Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.26 - Level III.7: Medically Monitored Intensive Residential Treatment Program for Adults

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Rule
			 Compliance. In addition to compliance with the rules as specified in this
			 chapter, each Level III.7 Medically Monitored Intensive Treatment Program for
			 Adults shall comply with the rules as specified in the following chapters.
(a) Program Description. The entity shall
			 develop, maintain and implement a written program description that defines its
			 Level III.7 Medically Monitored Intensive Residential Treatment Program, as
			 according to Rule 580-9-44-.13 and the following specifications:
1. Location. The entity shall specifically
			 identify and describe the setting in which the Level III.7 Program shall be
			 provided. Services may be provided in any facility that meets all applicable
			 federal, state and local certification, licensure, building, life-safety, fire,
			 health and zoning regulations including the DMH facility certification
			 standards.
2. Admission Criteria:
			 The entity shall develop, maintain and document implementation of written
			 criteria for admission to its Level III.7 Program, in compliance with the
			 requirements of Rule 580-9-44-.13(9) and the following specifications:
(i) The entity's admission criteria shall
			 specify the target population for its Level III.7 Program which shall include,
			 at a minimum, individuals:
(I) Whose assessed
			 severity of illness warrants this level of care, including but not limited to,
			 adults whose subacute biomedical and emotional, behavioral, or cognitive
			 problems are so severe that they require medically monitored treatment, but do
			 not need the full resources of an acute care general hospital.
(II) For whom treatment for identified
			 problems has been rendered ineffective at less intensive levels of
			 care.
(ii) The entity
			 shall provide written documentation in individual case records that each client
			 admitted to a Level III.7 Adult Program meets:
(I) The diagnostic criteria for a substance
			 dependence disorder as defined in the most recent edition of the Diagnostic and
			 Statistical Manual of Mental Disorders of the American Psychiatric
			 Association.
(II) The dimensional
			 criteria for admission to this level of care as defined in the most recent
			 edition of the ASAM PPC-2R.
(iii) Co-occurring Disorders Program Specific
			 Criteria. The entity shall provide written documentation in individual case
			 records that each individual admitted to a Level III.7 Co-occurring Enhanced
			 Treatment Program meets:
(I) The diagnostic
			 criteria for a substance dependence and mental illness disorder as defined in
			 the most recent edition of the Diagnostic and Statistical Manual for Mental
			 Disorders.
(II) The dimensional
			 criteria for admission to this level of care as defined in the most recent
			 edition of the ASAM PPC-2R.
(iv) Women and Dependent Children Program
			 Specific Criteria: The entity shall provide written documentation in individual
			 case records that each client admitted to a Level III.7 Program for Women and
			 Dependent Children:
(I) Meets the diagnostic
			 criteria for a substance dependence disorder as defined in the most recent
			 edition of the Diagnostic and Statistical Manual for Mental
			 Disorders.
(II) The dimensional
			 criteria for admission to this level of care as defined in the most recent
			 edition of the ASAM PPC-2R.
(III)
			 Is pregnant; or
(IV) Has care and
			 custody of dependent children; or
(V) Has lost custody of dependent children
			 and has the potential for family reunification.
3. Core Services: Each Level III.7 Medically
			 Monitored Intensive Residential Program shall demonstrate the capacity to
			 provide a basic regimen of treatment services appropriate to the client's
			 developmental and cognitive levels and other assessed needs.
(i) At a minimum, the entity shall
			 demonstrate and document its capacity to provide a twenty-four (24) hour
			 structured residential treatment environment with accessibility to the
			 following core services:
(I) Placement
			 assessment.
(II) Individual
			 counseling.
(III) Group
			 counseling.
(IV) Family
			 counseling.
(V)
			 Psychoeducation.
(VI) Peer
			 support.
(VII) Medical and somatic
			 services.
(VIII) Daily living
			 skills.
(IX) Medication
			 management.
(X) Medication
			 administration.
(XI) Alcohol and/or
			 drug screening/testing.
(XII)
			 Transportation.
(XIII) Activity
			 therapy.
(XIX) Case management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV. Monitoring.
(ii) Medical Services. The entity shall
			 implement procedures for the provision of medical services, as according to
			 protocols established in compliance with Rule 580-9-44-.13(24).
(I) Pregnant clients who are not receiving
			 routine prenatal care shall be seen by physician within two (2) weeks of
			 admission.
(iii) Mental
			 Health Services. The entity shall develop, maintain and document implementation
			 of written policies and procedures to ensure that each client's mental health
			 needs are identified through the assessment service process and access to
			 appropriate care for these needs is provided concurrently with treatment for
			 assessed substance related disorders.
(iv) Family Support. The entity shall
			 initiate and document in the client record continuous efforts to involve the
			 client's family and other natural supports in the treatment process.
(v) Co-occurring Disorders Program Specific
			 Criteria: Each Level III.7 Co-occurring Disorders Medically Monitored Intensive
			 Residential Treatment Program shall document the capacity to provide each of
			 the core services and the following services:
(I) Mental health consultation.
(II) Crisis intervention services.
(III) Intensive case
			 management.
(vi) Women
			 and Dependent Children Program Specific Criteria: Each Level III.7 Women and
			 Dependent Children Medically Monitored Intensive Residential Treatment Program
			 shall document the capacity to provide each of the core services and the
			 following services:
(I) Child sitting
			 services.
(II) Developmental delay
			 and prevention services.
(III)
			 Parenting skills development.
(IV)
			 Academic and vocational services.
(V) Financial resource development and
			 planning.
(VI) Family planning
			 services.
4.
			 Therapeutic Component Implementation. The entity shall document the
			 implementation of a planned regimen of professionally directed program
			 activities for clients and their families. Evaluation, treatment and care shall
			 be provided in an amount, frequency and intensity appropriate to each client's
			 assessed needs and expressed desires for care.
(i) Service strategies for each Level III.7
			 Residential Program shall include, at a minimum:
(I) On duty awake staff shall provide
			 supervision of client's health, welfare and safety twenty-four (24) hours a
			 day.
(II) Clients shall have access
			 to clinical services personnel twenty-four (24) hours a day, seven (7) days a
			 week.
(III) Daily clinical services
			 to improve the client's ability to structure and reorganize the tasks of daily
			 living and recovery.
(IV) The
			 provision of daily scheduled treatment and recovery support services and
			 activities that shall, at a minimum, include those that address:
I. Implementation of individualized service
			 plan strategies.
II. Development
			 and application of recovery skills including relapse prevention.
III. Interpersonal choice/decision making
			 skill development.
IV. Enhancement
			 of the understanding of addiction.
V. Development of a social network supportive
			 of recovery.
VI. Random drug
			 screening.
VII. Health
			 education.
VIII. Medication
			 administration and monitoring.
IX.
			 Promotion of successful involvement in regular productive daily activity, such
			 as school or work.
X. Skill
			 development to support productive daily activity and successful reintegration
			 into the family and community.
XI.
			 Supervised therapeutic recreational activities.
(ii) The entity shall actively promote and
			 provide referrals and/or access to community support services.
(iii) All services shall be organized and
			 provided according to evidence-based and best practice standards and
			 guidelines.
5.
			 Documentation: Each Level III.7 Medically Monitored Intensive Residential
			 Program shall provide the following documentation in each client record:
(i) Individualized progress notes shall be
			 recorded each day for each respective service provided.
6. Support Systems. Each Level III.7 Program
			 shall develop, maintain and document implementation of written policies and
			 procedures, which govern the process used to provide client access to support
			 services on site or through consultation or referral, which shall minimally
			 include:
(i) The availability of a physician
			 or physician extender to assess each client in person within twenty-four (24)
			 hours of admission and thereafter as medically necessary.
(ii) Emergency consultation with a physician
			 available twenty-four (24) hours a day, seven (7) days a week.
(iii) Telephone or in person consultation
			 with emergency services twenty-four (24) hours a day, seven (7) days a
			 week.
(iv) The availability of a
			 MAS Registered Nurse to conduct a nursing assessment at the time of admission,
			 monitor the client's progress during treatment and manage medication
			 administration.
(v) Telephone or in
			 person consultation with a MAS Nurse twenty-four (24) hours a day, seven (7)
			 days a week.
(vi) Indicated
			 laboratory and toxicology testing.
(vii) Indicated medical procedures.
(viii) Medical treatment.
(ix) Psychiatric services shall be available
			 within eight (8) hours by telephone or twenty-four (24) hours in
			 person.
(x) Community based
			 services assessed as needed but not provided by the entity.
(xi) Direct affiliation with or coordination
			 through referral to more and less intensive levels of care including
			 detoxification services.
7. Program Personnel. Each Level III.7
			 Intensive Residential Program shall employ an adequate number of qualified
			 individuals to provide personalized care for its clientele and to meet the
			 program's goals and objectives.
(i) Nursing
			 Personnel. MAS Registered Nurses or Licensed Practical Nurses shall be
			 available for primary nursing care and observation twenty-four (24) hours a
			 day.
(ii) Direct Care Personnel.
			 All direct care personnel shall have the qualifications as a qualified
			 paraprofessional to provide the specific services delineated in the entity's
			 program description for this level of care.
(iii) Clinical Personnel. The entity shall
			 maintain an adequate number of clinical personnel to sustain the Level III.7
			 Adult Program as delineated in its operational procedures.
(iv) Administrative Support Personnel. The
			 entity shall maintain an adequate number of support personnel to sustain the
			 program's administrative functions.
(v) Every client in a Level III.7 Program
			 shall be assigned to a specific primary counselor.
(vi) Each primary counselor shall maintain a
			 case load not to exceed ten (10) clients with active cases at any one
			 time.
(vii) Co-occurring Disorders
			 Program Specific Criteria.
(I) Each Level
			 III.7 Co-occurring Enhanced Medically Monitored Intensity Residential Program
			 shall be coordinated by a full-time member of the staff who has the minimum of
			 a master's degree in a mental health related field and at least two (2) years
			 supervised experience in a direct service area treating individuals who have
			 co-occurring disorders.
(II) Each
			 Level III.7 Co-occurring Enhanced Intensive Residential Program shall have
			 access to psychiatric services led by a qualified psychiatrist or nurse
			 practitioner that are fully capable of evaluating, diagnosing and prescribing
			 medications to clients with co-occurring disorders. On-call psychiatric
			 services shall be available twenty-four (24) hours a day, seven (7) days a
			 week.
(III) The treatment
			 organization/agency shall have access to an Alabama licensed physician, full
			 time, part time, or on contract who shall be available to the program for
			 client care and shall assume responsibility for the medical aspects of the
			 program.
(IV) Treatment staff that
			 provide therapy and ongoing clinical assessment services to individuals
			 diagnosed with co-occurring disorders shall have, at a minimum,
I. A master's degree in a behavioral health
			 related field with a minimum of two (2) years' work experience with individuals
			 who have co-occurring disorders, mental health, or substance use
			 disorders.
II. Specialized training
			 to work with individuals who have co-occurring disorders.
(V) Direct Care Personnel. All other direct
			 care personnel in a Level III.7 Co-occurring Enhanced Intensive Residential
			 Program shall be qualified as a qualified paraprofessional to provide the
			 specific services delineated in the entity's operational plan for this level of
			 care.
(VI) Clinical Personnel. The
			 entity shall maintain an adequate number of clinical personnel to sustain the
			 Level III.7 Co-occurring Enhanced Residential Program as delineated in its
			 operational plan.
(VII)
			 Administrative Support Personnel. The entity shall maintain an adequate number
			 of support personnel to sustain the program's administrative
			 functions.
(VIII) Every client in a
			 Level III.7 Residential Program shall be assigned to a primary
			 counselor.
(IX) Each primary
			 counselor shall maintain a case load not to exceed ten (10) clients with active
			 cases at any one time.
(ix) Women and Dependent Children Program
			 Specific Criteria.
(I) Direct Care Personnel.
			 All direct care personnel shall be qualified as a qualified paraprofessional to
			 provide the specific services delineated in the entity's operational plan for
			 this level of care.
(II) Clinical
			 Personnel. The entity shall maintain an adequate number of clinical personnel
			 to sustain the Level III.7 Intensive Women and Dependent Children Residential
			 Program as delineated in its operational plan.
(III) Administrative Support Personnel. The
			 entity shall maintain an adequate number of support personnel to sustain the
			 program's administrative functions.
(IV) Every client in a Level III.7 Women and
			 Dependent Children Program shall be assigned to a primary counselor.
(V) Each primary counselor shall maintain a
			 case load not to exceed ten (10) clients with active cases at any one
			 time.
8.
			 Training. The entity shall provide written documentation that all Level III.7
			 Program personnel satisfy the competency and training requirements as specified
			 in Rule 580-9-44-.02(3).
9. Service
			 Intensity:
(i) The entity shall document that
			 the amount and frequency of Level III.7 Intensive Residential Treatment
			 Services are established on the basis of the unique needs of each client
			 served. To assist in addressing these needs the entity shall ensure the
			 availability of no less than twenty (20) hours of structured services each
			 week.
10. Length of
			 Service: The entity shall provide written documentation that the duration of
			 treatment in each Level III.7 Intensive Residential Program shall vary as
			 determined by:
(i) The severity of the
			 client's illness.
(ii) The client's
			 ability to comprehend the information provided and use that information to
			 implement treatment strategies and attain treatment goals.
(iii) The appearance of new problems that
			 require another level of care; or
(iv) The availability of services at an
			 assessed level of need, when a Level III.7 Residential Program has been
			 utilized to provide interim services.
11. Service Availability: The entity shall
			 provide written documentation describing the process utilized to establish
			 hours of assessment and intake services at its Level III.7 Medically Monitored
			 Intensive Residential Program. At a minimum, this process shall:
(i) Include consideration of the needs of the
			 target population, including work, school and parenting
			 responsibilities.
(ii) Include
			 consideration of transportation accessibility.
(iii) Not be based solely on standard eight
			 (8) to five (5), Monday through Friday office
			 hours.