COMAR Title10, Subtitle 47 Alcohol & Drug Abuse Administration Effective May 5, 2008

COMAR Title10, Subtitle 47Alcohol & Drug AbuseAdministrationEffective May 5, 2008

Presenter:DonaldL. Hall, MHS, LCADCDivision Director Quality Assurance Maryland Alcohol & Drug Abuse Administration(410) 402 – 8590dhall@dhmh.state.md.us

Goal • The goal of this workshop is to highlight some of the changes in COMAR Title 10 Subtitle 47 and provide an understanding of what will be expected of substance abuse providers to meet the requirements of certification, recertification and compliance reviews.

The process of revising the regulations has taken four years. It started with meeting and focus groups of ADAA stake holders. It continued with postings of the COMAR drafts on the ADAA website and rewrites based on the comments from the field.

Once the final draft had been completed it was posted on the Maryland Register for 30 days for comments. All comments from the public and the field were responded to by ADAA. At that point the draft was submitted to the Joint Committee on Administrative, Executive, and Legislative Review (AELR) for promulgation.

The AELR Committee expressed some concerns which lead to additional meetings and a revision to the COMAR draft. Now the field has a revised Code of Maryland Regulations Title 10, Subtitle 47 Alcohol and Drug Abuse Administration

Revisions have been made in most of the chapters of COMAR 10.47. One chapter has been removed, Chapter 6, Alcohol and Drug Treatment to Work Pilot Program. New Chapter 3, Specific Program Requirements for Correctional Levels of Care.

Chapter 01 Requirements

.02 Definitions. (19) Correctional Facility. (a) “Correctional facility” means an institution overseen by the State or one of the 24 subdivisions where individuals are incarcerated. (b) “Correctional facility” includes a jail, detention center, prison, or correctional halfway house.

(22) Critical Incident. (a) “Critical incident” means a life, safety, or health threat involving the staff or patients participating in a program. (b) “Critical incident” includes, but is not limited to, death or physical or sexual assault. (23) “Critical incident report” means the documentation of a critical incident.

(48) “Prevention program” means the Early Intervention Level 0.5 level of treatment as described in COMAR 10.47.02.03. This reference is based on statutory language and will be changed when COMAR is revised in the near future. This is NOT a reference to the traditional community Prevention Program. This is clearly a reference to EARLY INTERVENTION Level 0.5.

(57) “Treatment plan goal” means an intended resolution of a patient's clinical condition or problem that is completed within a specific amount of time and will contribute to the completion of treatment in a program.

(58) “Treatment plan objective” means a behaviorally measurable symptom or social, legal, or family change that results in a stepwise achievement of a treatment goal.

.03 Governance. 10.47.01.03. C. Implement personnel policies and procedures that include: (2) Personnel policies that include:

(h) As part of the employment or volunteer application process, requiring the applicant to complete and sign a sworn statement or written affirmation disclosing the existence of a criminal conviction, probation before judgment disposition, not criminally responsible disposition, or pending charges without a final disposition; Documentation must be provided for volunteers as well as employees

(j) Providing information to the employee so the employee may determine whether he or she needs testing or vaccination or both for hepatitis. Programs must implement employee education regarding hepatitis, as part of their orientation as well as update their policy and procedure manual.

10.47.01.03 D. Manage the program by: (1) Implementing a policy and procedure manual that contains: (a) An all hazards emergency protocol plan, approved by the Administration and updated at the time of recertification, that includes:

(i) The name of the contact person for access to medical and clinical records; (iii) Notification procedures for the State Methadone Authority, program staff, and patients; (iv) A policy regarding patient access to emergency mental health services necessitated by a hazardous event; and (v) A policy assuring that correctional levels of care comply with the institution's all hazards emergency plan;

Prepare a plan for managing all emergencies necessitated by a hazardous event. ADAA can provide a check list as a guide. Update policies and procedures for each situation. Reporting information: Alcohol and Drug Abuse Administration, Compliance Section, Fax # for reporting is 410-402-8606.

.04 Clinical Requirements B. Assessment. (1) 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.

Programs update comprehensive assessment information in the policy and procedure manuals and review requirements when patients are admitted from prior treatment.

C. Treatment Plans. (i) Long-range and short-range treatment plan goals and objectives; (ii) Strategy for implementation of treatment plan goals and objectives; (iii) Target dates for completion of treatment plan goals and objectives; “Drop-down treatment plan in SMART”

D. 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: Programs must include required information in education and risk assessment for patients.

G. Discharge. (3) The discharge summary shall be completed within 30 days of the patient's discharge from the program. (4) In the event of a patient's transfer from the program to another program, the discharging program shall complete a written transfer summary.

(5) The transfer summary shall include: (a) The reason for admission; (b) The reason for discharge; (c) The individual's address; (d) The diagnosis and prognosis at the time of discharge; and (e) Current medications, if applicable. (6) The transfer summary shall be completed at the time of the patient's discharge from the program.

I. Medication Control and Staff Requirements. (1) 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: (e) Procedures for all Level III programs to hold securely all take-home opioid therapy medication for patients who are on opioid maintenance therapy.

(4) Medication Errors. (a) 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. Programs must update policy and procedure manuals address the management of medication errors.

(b) The report shall be filed and brought to the immediate attention of the: (i) Administrator; and (ii) Medical director, if a medical director is employed by the program. (5) Programs shall report the diversion of any controlled substance to the Administration as soon as the diversion is discovered. Reporting information: Alcohol and Drug Abuse Administration, Compliance Section, Fax # for reporting is 410-402-8606.

.05Environmental Requirements. A. Life Safety Requirements. A Program shall: (3) Maintain documentation of legally required periodic evacuation drills, if applicable;

.06 Staff Requirements • 10.47.01.06 • Administrator. • Required the position • Establishes the qualifications and duties • D. Clinical Staff. • Must be credentialed and or privileged to • include students, interns, and volunteers. • All staff must sign statement that they • reviewed and understand P&P.

.07 Patient Rights and Grievance Procedures In this chapter the language was made clearer to clarify the expectations.

. .08 Records Established that records must be maintained, transferred, and destroyed as per identified state and federal laws. C. Electronic Records. Establishes how an electronic record shall be maintained and what the hard copy file shall contain.

. .09 Referral Agreements and Program Cooperation There were no changes in this section

Chapter 02 Specific Program Requirements

.03 Early Intervention Level 0.5 A. Prevention Program Description. The prevention program shall treat patients who are, for a known reason, at risk for developing alcohol or other drug abuse or dependence but for whom there is not yet sufficient information to document alcohol or other drug abuse or dependence. Level 0.5 is Early Intervention (This is NOT a reference to Community prevention programs)

D. Program services include: (1) Assessments as described in COMAR 10.47.01.04 within 2 weeks of admission; (2) An individualized treatment plan as described in COMAR 10.47.01.04, completed and signed by the alcohol and drug counselor and patient within 7 working days of the comprehensive assessment and updated every 90 days;

.04 Outpatient Services Level I. A. Program Description. The program shall provide outpatient evaluation and treatment to patients who require services for less than 9 hours weekly for adults and 6 hours weekly for adolescents.

D. Program Services. A program shall provide the following services: (1) An assessment as described in COMAR 10.47.01.04 within 2 weeks of admission; (2) An individualized treatment plan as described in COMAR 10.47.01.04 completed and signed by the alcohol and drug counselor and patient within 7 working days of the comprehensive assessment and updated every 90 days;

(5) Family services that shall includean assessment for family treatment needs and, as clinically appropriate: Family assessment and treatment, if needed is now required.

.05 Intensive Outpatient Services Level II.1 and Partial Hospitalization Services Level II.5. • (1) From 9 to 20 hours weekly for adult • intensive outpatient services; • (2) From 6 to 20 hours weekly for adolescent intensive outpatient services, based on the adolescents' developmental and clinical needs; and • (3) From 20 to 35 hours weekly for adult and adolescent partial hospitalization services.

D. Program Services. A program shall provide the following services: (1) An assessment as described in COMAR 10.47.01.04 within 1 week of admission; (2) An individualized treatment plan as described in COMAR 10.47.01.04 completed and signed by the alcohol and drug counselor and patient within 5 working days of thecomprehensive assessment and updated every 30 days;

F. Referral Services. The program shall offer the following services or maintain a listing of agency referral agreements for the following services: • Medical services with medical consultations available: • Specifies the time frames for services • (4) Mental health services with psychiatric consultations available: • Specifies the time frames for services

.06 Residential Service— Clinically Managed Low Intensity Treatment Level III.1. D. Program Services. A clinically managed low intensity treatment program shall provide the following services: (1) An assessment as described in COMAR 10.47.01.04 within 2 weeks of admission;

(2) An individualized treatment plan as described in COMAR 10.47.01.04 completed and signed by the alcohol and drug counselor and patient within 7 working days of the comprehensive assessment and updated every 60 days;

F. Referral Services. The program shall offer the following services or maintain a listing of agency referral agreements for the following services: (1) Physical examinations as determined by medical condition, within a reasonable time; (2) Services through the Division of Rehabilitation Services;

(4) Mental health services, which shall include: (a) Medication monitoring for patients who are admitted on or are prescribed psychotropic medications; and (b) Services appropriate to the severity and urgency of the patient's mental condition;

.07 Residential Services— Clinically Managed Medium Intensity Treatment Level III.3. D. Program Services. A program shall provide the following services: (1) An assessment as described in COMAR 10.47.01.04 within 1 week of admission;

(2) An individualized treatment plan as described in COMAR 10.47.01.04 completed and signed by the alcohol and drug counselor and patient within 3 working days of the comprehensive assessment and updated every 30 days;

F. Referral Services. The program shall offer the following services or maintain a listing of agency referral agreements for the following services: (1) Physical examinations as determined by medical condition, within a reasonable time; (3) Services through the Division of Rehabilitation Services;

(5) Mental health services, which shall include, as appropriate to the severity and urgency of the patient's mental condition: (a) Medication monitoring for patients who are admitted on or are prescribed psychotropic medications; and Monitoring would include observing signs and symptoms. This includes how a patient is clinically responding to medication, dose adjustments, etc… and managing, if co-occurring disorder capable, or referring out.

COMAR Title10, Subtitle 47 Alcohol & Drug Abuse Administration Effective May 5, 2008