Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.23 - Level III.3: Clinically Managed Medium Intensity 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.3 Clinically Managed Medium Intensity Residential
			 Treatment Program 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 the Level III.3 Clinically Managed Medium Intensity Residential
			 Treatment Program it provides, 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.3 Program shall be provided. Services shall 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.3 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.3 Services which shall include,
			 at a minimum, individuals:
(I) Who are at
			 least nineteen (19) years old.
(II)
			 Whose assessed severity of illness warrants this level of care including, but
			 not limited to:
I. Individuals who have a
			 substance dependence disorder and concomitant cognitive impairments,
			 developmental delays, emotional, and/or behavioral problems; and/or
II. Significant functional deficits in regard
			 to management of activities of daily living.
(ii) The entity shall provide written
			 documentation in individual case records that each client admitted to a Level
			 III.3 Program meets:
(I) 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) Co-occurring Disorders Program Specific
			 Criteria. The entity shall provide written documentation in individual case
			 records that each individual admitted to a Level III.3 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.3 Program for Women and
			 Dependent Children:
(I) Meets the diagnostic
			 criteria for a substance dependence disorder as defined in the most recent
			 edition 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.3 Medium
			 Intensity Residential Program shall demonstrate the capacity to provide a basic
			 level of treatment services appropriate to the needs of its clientele.
(i) At a minimum, the entity shall
			 demonstrate and document its capacity to provide a twenty-four (24) hour
			 structured residential treatment environment with 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) Alcohol and/or drug
			 screening/testing.
(XI)
			 Transportation.
(XII) Case
			 management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV. Monitoring.
(ii) Medical Services. Medical Services shall
			 be provided as specified by the entity's medical protocols established as
			 required by Rule 580-9-44-.13(24).
(I)
			 Clients who have not had a physical examination within the last twelve (12)
			 months shall be scheduled a physical examination within two weeks of
			 admission.
(II) Pregnant clients
			 who are not receiving routine prenatal care shall be seen by physician within
			 two (2) weeks of admission.
(iii) 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.
(iv) Co-occurring Disorders Program Specific
			 Criteria: Each Level III.3 Co-occurring Disorders Low Intensity 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)
			 Activity therapy.
(IV) Intensive
			 case management.
(v)
			 Women and Dependent Children Program Specific Criteria: Each Level III.3 Women
			 and Dependent Children Medium Intensity 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)
			 Activity therapy.
(IV) Parenting
			 skills development.
(V) Academic
			 and vocational services.
(VI)
			 Financial resource development and planning.
(VII) Family planning
			 services.
4.
			 Therapeutic Component Implementation. The entity shall document implementation
			 of regularly scheduled treatment sessions that are provided in an amount,
			 frequency and intensity appropriate to the client's assessed needs and
			 expressed desires for care.
(i) Service
			 strategies for each Level III.3 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) Client 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. Relapse
			 prevention.
III. Interpersonal
			 choice/decision making skill development.
IV. Development of a social network
			 supportive of recovery.
V. Daily
			 living and recovery skills development.
VI. Random drug screening.
VII. Health education.
VIII. Medication administration and
			 monitoring.
5. Documentation: Each Level III.3 Medium
			 Intensity 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 in Level
			 III.3 Services.
6.
			 Support Systems. Each Level III.3 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) Telephone or in person consultation with
			 a physician available twenty-four (24) hours a day, seven (7) days a
			 week.
(ii) Telephone or in person
			 consultation with emergency services twenty-four (24) hours a day, seven (7)
			 days a week.
(iii) Telephone or in
			 person consultation with a registered nurse twenty-four (24) hours a day, seven
			 (7) days a week.
(iv) Direct
			 affiliation with or coordination through referral to more and less intensive
			 levels of care.
(v) Direct
			 affiliation with or coordination through referral to supportive services
			 including vocational rehabilitation, literacy training and sheltered
			 workshops.
(vi) Mutual self-help
			 groups which are tailored to the needs of the specific client
			 population.
(vii) Appropriate
			 laboratory and toxicology testing.
(viii) Psychological and psychiatric
			 services.
(ix) Direct affiliation
			 with or coordination through referral to more and less intensive levels of
			 care.
7. Program
			 Personnel. Each level III.3 Medium Intensity 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) Direct Care Personnel. All direct care
			 personnel shall have the qualifications to provide the specific services
			 delineated in the entity's program description for this level of
			 care.
(ii) Clinical Personnel. The
			 entity shall maintain an adequate number of clinical personnel to sustain the
			 Level III.3 Program as delineated in its operational procedures.
(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.3 Program
			 shall be assigned to a specific primary counselor for care
			 management.
(v) Each primary
			 counselor shall maintain a case load not to exceed twenty (20) clients with
			 active cases at any one time.
(vi)
			 Co-occurring Disorders Program Specific Criteria.
(I) Each Level III.3 Co-occurring Enhanced
			 Medium Intensity 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.
(II) 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
			 liability for the medical aspects of the program.
(III) 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) All other direct care personnel in a
			 Level III.3 Co-occurring Enhanced Medium Intensity 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) Every client in a Level III.3
			 Residential Program shall be assigned to a specific primary counselor for care
			 management.
(VII) Each primary
			 counselor shall maintain a case load not to exceed ten (10) clients with active
			 cases at any one time.
(vii) 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.3 Medium Intensity 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.3 Women and
			 Dependent Children Program shall be assigned to a specific primary counselor
			 for care management.
(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.3 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.3 Medium Intensity 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 fifteen (15) 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.3 Medium Intensity 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.3 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 availability for screening, assessment and intake service and
			 counseling services at its Level III.3 Medium Intensity 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.