Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 118 - OFFICE OF SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES (SAMHS) › Chapter 5 - REGULATIONS FOR LICENSING AND CERTIFYING OF SUBSTANCE ABUSE TREATMENT PROGRAMS › Section 118-5-19 - SUBSTANCE ABUSE TREATMENT SERVICES

Current through 2024-29, July 17, 2024
19.1
Medically Managed Intensive Inpatient Detoxification Programs (ASAM Level
				IV-D).
19.1.1 Definition. Medically
				managed intensive inpatient detoxification programs provide services to persons
				who are experiencing severe withdrawal symptoms and therefore require full
				medical acute care services in a twenty-four hour hospital setting. Services
				include a biopsychosocial evaluation, medical observation, monitoring, and
				treatment, counseling, and follow-up referral. Services shall be delivered in
				an appropriately licensedcertified acute
				care inpatient setting, adhering to medically-approved procedures and
				protocols.
19.1.2 Services
				provided. Medically managed intensive inpatient detoxification programs will
				provide immediate medical evaluation and continued medical management,
				including:
19.1.2.1 Highly individualized
				biomedical, emotional, behavioral, and addiction treatment. This includes the
				management of all concomitant biomedical, emotional, behavioral, and cognitive
				conditions in the context of addiction treatment;
19.1.2.2 Availability of hourly or more
				frequent nurse monitoring;
19.1.2.3
				A range of cognitive, behavioral, medical, mental health, and other therapies,
				to enhance the client's understanding of addiction, the completion of the
				detoxification process, and referral for continuing treatment and
				support;
19.1.2.4 Health education
				services;
19.1.2.5 Services to
				families and significant others;
19.1.2.6 Availability of specialized medical
				consultation. Providers of detoxification services shall make and maintain
				arrangements with external clinicians and facilities for referral of the client
				for specialized services beyond the capability of the program;
19.1.2.7 Full medical acute care
				services;
19.1.2.8 Intensive care,
				as needed;
19.1.2.9 Nutritional
				services, including special diets, as needed.
19.1.3 Staff.
19.1.3.1 Medically managed intensive
				inpatient detoxification programs shall be staffed by physicians or physician
				extenders who are available 24 hours a day as an active member of an
				interdisciplinary team of appropriately trained professionals, and who
				medically manage the care of the client.
19.1.3.2 A registered nurse or other licensed
				and credentialed nurse shall be available for primary nursing care and
				observation 24 hours a day.
19.1.3.3 An alcohol and drug counselor shall
				be available 8 hours a day to administer planned interventions according to the
				assessed needs of the client.
19.1.3.4 An interdisciplinary team of
				appropriately trained clinicians shall be available to assess and treat the
				client with a substance-related disorder, or an addicted client with a
				concomitant acute biomedical, emotional, or behavioral disorder.
19.1.4 Client records.
19.1.4.1 Elements of the assessment and
				treatment plan will include, but not be limited to:
19.1.4.1.1 A comprehensive nursing
				assessment, performed at admission;
19.1.4.1.2 Approval of the admission by a
				physician;
19.1.4.1.3 A record of a
				comprehensive history and physical examination performed within 24 hours of
				admission, accompanied by appropriate laboratory and toxicology tests OR the
				evaluation of the records of a physical examination administered within the
				preceding 7 calendar days prior to admission, by a physician or physician
				extender;
19.1.4.1.4 An
				addiction-focused history, obtained as part of the initial assessment and
				reviewed by a physician during the admission process;
19.1.4.1.5 Sufficient biopsychosocial
				screening assessments to determine placement, and for the individualized care
				plan to address treatment priorities. This assessment must be completed as soon
				as the client is medically stable, but no later than the fourth day of
				admission, to include screening for history of abuse or trauma;
19.1.4.1.6 An individualized treatment plan,
				including problem identification, treatment goals, measurable treatment
				objectives, and activities designed to meet those objectives.
19.1.4.2 Other documentation will
				include:
19.1.4.2.1 Progress notes entered by
				clinical staff at least once in each 24 hour period that clearly reflect
				implementation of the treatment plan and the client's response to treatment, as
				well as subsequent amendments to the plan;
19.1.4.2.2 Detoxification rating scale tables
				and flow sheets, as needed;
19.1.4.2.3 Physician services, documented in
				the client record as they occur;
19.1.4.2.4 Notes of client progress entered
				by nurses at least once each shift or every 8 hours;
19.1.4.2.5 A record of discharge/transfer
				planning, beginning at admission.
19.1.5 Methadone detoxification. Persons
				presenting symptoms of severe opiate withdrawal in a residential setting may
				require the use of methadone to facilitate a successful withdrawal. The
				administration of methadone to facilitate detoxification will require
				compliance with a variety of Federal and State of Maine laws, and will also
				involve oversight by Federal and State agencies to monitor compliance with
				these laws. The detoxification process using methadone involves the reduction
				of dosage from the stabilization dosage to a zero dosage upon discharge.
				Methadone detoxification programs must meet the following requirements:
19.1.5.1 Programs using methadone must
				include documentation of approval from and compliance with regulations of the
				Substance Abuse and Mental Health Services Administration (SAMHSA), the Federal
				Drug Enforcement Administration, the Maine State Pharmacy Board, and the Maine
				Department of Health and Human Services, Division of Licensing and Regulatory
				Services.
19.1.5.2 Also required is
				proof of appropriate accreditation by the Joint Commission for the
				Accreditation of Health Care Organizations, or the Commission on Accreditation
				of Rehabilitation Facilities. Detoxification programs that employ the services
				of a physician certified by the American Society of Addiction Medicine must
				provide a copy of such certificate.
19.1.5.3 Programs using methadone must submit
				de-identified client data to the Office of Substance Abuse on forms provided by
				the office. This data will be made available only for research and program
				evaluation functions.