<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.47.01.04" title_num="10" subtitle_num="47" chapter_num="01" heading="Clinical Requirements.">
  <paragraph num="A.">
    <text>Admission. The program:</text>
    <paragraph num="(1)">
      <text>Shall upon request for admission:</text>
      <paragraph num="(a)">
        <text>Establish an interview date that falls within 10 working days of the individual's initial contact;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Refer or recommend another program to the individual; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Place the individual on a waiting list;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Shall have a detailed description of patient placement criteria for admission to the program, including:</text>
      <paragraph num="(a)">
        <text>Eligibility criteria, using guidelines such as the American Society of Addiction Medicine Patient Placement Criteria or other guidelines approved by the Administration; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Procedures for admission;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Shall include in its admission procedures:</text>
      <paragraph num="(a)">
        <text>An intake process;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>An emergency intake process, including a procedure to refer individuals who are not suitable for its program to a more suitable program;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A procedure for developing and maintaining a waiting list; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A fee schedule; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>May not admit a patient unless the individual meets the admission criteria of the American Society of Addiction Medicine Patient Placement Criteria or other guidelines approved by the Administration.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Assessment.</text>
    <paragraph num="(1)">
      <text>A program shall prepare a comprehensive assessment for each patient, unless the patient is being readmitted to the same program or admitted to a different program within 30 days of the patient's last discharge, or has received an assessment by a licensed or certified clinician or program within 30 days, in which case the program may update the prior assessment.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The comprehensive assessment shall assess the following areas:</text>
      <paragraph num="(a)">
        <text>Physical health;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Employment or financial support;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Drug and alcohol;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Treatment history;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Legal;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Family and social;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Educational; and</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Mental health.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Programs shall use the Addiction Severity Index as the standardized assessment instrument for adults, or an equivalent assessment instrument chosen by the Administration.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Programs shall use the Problem Oriented Screening Instrument for Teenagers as the standardized screening instrument for adolescents, or an equivalent screening instrument chosen by the Administration.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The initial physical health assessment shall meet the requirements of the appropriate level of treatment.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Treatment Plans.</text>
    <paragraph num="(1)">
      <text>A program shall develop a written treatment plan, with the participation of the patient, based on the comprehensive assessment and patient placement criteria, that shall set forth:</text>
      <paragraph num="(a)">
        <text>The patient's individualized needs, including:</text>
        <paragraph num="(i)">
          <text>Socialization;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Alcohol and drug abuse or dependence;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Psychological;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Vocational;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Educational;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Physical health;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Legal; and</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Family; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Individualized interventions, including:</text>
        <paragraph num="(i)">
          <text>Long-range and short-range treatment plan goals and objectives;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Strategy for implementation of treatment plan goals and objectives;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Target dates for completion of treatment plan goals and objectives;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>A schedule of clinical services including individual, group, and, if appropriate, family counseling;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Criteria for successful completion of treatment;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Referrals to ancillary services, if needed; and</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Referrals to self-help groups, if recommended.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If the alcohol and other drug counselor is unable to develop a treatment plan within the required time, the clinical director or the clinical supervisor shall:</text>
      <paragraph num="(a)">
        <text>Determine the reason for a delay in development of a treatment plan;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Document the reason in the patient's record; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Direct an appropriate clinical staff person to develop a treatment plan within 7 working days of the clinical director's or clinical supervisor's documentation of the delay.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The length of stay in the program shall be based on the patient's level of illness severity and response to treatment.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Infectious Disease Education. Within the first 30 days of treatment, a program shall ensure and document in the patient record that human immunodeficiency virus, hepatitis, sexually transmitted diseases, and tuberculosis education was completed, including:</text>
    <paragraph num="(1)">
      <text>Risk assessment;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Risk reduction; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If appropriate, referral for counseling and testing.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Family Involvement and Utilization of Self-Help Groups.</text>
    <paragraph num="(1)">
      <text>A program may provide education and support services to a patient's family directly or through referrals to appropriate community agencies.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A program shall:</text>
      <paragraph num="(a)">
        <text>Develop procedures for obtaining an assessment of the treatment needs of the patient's family;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provide access or referral to family counseling;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Describe how family members are involved in the patient's recovery process; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Develop procedures to encourage ongoing active participation by the patient and the patient's family in self-help groups and support activities.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Referrals. Referral documentation shall include the:</text>
    <paragraph num="(1)">
      <text>Reason for referral;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Name of the individual;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Referring program;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Receiving program; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Final disposition of referral.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Discharge.</text>
    <paragraph num="(1)">
      <text>A program shall complete a written discharge summary.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The discharge summary shall include:</text>
      <paragraph num="(a)">
        <text>The reason for admission;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The reason for discharge;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The individual's address;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A summary of services delivered, including frequency and duration of services, and progress made;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>If appropriate, the diagnosis and prognosis at the time of discharge;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Current medications, if applicable;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Continuing service recommendations and summary of transition process; and</text>
      </paragraph>
      <paragraph num="(h)">
        <text>The extent of the individual's involvement in the discharge plan.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The discharge summary shall be completed within 30 days of the patient's discharge from the program.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>In the event of a patient's transfer from the program to another program, the discharging program shall complete a written transfer summary.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The transfer summary shall include:</text>
      <paragraph num="(a)">
        <text>The reason for admission;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The reason for discharge;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The individual's address;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The diagnosis and prognosis at the time of discharge; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Current medications, if applicable.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>The transfer summary shall be completed at the time of the patient's discharge from the program.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Child and Adolescent Services.</text>
    <paragraph num="(1)">
      <text>A parent or guardian of a child or adolescent, with the child or adolescent's consent, may apply on behalf of the child or adolescent for admission to a certified program.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A program exclusively for children and adolescents shall:</text>
      <paragraph num="(a)">
        <text>Maintain written treatment protocols providing for the needs of adolescents and children, emphasizing the use of family interventions;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provide for the educational needs of adolescents in compliance with local, State, and federal laws and regulations;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Comply with criminal background requirements for all staff; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Meet any other requirements requested by the Administration.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A program that admits children and adolescents:</text>
      <paragraph num="(a)">
        <text>May not admit a child or adolescent into treatment unless the treatment plan indicates that the program is appropriate for the child or adolescent;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Shall provide separate social, residential, dietary, and recreational activities for the child or adolescent, if appropriate;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Shall obtain informed consent from the child or adolescent, or the parents or guardians for the child or adolescent, to be admitted to the program;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Shall comply with criminal background requirements for all staff; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Shall meet any other requirements requested by the Administration.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>A program that does not admit children and adolescents shall:</text>
      <paragraph num="(a)">
        <text>Identify in its program service plan the elements of the program that make treatment, care, and rehabilitation for children or adolescents contraindicated; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Meet any other requirements requested by the Administration.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Programs that provide services to adults and permit the adult's children or adolescents to be present at the program shall verify that the children and adolescents:</text>
      <paragraph num="(a)">
        <text>Receive proper supervision;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Are appropriately enrolled in education services; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Have access to appropriate health care.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Medication Control and Staff Requirements.</text>
    <paragraph num="(1)">
      <text>A program shall develop and implement a written policy and procedure governing the use of controlled dangerous substances and other drugs used by the program. The policies shall include:</text>
      <paragraph num="(a)">
        <text>A list of controlled dangerous substances and other drugs administered, dispensed, or stored at the program;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Procedures to account for and secure the drugs from time of order until dispensing;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Computer security and accountability, if applicable;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Other policy and procedures required by the Administration; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Procedures for all Level III programs to hold securely all take-home opioid therapy medication for patients who are on opioid maintenance therapy.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A program shall dispense medications to the patient according to the instructions, supervision, and directions of the licensed physician.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If staff observes an adverse reaction to medication, the program immediately shall contact a licensed physician or emergency medical service to ensure the patient receives treatment.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Medication Errors.</text>
      <paragraph num="(a)">
        <text>For a medication error regarding administration, dispensing, documentation, inventory, or storage, an appropriate clinical staff person shall complete a report at the time of the incident.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The report shall be filed and brought to the immediate attention of the:</text>
        <paragraph num="(i)">
          <text>Administrator; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Medical director, if a medical director is employed by the program.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Programs shall report the diversion of any controlled substance to the Administration as soon as the diversion is discovered.</text>
    </paragraph>
  </paragraph>
</regulation>