Alabama Administrative Code › Title 580 - ALABAMA DEPARTMENT OF MENTAL HEALTH › Chapter 580-9-44 - PROGRAM OPERATIONS › Section 580-9-44-.16 - Level I-D: Ambulatory Detoxification Without Extended On-Site Monitoring

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Rule Compliance. Each Level I-D
			 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 I-D Ambulatory Detoxification without
			 Extended On-site Monitoring Program it provides to include the following
			 specifications:
1. Location: The entity shall
			 specifically identify and describe the setting in which Level I-D Ambulatory
			 Detoxification without 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 including but not limited to, a
			 general healthcare facility, a physician's office or an addiction or mental
			 health treatment facility as pre-authorized by DMH.
2. Admission Criteria: The entity shall
			 develop, maintain and document implementation of written criteria for admission
			 to its Level I-D Ambulatory Detoxification without Extended On-Site Monitoring
			 Program and the following specifications:
(i)
			 The entity's admission criteria shall specify the target population for the
			 Level I-D Program, which shall include, at a minimum, individuals:
(I) Experiencing mild withdrawal or at risk
			 of experiencing withdrawal from alcohol and/or other drugs at a level of
			 assessed severity appropriate for outpatient care.
(II) Who have adequate systems in place to
			 support outpatient detoxification process.
(ii) The entity shall provide written
			 documentation in individual case records that each client admitted to receive
			 Level I-D Ambulatory Detoxification without Extended On-Site Monitoring
			 Services meets:
(I) The diagnostic criteria
			 for a Substance Induced Disorder as defined in the most recent edition of 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 I-D 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
			 I-D Ambulatory Detoxification Program shall document the capacity to provide
			 the following core services:
(I) Placement
			 assessment.
(II) Individual
			 counseling.
(III)
			 Psychoeducation.
(IV) Family
			 counseling.
(V) Peer
			 support.
(VI) Medication
			 administration.
(VII) Medication
			 monitoring.
(VIII) Alcohol and/or
			 drug screening/testing.
(IX) 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.
(i) Service strategies for each Level I-D
			 Detoxification Program shall include, at a minimum:
(I) Implementation of individualized
			 counseling plan strategies.
(II)
			 Completion of a comprehensive medical history and physical examination of the
			 client at admission.
(III)
			 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, including but not limited to, Substance Abuse and Mental Health
			 Services Administration (SAMHSA), American Society of Addiction Medicine
			 (ASAM), the American Psychiatric Association, and the American Academy of
			 Addiction Psychology.
I. Level I-D Ambulatory
			 Detoxification Programs that utilize Benzodiazepines in the detoxification
			 protocol:
A. Shall have written protocols and
			 procedures to show that all doses or amounts of benzodiazepines are carefully
			 monitored and are slowly reduced as appropriate.
B. 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.
(IV) Individual ongoing assessment services,
			 including, but not limited to:
I. Physical
			 examination by a physician, physician assistant or nurse
			 practitioner.
II. Human services
			 need assessment by a case manager.
(V) Medication administration and monitoring
			 services including specific procedures for pregnant women.
(VI) Motivational enhancement
			 therapy.
(VII) Direct affiliation
			 with other levels of care.
5. Documentation: In addition to meeting the
			 requirements an individualized progress note shall be recorded for each
			 respective service provided in Level I-D:
(i)
			 Daily assessment of progress, including response to medication, which also
			 notes any treatment regimen changes.
(ii) Regular and frequent monitoring of vital
			 signs.
(iii) The use of
			 detoxification rating scale tables and flow sheets.
(iv) Physician review of all
			 services.
6. Support
			 Systems. The Level I-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)
			 Twenty-four (24) hour access to emergency services.
(v) Transportation.
7. Program Personnel. Each Level I-D
			 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 I-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 use disorders. The medical
			 director shall be responsible for admission, diagnosis, medication management
			 and client care.
(ii) Nursing
			 Services Director: The Level I-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.
(iv) Case Manager Coordinator: The entity
			 shall have a case manager coordinator who shall be available to the Level I-D
			 Program on at least a 50% Full-time Equivalent (FTE) basis and shall, at a
			 minimum:
(I) Have a Bachelor's Degree in a
			 behavioral science, at least two (2) years case management experience relative
			 to substance use disorders, and completed DMH/Mental Illness and Substance
			 Abuse Services Division approved case management training.
(II) Supervise and delegate responsibilities
			 to case managers working in the Level I-D Program.
(III) Ensure the availability of
			 person-centered case management services to facilitate Level I-D clients'
			 transition into ongoing treatment and recovery.
(IV) Each client shall be assigned to a case
			 manager for care management.
(V)
			 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.
8. Training. The entity shall provide written
			 documentation that all Level I-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 I-D Services are provided in
			 regularly scheduled sessions and that the frequency and amount of these
			 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 I-D Program shall vary 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 I-D Ambulatory Detoxification
			 Programs. 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.