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37.27.130    INPATIENT - FREE STANDING CARE COMPONENT REQUIREMENTS

(1) Patient placement criteria shall address the following:

(a) Persons requiring intensive residential care outside a hospital for the treatment of chemical dependency shall be admitted to this component. Persons manifesting signs and symptoms of a condition that warrants acute medical care and/or medical detoxification shall not be admitted but shall be referred to a licensed hospital.

(b) Persons requiring this level of care must exhibit at least two of the following: a significant likelihood of withdrawal syndrome; previous history of having failed at attempts at outpatient withdrawal; the presence of a medical condition serious enough to warrant inpatient (non-hospital) management as determined by the licensed physician; 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. In addition, 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 - free standing care 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 a determination of chemical dependency must be confirmed by the use of at least three cross-referenced diagnostic/assessment tools.

(b) Twenty-four hour, 7-day a week supervision in a community-based residential setting.

(c) A physical exam signed by a physician.

(d) Contract with a physician for physicals, referral and consultation with the staff nurse.

(e) Twenty to sixty hours of therapeutic contact time per week which includes at least four skilled treatment services per day for at least five 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.

(f) 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 considered as group therapy hours.

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

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

(i) Periodic assessment by certified staff.

(j) Social and recreation 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 chemical dependency counselor(s) , house manager(s) , support staff, and a registered nurse or licensed practical nurse on staff for at least 4 hours per week.

(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. House manager may be utilized for nights.

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

(5) Residential requirements for the inpatient - free standing care component shall include:

(a) A facility license from the department of public health and human services, or if under 8 beds, an acceptable life and safety inspection by appropriate officials.

(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) Contract with a licensed physician for physical referral, emergencies and consultation with the staff nurse.

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

(f) Medical policies and procedures which include: screening, care of residents with minor acute illnesses, medical emergencies, dangerous behavior, cardiopulmonary resuscitation, care of residents having convulsions, and first aid.

(g) Medication control which ensures the handling, storing and administration of medications within the program 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 date of admission, date of discharge, discharge and referral notes.

(6) Client recordkeeping and reporting requirements specific to the inpatient - free standing care 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/assessment tools.

(d) Dimensional admission criteria checklist.

(e) Biopsychosocial assessment.

(f) Documentation of a physical exam signed by a physician.

(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 shall be written at a minimum of 3 times a week and respond to ARM 37.27.120(h) .

(j) Continued stay/utilization review note which justifies continuation of inpatient treatment 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 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 accomplished through weekly staff meetings and/or staff reviews. All involved treatment staff must participate.

(ii) Ensure that 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 bed utilization, recidivism, completion ratios, supportive services and delays in the provision of supportive services, effectiveness 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 current 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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