of general care, emergency care and medication control in accordance with hospital standards.

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

(6) Client recordkeeping requirements specific to the inpatient care component shall include:

(a) ADIS admission and 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/assessment tools:

(d) Dimensional admission criteria checklist.

(e) Biopsychosocial assessment.

(f) Results of physical examination conducted by a licensed physician, medical history and lab workup.

(g) Documentation of all supportive service contacts.

(h) Individualized treatment plan which is reviewed and updated weekly and responds to ARM 37.27.120(g) .

(i) Progress notes written a minimum of three times a week and meeting the requirements of ARM 37.27.120(h) .

(j) Nurses' notes which summarize the client's activities, response and physical condition and any medical treatment during an 8-hour period. They shall be written each shift and document the client's presence in the inpatient unit.

(k) Continued stay/utilization review note which justifies continuation of inpatient or transfer based on dimensional criteria.

(l) 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 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 the client is evaluated and updated weekly, according to the needs of each individual client.

(ii) Be accomplished through weekly staff meetings and/or reviews. All involved treatment staff must participate.

(iii) Ensure a staffing or review note is developed at the review and inserted in the progress notes. Corresponding updates and/or revisions to the treatment plan shall be documented on the plan.

(b) Quality assurance program is designed to identify problems by monitoring quality of care indicators and to initiate corrections in provider performance or to demonstrate that services provided are of optimal, achievable quality. To accomplish this, the process shall:

(i) Identify the most important aspects of services provided;

(ii) Utilize indicators to systematically monitor these aspects of care;

(iii) Evaluate services provided via indicators to identify problems or opportunities to further improve care; and

(iv) Implement corrective action to resolve problems or improve care.

(c) 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 including recidivism, supportive services, effective-ness of an 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 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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