Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.19 - Level II-D: Ambulatory Detoxification With Extended On-site Monitoring

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Rule Compliance. Each Level II-D
			 Ambulatory Detoxification Program shall comply with the following rules and the
			 rules specified in this chapter.
(a) Program
			 Description. The entity shall develop, maintain and implement a written program
			 description that defines the Level II-D Ambulatory Detoxification 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 Level II-D Ambulatory Detoxification
			 with Extended On-Site Monitoring services shall be provided. Services may be
			 provided in any appropriate setting that protects the client's right to
			 privacy, confidentiality, safety and meets the DMH facility certification
			 standards.
2. Admission Criteria:
			 The entity shall develop, maintain and document implementation of written
			 criteria for admission to its Level II-D Ambulatory Detoxification With
			 Extended On-Site Monitoring 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 the Level II-D program, which shall include,
			 at a minimum, individuals who:
(I) Have been
			 assessed as being at moderate risk of severe withdrawal syndrome outside of the
			 program setting.
(II) Are free of
			 severe, unstabilized physical and psychiatric complications.
(III) Who do not have adequate family or
			 other service systems in place to support an outpatient detoxification
			 process.
(ii) The entity
			 shall provide written documentation in individual case records that each client
			 admitted to receive Level II-D Ambulatory Detoxification with Extended On-Site
			 Monitoring Services meets:
(I) The diagnostic
			 criteria for Substance Induced Disorder as defined in the Diagnostic and
			 Statistical Manual of Mental Disorders.
(II) The dimensional criteria for admission
			 to this level of care as defined in the ASAM
			 PPC-2R.
3. Core
			 Services: Each Level II-D Ambulatory Detoxification Program shall demonstrate
			 the capacity to provide a basic level of skilled treatment services appropriate
			 to the needs of its clientele.
(i) At a
			 minimum, the Level II-D Ambulatory Detoxification Program shall document the
			 capacity to provide the following core services:
(I) Placement assessment.
(II) Individual counseling.
(III) Group counseling.
(IV) Psychoeducation.
(V) Family counseling.
(VI) Medical and somatic services.
(VII) Medication administration.
(VIII) Medication monitoring.
(IX) Alcohol and/or drug
			 screening/testing.
(X) Case
			 management:
I. Case planning.
II. Linkage.
III. Advocacy.
IV.
			 Monitoring.
4. Therapeutic Component Implementation: The
			 entity shall document implementation of medical and other clinical services
			 organized to enhance the client's understanding of addiction, support
			 completion of the detoxification process and initiate transfer to an
			 appropriate level of care for continued treatment. The entity's Level II-D
			 program shall, at a minimum, consist of the following components:
(i) Completion of a comprehensive medical
			 history and physical examination of the client at admission.
(ii) Protocols and/or standing orders,
			 established by the entity's medical director, for management of detoxification
			 from each major drug category of abused drugs that are consistent with
			 guidelines published by nationally recognized organizations (e.g., SAMHSA,
			 ASAM, American Academy of Addiction Psychology).
(I) Level II-D Ambulatory Detoxification
			 Programs that utilize benzodiazepines in the detoxification protocol:
I. Shall have written protocols and
			 procedures to show that all doses or amounts of benzodiazepines are carefully
			 monitored and are slowly reduced as appropriate.
II. Shall have written longer-term
			 detoxification protocols and procedures that adhere to general principles of
			 management including clear indications of benzodiazepine dependence, clear
			 intermediate treatment goals and strategies, regular review and methods to
			 prevent diversion from the plan.
(iii) On-site physician and/or nurse
			 monitoring, assessment and management of signs and symptoms of intoxication and
			 withdrawal.
(iv) Medication
			 administration and monitoring services including specific procedures for
			 pregnant women.
(v) Ongoing Intake
			 Interview Examination.
(vi) Direct
			 affiliation with other levels of care.
5. Documentation: Level II-D Ambulatory
			 Detoxification Programs shall provide the following:
(i) Documentation of each
			 clinical/therapeutic intervention provided.
(ii) Daily assessment of progress including
			 response to medication, which also notes any treatment changes.
(iii) Monitoring of vital signs each day the
			 client is on site.
(iv) The use of
			 detoxification rating scale tables and flow sheets.
(v) Physician review of all
			 services.
6. Support
			 Systems. The Level II-D Ambulatory Detoxification Program shall develop,
			 maintain and document implementation of written policies and procedures
			 utilized to provide client access to support services on site, or through
			 consultation or referral, which shall minimally include:
(i) Specialized clinical consultation for
			 biomedical, emotional, behavioral and cognitive problems.
(ii) Appropriate laboratory and toxicology
			 testing.
(iii) Psychological and
			 psychiatric services.
(iv)
			 Transportation.
(v) Twenty-four
			 (24) hour access to emergency medical services.
7. Program Personnel: Each Level II-D
			 Ambulatory Detoxification 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) Medical
			 Director: The Level II-D Detoxification Program shall have a medical director
			 who is a physician licensed to practice in the state of Alabama, with a minimum
			 of one (1) year experience treating persons with substance induced disorders.
			 The medical director shall be responsible for admission, diagnosis, medication
			 management and client care.
(ii)
			 Nursing Services Director: The Level II-D Program shall have a nursing services
			 director who shall be a Registered Nurse licensed according to Alabama law,
			 with training and work experience in behavioral health.
(iii) Nursing Personnel: The entity shall
			 have an adequate number of Alabama licensed nurses to assure that the
			 administration of medications during Level I-D services complies with
			 applicable state and federal regulations.
(I)
			 There shall be a Registered Nurse or Licensed Practical Nurse on site during
			 all hours of the Level II-D Program's operation.
(v) Clinical staff providing services shall
			 have access to a full-time clinical director.
(vi) 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.
(vii) The entity shall
			 maintain an adequate number of physicians, nurses, counselors and case managers
			 to sustain the Level II-D Ambulatory Detoxification Outpatient Program as
			 delineated in its program operational procedures.
(viii) The entity shall maintain an adequate
			 number of administrative support personnel to sustain the program's
			 administrative functions.
8. Training. The entity shall provide written
			 documentation that all Level II-D Program personnel satisfy the competency and
			 training requirements as specified in Rule 580-9-44-.02(3).
9. Service Intensity. The entity shall
			 document in the clinical record that Level II-D Services are provided in
			 regularly scheduled sessions and that:
(i) The
			 entity has the demonstrated capacity to provide a structured program of
			 clinical services for a minimum of nine (9) hours per week.
(ii) The frequency and amount of Level II-D
			 Services are established on the basis of the unique needs of each client
			 served.
10. Length of
			 Service. The entity shall provide written documentation in the clinical record
			 that the duration of treatment in a Level II-D Program varies as determined by
			 the client's assessed needs and that the client continues in treatment until:
(i) Withdrawal signs and symptoms are
			 sufficiently resolved; or
(ii)
			 Withdrawal signs and symptoms have failed to respond to treatment and have
			 intensified warranting a transfer to a more intense level of care; or
(iii) The client is, otherwise, unable to
			 complete detoxification at this level of care.
11. Service Availability: The entity shall
			 provide written documentation describing the process utilized to establish the
			 hours of service availability for its Level II-D 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.
(iii) Not be based solely on standard
			 eight(8) to five(5), Monday through Friday office
			 hours.