West Virginia Code of State Rules › Agency 69 - Health And Human Resources › Title 69 - LEGISLATIVE RULE DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 69-11 - Medication-Assisted Treatment - Opioid Treatment Programs › Section 69-11-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. Definitions
				incorporated by reference. -- Those terms defined in W. Va. Code §§
									16-5Y-1,
et seq.
are incorporated herein by reference.
2.2. Accreditation Body -- A body approved by
				the Substance Abuse and Mental Health Services Administration (SAMHSA) under
				42 C.F.R. §
										8.3 to accredit opioid treatment programs
				that use medication-assisted treatment medications.
2.3. Administrative Detoxification or
				Administrative Withdrawal -- The detoxification from the approved
				medication-assisted treatment medication for the safety and well-being of the
				patient, other patients, and staff of the MAT program.
2.4. Admissions Committee -- A designated
				group of individuals within the opioid treatment program consisting of the
				program administrator, or his or her designee; the medical director, or his or
				her designee; and a senior counselor, who is responsible for developing,
				implementing, administering, and reviewing program admissions policies and
				procedures, granting any exceptions to program admissions policies and
				procedures, and tracking the outcomes of patient admissions and
				exceptions.
2.5. Advanced Practice
				Registered Nurse -- A registered nurse who has acquired advanced clinical
				knowledge and skills preparing him or her to provide direct and indirect care
				to patients, completed a board-approved graduate-level education program,
				passed a board-approved national certification examination, and has met all the
				requirements set forth by the West Virginia Board of Examiners for Professional
				Registered Nurses.
2.6. Adverse
				Event or Incident -- An event involving an immediate threat to the care or
				safety of an individual, either staff, patient, or visitor; the possibility of
				serious operational or personnel problems within the MAT program facility; or
				the potential to undermine public confidence in the MAT program.
2.7. Advisory Council -- A designated group
				of individuals representing staff, patients, and the community who are
				appointed to serve in a non-managerial advisory capacity to the governing body
				of an opioid treatment program.
2.8. Approved Authorities -- Programs or
				authorities that publish practice or treatment guidelines, standards, or
				protocols that the Secretary has approved for use by MAT programs. Approved
				authorities include, but are not limited to, the American Society of Addiction
				Medicine (ASAM); the Center for Substance Abuse Treatment (CSAT); the National
				Institute on Drug Abuse (NIDA); the American Association for the Treatment of
				Opioid Dependence (AATOD); the Federation of State Medical Boards (FSMB); and
				any other program or authority approved by the Secretary.
2.9. Case Management -- The process of
				coordinating and monitoring the services provided to a patient both within the
				program and in conjunction with other providers.
2.10. Certification -- The process by which
				SAMHSA determines that an opioid treatment program is qualified to provide
				medication-assisted treatment under federal opioid treatment
				standards.
2.11. Clinical Staff --
				The individuals employed by or associated with a MAT program who provide
				treatment, care, or rehabilitation to program patients or patients'
				families.
2.12. Co-Occurring
				Disorders -- The combination of current or former substance use disorders and
				any other mental disorders recognized in the current edition of the
Diagnostic and Statistical Manual of Mental Disorders
published by the American Psychiatric Association.
2.13. Counseling Session -- A face-to-face
				interaction, which could include telehealth, in a private location between a
				patient and a primary counselor for a period of no less than 30 continuous
				minutes designated to address patient substance use disorder issues or coping
				strategies and individualized treatment plan of care.
2.14. Counselor -- A person who, by
				education, training, and experience, is qualified to provide psychosocial
				education, treatment and guidance to patients enrolled with a MAT program and,
				if desired, to the families of such patients, in order to accomplish behavioral
				health wellness, education, and other life goals.
2.15. Crisis -- A deteriorating or unstable
				situation often developing suddenly or rapidly that produces acute, heightened,
				emotional, mental, physical, medical, or behavioral distress; or any situation
				or circumstances in which the individual perceives or experiences a sudden loss
				of his ability to use effective problem-solving and coping skills.
2.16. Critical Incident -- A life, safety, or
				health threat involving the staff or patients participating in a program,
				including, but not limited to, death or physical or sexual assault.
2.17. Detoxification or Medically Supervised
				Withdrawal Treatment -- The dispensing of a medication-assisted treatment
				medication to a patient in decreasing doses over time, under the supervision of
				a program physician, to alleviate adverse physical or psychosocial effects
				incident to withdrawal from the continuous or substantial use of an opioid
				drug.
2.18. Discharge Plan -- The
				written plan that establishes the criteria for a patient's discharge from a
				service and identifies and coordinates delivery of any services needed after
				discharge.
2.19. Dispense -- The
				preparation and delivery of a medication-assisted treatment medication in an
				appropriately labeled and suitable container to a patient by a MAT program, but
				does not include the preparation and delivery of medications by a pharmacy
				licensed pursuant to the provisions of W. Va. Code §§
									30-5-1,
et seq.
2.20.
				Diversion -- An activity involving the legitimate acquisition of pharmaceutical
				agents illegally diverted to entities not intended as the recipients by the
				initial supplier.
2.21. Diversion
				Control Plan -- A required plan developed and implemented by the MAT program,
				which may include, but is not limited to, the assigning of responsibilities to
				medical and administrative staff and other specific measures to reduce the
				possibility of diversion of controlled substances from legitimate treatment to
				illicit use.
2.22. Federal Opioid
				Treatment Standards -- The standards established by the United States
				Department of Health and Human Services,
				42 C.F.R. §
										8.12, that are used to determine whether an
				opioid treatment program is qualified to engage in medication-assisted
				treatment and to determine the quantities of medication-assisted treatment
				medications which may be provided for unsupervised use.
2.23. For-Cause Inspection -- An inspection
				by any federal or state agency or accreditation body of a MAT program that may
				be operating in violation of 42 C.F.R. § 8 or state medication-assisted
				treatment rules, may be providing substandard treatment, or may be serving as a
				possible source of diverted medications.
2.24. Grievance -- A written or oral
				complaint filed by a patient with a program administrator, medical director, or
				state agency alleging inadequate treatment by the MAT program.
2.25. Individualized Treatment Plan of Care
				or Treatment Plan -- A plan or strategy of treatment and care developed by the
				patient's physician, counselors,, and other health care professionals in
				conjunction with the patient that outlines attainable short-term treatment
				goals that are mutually acceptable to the patient and the MAT program and which
				specifies the services to be provided and the frequency and schedule for their
				provision.
2.26. Induction --
				Initial treatment of a patient with medication-assisted treatment medication in
				order to suppress signs or symptoms of withdrawal or substance cravings; and
				generally includes a gradual increase in medication-assisted treatment
				medication therapy until the symptoms are regularly and reliably suppressed or
				controlled.
2.27. Initial
				Assessment -- An assessment conducted prior to or at admission and initial
				screening of a proposed patient that focuses on the individual's eligibility or
				need for admission and treatment; and provides indicators for initial dosage
				level and forms the basis for the individualized treatment plan of
				care.
2.28. Inspection or Survey --
				Any examination by the Secretary or his or her designee of a MAT program
				including, but not limited to, the premises, staff, patients, and documents
				pertinent to initial and continued licensing, so that the Secretary or his or
				her designee may determine whether a program is operating in compliance with
				licensing requirements or has violated any licensing requirements. This
				includes any survey, monitoring visit, complaint investigation or other inquiry
				conducted for the purposes of making a compliance determination with respect to
				licensing requirements.
2.29.
				Interdisciplinary Team -- A representative of the clinical staff of the opioid
				treatment program, and the patient's primary substance abuse counselor, working
				in conjunction with the patient and family members, if desired by the patient,
				to develop, approve, and coordinate the individualized treatment plan of care
				for the patient.
2.30. Long-Term
				Detoxification Treatment -- Detoxification or medically supervised withdrawal
				treatment for a period of more than 30 days.
2.31. Maintenance Dose -- The level of
				medication-assisted treatment medication considered medically necessary to
				consistently suppress signs or symptoms of substance use disorders and
				substance cravings for individuals with a substance use disorder; and is
				generally administered at the end of the induction period and is individualized
				for each patient and may gradually change over time.
2.32. Medical and Rehabilitative Services --
				Treatment and recovery services such as medical assessments and evaluations,
				counseling and rehabilitative and other special programs intended to help
				patients in MAT programs become and remain productive members of
				society.
2.33. Medical or Patient
				Record -- Medical histories, records, reports, summaries, diagnoses, prognoses,
				records of treatment, and medication ordered and given, entries, x-rays,
				radiology interpretations, and other written electronic, or graphic data
				prepared, kept, made, or maintained in a facility that pertains to services
				rendered to patients.
2.34. Medical
				Withdrawal -- The medically managed, gradual, voluntary, and therapeutic
				withdrawal of a patient from medication-assisted treatment, agreed upon by the
				patient and appropriate staff.
2.35. Medication Administration -- The direct
				application of medications by injection, inhalation, ingestion, or any other
				means to a patient receiving services by persons legally permitted to
				administer medication-assisted treatment medications or the individual at the
				direction and in the presence of persons legally permitted to administer
				medication-assisted treatment medications.
2.36. Medication Error -- An error in
				administering a medication to an individual and includes when any of the
				following occur: the wrong medication is given to an individual; the wrong
				individual is given the medication; the wrong dosage is given to an individual;
				medication is given to an individual at the wrong time or not at all; or the
				wrong method is used to administer the medication.
2.37. Mental Health Professional -- A person
				licensed under Chapter 30 of the West Virginia Code as a social worker,
				psychologist, or professional counselor.
2.38. Misuse or Non-Medical Use -- All uses
				of a prescription medication or substance other than those that are directed by
				a physician and used by an intended patient within the law and the requirements
				of good medical practice.
2.39.
				Opioid Antagonist -- A drug that blocks opioids by attaching to the opioid
				receptors without activating them thereby causing no opioid effect and blocking
				full agonist opioids.
2.40. Opioid
				Drug -- Any substance or drug having an addiction-forming or
				addiction-sustaining liability similar to morphine or being capable of
				conversion into a drug or substance having such addiction-forming or
				addiction-sustaining liability including, but not limited to, heroin, morphine,
				codeine, oxycodone, hydrocodone, fentanyl, oxymorphone, hydromorphone,
				methadone, buprenorphine, and any natural, semi-synthetic, or synthetic drug
				that acts primarily through the opioid receptor in the brain.
2.41. Opioid Treatment Services -- Treatment
				and services provided by a MAT program that uses medication-assisted treatment
				medications as a part of its treatment modality. Opioid treatment services may
				be provided through outpatient, residential, or hospital settings and may
				include medical maintenance, medically supervised withdrawal and
				detoxification, various levels of medical, psychosocial, and other types of
				care, detoxification treatment, and maintenance treatment.
2.42. Peer Recovery Support Services --
				Non-clinical recovery support services which are recipient directed and
				delivered by peers who have life experience with recovery.
2.43. Peer Review Committee -- A group of
				individuals designated by each opioid treatment program that is responsible for
				ensuring that the program follow approved national guidelines for opioid
				treatment facilities and programs, and shall include at least one physician
				licensed in the state of West Virginia.
2.44. Pharmacotherapy -- The treatment of
				disease or medical condition through the administration of drugs.
2.45. Physical Dependence -- A state of
				biologic adaption that is evidenced by a class-specific withdrawal syndrome
				when the substance is abruptly discontinued or the dose rapidly reduced, or by
				the administration of an antagonist.
2.46. Physician Assistant -- A person who
				meets the qualifications set forth in W. Va. Code §§
									30-3E-1,
et seq.
and is licensed pursuant to that article to practice
				medicine under the supervision of a physician or podiatrist licensed under the
				West Virginia Board of Medicine or the West Virginia Board of Osteopathic
				Medicine.
2.47. Physician Extender
				-- A medical staff person other than a program physician, functioning within
				his or her scope of practice to provide medical services to patients admitted
				to MAT programs. Physician extenders approved for employment at a MAT program
				include advanced practice registered nurses and physician assistants.
				Registered nurses and licensed practical nurses are not authorized to act as
				physician extenders in a MAT program, although they may work within the program
				in other capacities.
2.48. Plan of
				Correction -- A written description of the actions the MAT program intends to
				take to correct and prevent the reoccurrence of violations of a statute, rule,
				regulation or policy identified by the designated state oversight agency during
				an investigation or survey.
2.49.
				Plan of Education -- An approved continuing education plan that results in a
				physician, counselor or physician extender attaining professional competence in
				the field of substance use disorder treatment.
2.50. Positive Drug Screen -- A test that
				results in the presence of any drug or substance listed in subdivision 34.2.e.
				of this rule or any other drug or substance prohibited by the MAT program. The
				presence of medication which is part of the patient's individualized treatment
				plan of care shall not be considered a positive test. Any refusal to
				participate in a random drug test shall be considered a positive drug
				test.
2.51. Primary Counselor --
				The individual designated by the MAT program to serve as a consultant and
				advisor to a patient on a regular basis. The primary counselor may be an
				addiction counselor and shall be included as a member of the patient's
				interdisciplinary team for opioid treatment programs.
2.52. Program Physician -- Any physician
				licensed in this state pursuant to Chapter 30 of the West Virginia Code,
				designated and approved by the medical director to prescribe and monitor
				medication-assisted treatment for patients admitted to a MAT program. The
				medical director may serve as a program physician.
2.53. Random Drug Testing -- Approved medical
				screening and testing of patients for drugs, alcohol or other substances that
				shall be conducted so each patient of a MAT program has a statistically equal
				chance of being selected for testing at random, unscheduled times.
2.54. Recovery -- A process of change through
				which an individual improves his or her health and wellness, lives a
				self-directed life and strives to achieve his or her full potential.
2.55. Relapse Prevention Plan -- A plan of
				action developed by a patient and his or her primary counselor to help the
				patient anticipate and prepare for situations or environmental stimuli that
				were previously associated with substance abuse or addiction in order to avoid
				a return to use of opioids or other inappropriate or addictive
				substances.
2.56. Take-Home
				Medication -- Any medication that is approved under federal standards to be
				dispensed to a patient for unsupervised use based upon the patient's
				demonstrated compliance with the individualized treatment plan of care. Each
				dose of take-home medication must be recommended by the primary counselor and
				be approved by the medical director or program physician. Take-home medication
				may not exceed the dosages permitted under federal law or recommended by
				approved national guidelines.
2.57.
				Titration -- The gradual increasing or decreasing of doses of a
				medication-assisted treatment medication to the minimal level clinically
				required for maintenance.