PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 05-17-191.
Title of Rule and Other Identifying Information: Chapter 388-805 WAC, Certification requirements for chemical dependency service providers.
Purpose: These rules are being revised to establish the level of quality and patient care standards for chemical dependency service providers seeking certification by DSHS/division of alcohol and substance abuse (DASA).
Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6097), on April 25, 2006, at 10:00 a.m.
Date of Intended Adoption: Not earlier than April 26, 2006.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., April 25, 2006.
Assistance for Persons with Disabilities: Contact Stephanie Schiller, DSHS Rules Consultant, by April 21, 2006, TTY (360) 664-6178 or (360) 664-6097 or by e-mail at schilse@dshs.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: To meet the requirements of chapters 70 and 504, Laws of 2005 and chapter 166, Laws of 2004, the department is amending the sections that refer to clinical manual content, administrative manual, assessment requirements, patient record content, and education, referral, and application criteria for opiate substitution treatment programs, and adding new language as appropriate.
Reasons Supporting Proposal: 1. DASA is proposing amendments to chapter 388-805 WAC. The key new rules amendments proposed will implement:
a. RCW 70.96A.142, effective July 1, 2004 (chapter 166, Laws of 2004), amended by the 2004 Washington state legislature.
b. RCW 70.96A.090, effective July 24, 2005 (chapter 70, Laws of 2005), amended by the 2005 Washington state legislature.
c. RCW 70.96A.157, effective July 1, 2005 (chapter 504, Laws of 2005), amended by the 2005 Washington state legislature.
2. In addition, DASA stakeholders recommended language clarifying the federal requirements of 42 Code of Federal Regulation, Part 2 and federal requirements regarding court ordered release of patient confidential information listed in 42 Code of Federal Regulations, Part 2.s 2.63 through 2.67 prior to the release of any patient identifying information. Other revisions included:
a. Language to clarify requirement of agencies to report critical incidents to the division of alcohol and substance abuse.
b. Language to clarify definitions for change of ownership, community relations plan, county coordinator, critical incident, determination of need, established ratio and opiate substitution treatment program.
c. Language is proposed to synchronize the term "client" to "patient" throughout the chapter.
d. Language is proposed to clarify for opiate substitution treatment programs:
• Application and relocation process.
• The state methadone authority must authorize exception to the take-home regulations as defined in 42 Code of Federal Regulations, Part 8.12.
• Treatment plan reviews every six months after two years of continued care of a patient.
• The administrator must formally appoint a medical director. The medical director is responsible for all medical services and compliance with state and federal regulations.
3. In addition, other sections of this chapter were subject to review and amendment deemed appropriate as required by Executive Order 97-02 on regulatory improvement.
Amending WAC 388-805-005 What definitions are important throughout this chapter?, 388-805-010 What chemical dependency services are certified by the department?, 388-805-030 What are the requirements for opiate substitution treatment program certification?, 388-805-035 What are the responsibilities for the department when an applicant applies for approval of an opiate substitution treatment program?, 388-805-040 How does the department determine there is a need in the community for opiate substitution treatment?, 388-805-085 What are the fees for agency certification?, 388-805-090 May certification fees be waived?, 388-805-100 What do I need to do to maintain agency certification?, 388-805-110 What do I do to relocate or remodel a facility?, 388-805-145 What are the key responsibilities required of an agency administrator?, 388-805150 What must be included in an agency administrative manual?, 388-805-300 What must be included in the agency clinical manual?, 388-805-310 What are the requirements for chemical dependency assessments?, 388-805-315 What are the requirements for treatment, continuing care, transfer, and discharge plans?, 388-805-325 What are the requirements for patient record content?, 388-805-330 What are the requirements for reporting patient noncompliance?, 388-805-620 What are the requirements for outpatient services?, 388-805-625 What are the requirements for outpatient services for persons subject to RCW 46.61.5056?, 388-805-640 What are the requirements for providing off-site chemical dependency treatment services?, 388-805-710 What are the requirements for opiate substitution medical management?, 388-805-715 What are the requirements for opiate substitution medication management?, 388-805-740 What are the requirements for opiate substitution treatment counseling?, 388-805-750 What are the requirements for opiate substitution treatment take-home medications?, 388-805-800 What are the requirements for ADATSA assessment services?, 388-805-810 What are the requirements for DUI assessment providers?, 388-805-815 What are the requirements for DUI assessment services? and 388-805-820 What are the requirements for alcohol and other drug information school?; and repealing WAC 388-805-850 What are the requirements for treatment accountability for safer communities (TASC) providers and services?
Statutory Authority for Adoption: Chapter 70.96A RCW.
Statute Being Implemented: Chapter 70.96A RCW.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of social and health services, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Deb Cummins, Division of Alcohol and Substance Abuse, P.O. Box 45330, Olympia, WA 98504-5330, (360) 725-3716, toll free (877) 301-4557.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rules cause only a minor cost, if any, to small businesses that are required to comply.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Deb Cummins, Certification Policy Manager, Division of Alcohol and Substance Abuse, P.O. Box 45330, Olympia, WA 98504-5330, phone (360) 725-3716, fax (360) 438-8057, e-mail cummida@dshs.wa.gov.
February 13, 2006
Andy Fernando, Manager
Rules and Policies Assistance Unit
3636.2"Addiction counseling competencies" means the knowledge, skills, and attitudes of chemical dependency counselor professional practice as described in Technical Assistance Publication No. 21, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services 1998.
"Administrator" means the person designated responsible for the operation of the certified treatment service.
"Adult" means a person eighteen years of age or older.
"Alcoholic" means a person who has the disease of alcoholism.
"Alcoholism" means a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.
"Approved supervisor" means a person who meets the education and experience requirements described in WAC 246-811-030 and 246-811-045 through 246-811-049 and who is available to the person being supervised.
"Authenticated" means written, permanent verification of an entry in a patient treatment record by an individual, by means of an original signature including first initial, last name, and professional designation or job title, or initials of the name if the file includes an authentication record, and the date of the entry. If patient records are maintained electronically, unique electronic passwords, biophysical or passcard equipment are acceptable methods of authentication.
"Authentication record" means a document that is part of a patient's treatment record, with legible identification of all persons initialing entries in the treatment record, and includes:
(1) Full printed name;
(2) Signature including the first initial and last name; and
(3) Initials and abbreviations indicating professional designation or job title.
"Bloodborne pathogens" means pathogenic microorganisms that are present in human blood and can cause disease in humans. The pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).
"Branch site" means a physically separate certified site where qualified staff provides a certified treatment service, governed by a parent organization. The branch site is an extension of a certified provider's services to one or more sites.
"Certified treatment service" means a discrete program of chemical dependency treatment offered by a service provider who has a certificate of approval from the department of social and health services, as evidence the provider meets the standards of chapter 388-805 WAC.
"Change in ownership" means one of the following conditions:
(1) When the ownership of a certified chemical dependency
treatment provider changes from one distinct legal ((entity
())owner(())) to ((a)) another distinct ((other)) legal owner;
(2) When the type of business changes from one type to another such as, from a sole proprietorship to a corporation; or
(3) When the current ownership takes on a new owner of five percent or more of the organizational assets.
"Chemical dependency" means a person's alcoholism or drug addiction or both.
"Chemical dependency counseling" means face-to-face individual or group contact using therapeutic techniques that are:
(1) Led by a chemical dependency professional (CDP), or CDP trainee under supervision of a CDP;
(2) Directed toward patients and others who are harmfully affected by the use of mood-altering chemicals or are chemically dependent; and
(3) Directed toward a goal of abstinence for chemically dependent persons.
"Chemical dependency professional" means a person certified as a chemical dependency professional by the Washington state department of health under chapter 18.205 RCW.
"Child" means a person less than eighteen years of age, also known as adolescent, juvenile, or minor.
"Clinical indicators" include, but are not limited to, inability to maintain abstinence from alcohol or other nonprescribed drugs, positive drug screens, patient report of a subsequent alcohol/drug arrest, patient leaves program against program advice, unexcused absences from treatment, lack of participation in self-help groups, and lack of patient progress in any part of the treatment plan.
"Community relations plan" means a plan to minimize the
impact of an opiate substitution treatment program as
((required)) defined by the Center for Substance Abuse
Guidelines for the Accreditation of Opioid Treatment Programs,
section XVIII.
"County coordinator" means the person designated by the
((chief executive officer)) legislative authority of a county
to carry out administrative and oversight responsibilities of
the county chemical dependency program.
"Criminal background check" means a search by the Washington state patrol for any record of convictions or civil adjudication related to crimes against children or other persons, including developmentally disabled and vulnerable adults, per RCW 43.43.830 through 43.43.842 relating to the Washington state patrol.
"Critical incidents" includes:
(1) Death of a patient;
(2) Serious injury ((or));
(3) Sexual assault of patients, staff members, or public citizens on the facility premises;
(4) Abuse or neglect of an adolescent or vulnerable adult patient by another patient or agency staff member on facility premises;
(5) A natural disaster presenting a threat to facility operation or patient safety;
(6) A bomb threat; a break in or ((a burglary)) theft of
patient identifying information;
(7) Suicide attempt at the facility((; or, a case
alleging abuse or neglect of an adult patient by an agency
staff member that was not resolved by the agency's grievance
procedure)).
"CSAT" means the Federal Center For Substance Abuse Treatment, a Substance Abuse Service Center of the Substance Abuse and Mental Health Services Administration.
"Danger to self or others," for purposes of WAC 388-805-520, means a youth who resides in a chemical dependency treatment agency and creates a risk of serious harm to the health, safety, or welfare to self or others. Behaviors considered a danger to self or others include:
(1) Suicide threat or attempt;
(2) Assault or threat of assault; or
(3) Attempt to run from treatment, potentially resulting in a dangerous or life-threatening situation.
"Department" means the Washington state department of social and health services.
"Determination of need" means a process used by the
department for opiate substitution treatment program
((certification applications)) slots within a county area as
described in WAC 388-805-040.
"Detoxification" or "detox" means care and treatment of a person while the person recovers from the transitory effects of acute or chronic intoxication or withdrawal from alcohol or other drugs.
"Disability, a person with" means a person whom:
(1) Has a physical or mental impairment that substantially limits one or more major life activities of the person;
(2) Has a record of such an impairment; or
(3) Is regarded as having such an impairment.
"Discrete treatment service" means a chemical dependency treatment service that:
(1) Provides distinct chemical dependency supervision and treatment separate from any other services provided within the facility;
(2) Provides a separate treatment area for ensuring confidentiality of chemical dependency treatment services; and
(3) Has separate accounting records and documents identifying the provider's funding sources and expenditures of all funds received for the provision of chemical dependency treatment services.
"Domestic violence" means:
(1) Physical harm, bodily injury, assault, or the infliction of fear of imminent physical harm, bodily injury, or assault between family or household members;
(2) Sexual assault of one family or household member by another;
(3) Stalking as defined in RCW 9A.46.110 of one family or household member by another family or household member; or
(4) As defined in RCW 10.99.020, 26.50.010, or other Washington state statutes.
"Drug addiction" means a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. Drug addiction is characterized by impaired control over use of drugs, preoccupation with drugs, use of a drug despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.
"Essential requirement" means a critical element of chemical dependency treatment services that must be present in order to provide effective treatment.
"Established ratio" means using 0.7 percent (.007) of a
designated county's adult population to determine an estimate
for the number of potential ((clients)) patients with an
opiate diagnosis in need of treatment services as described in
WAC 388-805-040.
"Faith-based organization" means an agency or organization such as a church, religiously affiliated entity, or religious organization.
"First steps" means a program available across the state for low-income pregnant women and their infants. First steps provides maternity care for pregnant and postpartum women and health care for infants and young children.
"Governing body" means the legal entity responsible for the operation of the chemical dependency treatment service.
"HIV/AIDS brief risk intervention (BRI)" means an
individual face-to-face interview with a ((client or))
patient, to help that person assess personal risk for HIV/AIDS
infection and discuss methods to reduce infection
transmission.
"HIV/AIDS education" means education, in addition to the brief risk intervention, designed to provide a person with information regarding HIV/AIDS risk factors, HIV antibody testing, HIV infection prevention techniques, the impact of alcohol and other drug use on risks and the disease process, and trends in the spread of the disease.
"Medical practitioner" means a physician, advanced registered nurse practitioner (ARNP), or certified physician's assistant. ARNPs and midwives with prescriptive authority may perform practitioner functions related only to indicated specialty services.
"Off-site treatment" means provision of chemical dependency treatment by a certified provider at a location where treatment is not the primary purpose of the site; such as in schools, hospitals, or correctional facilities.
"Opiate substitution treatment program" means an
organization that administers or dispenses an approved
((drug)) medication as specified in 212 CFR Part 291 for
treatment or detoxification of opiate ((substitution))
dependence. The agency is:
(1) Certified as an opioid treatment program by the Federal Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration;
(2) Licensed by the Federal Drug Enforcement Administration;
(3) Registered by the state board of pharmacy;
(4) Accredited by an opioid treatment program accreditation body approved by the Federal Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration; and
(5) Certified as an opiate substitution treatment program by the department.
"Outcomes evaluation" means a system for determining the effectiveness of results achieved by patients during or following service delivery, and patient satisfaction with those results for the purpose of program improvement.
"Patient" is a person receiving chemical dependency treatment services from a certified program.
"Patient contact" means time spent with a ((client or))
patient to do assessments, individual or group counseling, or
education.
"Patient placement criteria (PPC)" means admission, continued service, and discharge criteria found in the patient placement criteria for the treatment of substance-related disorders as published by the American Society of Addiction Medicine (ASAM).
"Probation assessment officer (PAO)" means a person employed at a certified district or municipal court probation assessment service that meets the PAO requirements of WAC 388-805-220.
"Probation assessment service" means a certified assessment service offered by a misdemeanant probation department or unit within a county or municipality.
"Progress notes" are a permanent record of ongoing assessments of a patient's participation in and response to treatment, and progress in recovery.
"Qualified personnel" means trained, qualified staff, consultants, trainees, and volunteers who meet appropriate legal, licensing, certification, and registration requirements.
"Registered counselor" means a person registered((, or
certified)) by the state department of health as required by
chapter 18.19 RCW.
"Relocation" means change in location from one office space to a new office space, or moving from one office building to another.
"Remodeling" means expansion of existing office space to additional office space at the same address, or remodeling of interior walls and space within existing office space.
"SAMHSA" means the Federal Substance Abuse and Mental Health Services Administration.
"Self-help group" means community based support groups that address chemical dependency.
"Service provider" or "provider" means a legally operated entity certified by the department to provide chemical dependency services. The components of a service provider are:
(1) Legal entity/owner;
(2) Facility; and
(3) Staff and services.
"Sexual abuse" means:
(1) Sexual assault((,));
(2) Incest((,)); or
(3) Sexual exploitation.
"Sexual harassment" means unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when:
(1) Submission to such conduct is made either explicitly or implicitly a term or condition of employment or treatment; or
(2) Such conduct interferes with work performance or creates an intimidating, hostile, or offensive work or treatment environment.
"Substance abuse" means a recurring pattern of alcohol or other drug use that substantially impairs a person's functioning in one or more important life areas, such as familial, vocational, psychological, physical, or social.
"Summary suspension" means an immediate suspension of certification, per RCW 34.05.422(4), by the department pending administrative proceedings for suspension, revocation, or other actions deemed necessary by the department.
"Supervision" means:
(1) Regular monitoring of the administrative, clinical, or clerical work performance of a staff member, trainee, student, volunteer, or employee on contract by a person with the authority to give directions and require change; and
(2) "Direct supervision" means the supervisor is on the premises and available for immediate consultation.
"Suspend" means termination of the department's certification of a provider's treatment services for a specified period or until specific conditions have been met and the department notifies the provider of reinstatement.
"TARGET" means the treatment and assessment report generation tool.
"Treatment plan review" means a review of active problems on the patient's individualized treatment plan, the need to address new problems, and patient placement.
"Treatment services" means the broad range of emergency, detoxification, residential, and outpatient services and care. Treatment services include diagnostic evaluation, chemical dependency education, individual and group counseling, medical, psychiatric, psychological, and social services, vocational rehabilitation and career counseling that may be extended to alcoholics and other drug addicts and their families, persons incapacitated by alcohol or other drugs, and intoxicated persons.
"Urinalysis" means analysis of a patient's urine sample for the presence of alcohol or controlled substances by a licensed laboratory or a provider who is exempted from licensure by the department of health:
(1) "Negative urine" is a urine sample in which the lab does not detect specific levels of alcohol or other specified drugs; and
(2) "Positive urine" is a urine sample in which the lab confirms specific levels of alcohol or other specified drugs.
"Vulnerable adult" means a person who lacks the functional, mental, or physical ability to care for oneself.
"Young adult" means an adult who is eighteen, nineteen, or twenty years old.
"Youth" means a person seventeen years of age or younger.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-005, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-005, filed 11/21/00, effective 1/1/01.]
(a) Detoxification services, which assist patients in withdrawing from alcohol and other drugs including:
(i) Acute detox, which provides medical care and physician supervision for withdrawal from alcohol or other drugs; and
(ii) Subacute detox, which is nonmedical detoxification or patient self-administration of withdrawal medications ordered by a physician, provided in a home-like environment.
(b) Residential treatment services, which provide chemical dependency treatment for patients and include room and board in a twenty-four-hour-a-day supervised facility, including:
(i) Intensive inpatient, a concentrated program of individual and group counseling, education, and activities for detoxified alcoholics and addicts, and their families;
(ii) Recovery house, a program of care and treatment with social, vocational, and recreational activities to aid in patient adjustment to abstinence and to aid in job training, employment, or other types of community activities; and
(iii) Long-term treatment, a program of treatment with personal care services for chronically impaired alcoholics and addicts with impaired self-maintenance capabilities. These patients need personal guidance to maintain abstinence and good health.
(c) Outpatient treatment services, which provide chemical dependency treatment to patients less than twenty-four hours a day, including:
(i) Intensive outpatient, a concentrated program of individual and group counseling, education, and activities for detoxified alcoholics and addicts and their families;
(ii) Outpatient, individual and group treatment services of varying duration and intensity according to a prescribed plan; and
(iii) Opiate substitution outpatient treatment, which meets both outpatient and opiate substitution treatment program service requirements.
(d) Assessment services, which include:
(i) ADATSA assessments, alcohol and other drug
assessments of ((clients)) patients seeking financial
assistance from the department due to the incapacity of
chemical dependency. Services include assessment, referral,
case monitoring, and assistance with employment; and
(ii) DUI assessments, diagnostic services requested by
the courts to determine a ((client's)) person's involvement
with alcohol and other drugs and to recommend a course of
action.
(e) Information and assistance services, which include:
(i) Alcohol and drug information school, an education program about the use and abuse of alcohol and other drugs, for persons referred by the courts and others, who may have been assessed and do not present a significant chemical dependency problem, to help those persons make informed decisions about the use of alcohol and other drugs;
(ii) Information and crisis services, response to persons having chemical dependency needs, by phone or in person;
(iii) Emergency service patrol, assistance provided to intoxicated persons in the streets and other public places;
(((iv) Treatment accountability for safer communities
(TASC), is a referral and case management service. TASC
providers furnish a link between the criminal justice system
and the treatment system. TASC identifies, assesses, and
refers appropriate alcohol and other drug dependent offenders
to community-based substance abuse treatment and monitors the
outcome for the criminal justice system.))
(2) The department may certify a provider for more than one of the services listed under subsection (1) of this section when the provider complies with the specific requirements of the selected services.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-010, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-010, filed 11/21/00, effective 1/1/01.]
(1) Documentation the provider has communicated with the
county legislative authority and if applicable, the city
legislative authority or tribal legislative authority, in
order to secure a location for the new opiate substitution
treatment program that((:
(a))) meets county, tribal or city land use ordinances((;
and
(b) Includes a)).
(2) A completed community relations plan developed in consultation with the legislative authority or their designee to minimize the impact of the opiate substitution treatment programs upon the business and residential neighborhoods in which the program is located. The plan must include documentation of strategies used to:
(((i))) (a) Obtain ((and document)) stakeholder input
regarding the proposed location;
(((ii))) (b) Address any concerns identified by
stakeholders; and
(((iii))) (c) Develop an ongoing community relations plan
to address new concerns expressed by stakeholders as they
arise.
(((2))) (3) A copy of the application for a registration
certificate from the Washington state board of pharmacy.
(((3))) (4) A copy of the application for licensure to
the Federal Drug Enforcement Administration.
(((4))) (5) A copy of the application for certification
to the Federal CSAT SAMHSA.
(((5))) (6) A copy of the application for accreditation
by an accreditation body approved as an opioid treatment
program accreditation body by the Federal CSAT SAMHSA.
(((6))) (7) Policies and procedures identified under WAC 388-805-700 through 388-805-750.
(((7))) (8) Documentation that transportation systems
will provide reasonable opportunities to persons in need of
treatment to access the services of the program.
(((8))) (9) At least three letters of support from the
administrator or their designee of other health care providers
within the existing health care system in the area the
applicant proposes to establish a new opiate substitution
treatment program ((to)). The letters must demonstrate ((an
appropriate)) a relationship to the service area's existing
health care system.
(((9))) (10) A declaration to limit the number of
individual program participants to three hundred fifty as
specified in RCW 70.96A.410 (1)(e).
(((10))) (11) For new applicants, who operate opiate
substitution treatment programs in another state, copies of
national and state certification/accreditation documentation,
and copies of all survey reports written by national and/or
state certification or accreditation organizations for each
site they have operated an opiate substitution program in over
the past six years.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-030, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-030, filed 11/21/00, effective 1/1/01.]
Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 03-20-020, filed 9/23/03,
effective 10/25/03)
WAC 388-805-035
What are the responsibilities for the
department when an applicant applies for approval of an opiate
substitution treatment program?
For purposes of this section,
"area" means the county in which an opiate substitution
treatment program applicant proposes to locate a certified
program, and counties adjacent or near to the county in which
the program is proposed to be located. When making a decision
on an application for certification of a program, the
department must:
(1) Consult with the county legislative authority in the
area in which an applicant proposes to locate a program and
the city legislative authority ((in any city)) or tribal
legislative authority applicable to the site in which an
applicant proposes to locate a program. The department will
request the county and city or tribal legislative authority to
notify the department of any applicable requirements or other
issues that the department should consider in order to fulfill
the requirements of WAC 388-805-030(7), or 388-805-040 (1)
through (5);
(2) Not discriminate in its certification decision on the basis of the corporate structure of the applicant;
(3) Consider the size of the population in need of treatment in the area in which the program would be located and certify only applicants whose programs meet the necessary treatment needs of the population;
(4) Determine there is a need in the community for opiate
substitution treatment and not certify more programs ((slots))
than justified by the need in that community as described in
WAC 388-805-040;
(5) Consider whether the applicant has the capability, or has in the past demonstrated the capability to provide appropriate treatment services to assist persons in meeting legislative goals of abstinence from opiates and opiate substitutes, obtaining mental health treatment, improving economic independence, and reducing adverse consequences associated with illegal use of controlled substances;
(6) Hold at least one public hearing in the county in which the facility is proposed to be located and one public hearing in the area in which the facility is proposed to be located. After consultation with the county legislative authority, the department may have the public hearing in the adjacent county with the largest population, the adjacent county with the largest underserved population, or the county nearest to the proposed location. The hearing must be held at a time and location most likely to permit the largest number of interested persons to attend and present testimony. The department must notify appropriate media outlets of the time, date, and location of the hearing at least three weeks in advance of the hearing.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-035, filed 9/23/03, effective 10/25/03.]
(1) For the number of potential ((clients)) patients in
an area, the department will consider the size of the
population in need of treatment in the area in which the
program would be located using adult population statistics
from the most recent area population trend reports. The
department will use the established ratio of .7 percent of the
adult population as an estimate for the number of potential
((clients)) patients with an opiate diagnosis in need of
treatment services.
(2) For the number of anticipated program slots in an area, the department will multiply the sum of the established ratio of .7 percent of the adult population in subsection (1) of this section by thirty-five percent to determine an estimate of the anticipated need for the number of opiate substitution treatment program slots in the area in which the program would be located.
(3) Demographic and trend data from the area in which the program would be located including the most recent department county trend data, TARGET admission data for opiate substitution treatment from the county, hospital and emergency department admission data from the county, needle exchange data from the county, and other relevant reports and data from county health organizations demonstrating the need for opiate substitution treatment program services.
(4) Availability of other opiate substitution treatment programs near the area of the applicant's proposed program. The department will determine the number of patients, capacity, and accessibility of existing opiate substitution treatment programs near the area of the applicant's proposed program and whether existing programs have the capacity to assume additional patients for treatment services.
(5) Whether the population served or to be served has need for the proposed program and whether other existing services and facilities of the type proposed are available or accessible to meet that need. The assessment will include, but not limited to, consideration of the following:
(a) The extent to which the proposed program meets the need of the population presently served;
(b) The extent to which the underserved need will be met adequately by the proposed program; and
(c) The impact of the service on the ability of low-income persons, racial and ethnic minorities, women, handicapped persons, the elderly, and other underserved groups to obtain needed health care.
(6) The department will review agency policies and
procedures that describe the cost of services to ((clients))
patients, sliding fee scales, and charity care policies,
procedures, and goals.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-040, filed 9/23/03, effective 10/25/03.]
| (a) New agency | $500 |
| (b) Branch agency | $500 |
| (c) Application for adding one or more services | $200 |
| (d) Change in ownership | $500 |
| (a) For detoxification and residential services: | $26 per licensed bed |
| (b) For nonresidential services: | |
| (i) Large size agencies: 3,000 or more
(( |
$1,125 per year |
| (ii) Medium size agencies: 1,000-2,999
(( |
$750 per year |
| (iii) Small size agencies: 0-999 (( |
$375 per year |
| (c) For agencies certified through deeming per WAC 388-805-115 | $200 per year |
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-085, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-085, filed 11/21/00, effective 1/1/01.]
(a) The fees would not be in the interest of public health and safety; or
(b) The fees would be to the financial disadvantage of the state; or
(c) The department determines that the cost of processing the application is so small that it warrants granting an application fee waiver.
(2) Providers may submit a letter requesting a waiver of fees to the Supervisor, Certification Section, Division of Alcohol and Substance Abuse, P.O. Box 45330, Olympia, Washington, 98504-5330.
(3) Fee waivers may be granted to qualified providers who receive funding from tribal, federal, state or county government resources as follows:
(a) For residential providers: The twenty-six dollar per bed annual fee will be assessed only for those beds not funded by a governmental source;
(b) For nonresidential providers: The amount of the fee waiver must be determined by the percent of the provider's revenues that come from governmental sources, according to the following schedule:
| Percent Government Revenues | 90-100% | 75-89% | 50-74% | 0-49% |
| Small agency | No fee | $90 | $185 | $375 |
| Medium agency | No fee | $185 | $375 | $750 |
| Large agency | No fee | $285 | $565 | $1,125 |
(a) The reason for the request;
(b) For residential providers:
(i) Documentation of the number of beds currently licensed by the department of health;
(ii) Documentation showing the number of beds funded by a government entity including, tribal, federal, state or county government sources.
(c) For nonresidential providers:
(i) Documentation of the number of ((clients)) patients
served during the previous twelve-month period;
(ii) Documentation showing the amount of government revenues received during the previous twelve-month period;
(iii) Documentation showing the amount of private revenues received during the previous twelve-month period.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-090, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-090, filed 11/21/00, effective 1/1/01.]
(a) Completion of an annual declaration of certification; and
(b) Payment of certification fees, if applicable.
(2) Providing the essential requirements for chemical dependency treatment, including the following elements:
(a) Treatment process:
(i) Assessments, as described in WAC 388-805-310;
(ii) Treatment planning, as described in WAC 388-805-315
(2)(a) and ((388-805-325(10))) 388-805-325(11);
(iii) Documenting patient progress, as described in WAC 388-805-315 (1)(b) and ((388-805-325(12))) 388-805-325(13);
(iv) Treatment plan reviews and updates, as described in
WAC 388-805-315 (2)(a), ((388-805-325(10))) 388-805-325(11)
and ((388-805-325 (12)(c))) 388-805-325 (13)(c);
(v) Patient compliance reports, as described in WAC 388-805-315 (4)(b), ((388-805-325(16))) 388-805-325(17), and
388-805-330;
(vi) Continuing care, and discharge planning, as
described in WAC 388-805-315 (2)(c) and (d) and (7)(a), and
((388-805-325 (17))) 388-805-325(18) and (((18))) (19); and
(vii) Conducting individual and group counseling, as
described in WAC 388-805-315 (2)(b) and ((388-805-325(12)))
388-805-325(13).
(b) Staffing: Provide sufficient qualified personnel for the care of patients as described in WAC 388-805-140(5) and 388-805-145(5);
(c) Facility:
(i) Provide sufficient facilities, equipment, and supplies for the care and safety of patients as described in WAC 388-805-140 (5) and (6);
(ii) If a residential provider, be licensed by the department of health as described by WAC 388-805-015 (1)(b).
(3) Findings during periodic on-site surveys and complaint investigations to determine the provider's compliance with this chapter. During on-site surveys and complaint investigations, provider representatives must cooperate with department representatives to:
(a) Examine any part of the facility at reasonable times and as needed;
(b) Review and evaluate records, including patient clinical records, personnel files, policies, procedures, fiscal records, data, and other documents as the department requires to determine compliance; and
(c) Conduct individual interviews with patients and staff members.
(4) The provider must post the notice of a scheduled department on-site survey in a conspicuous place accessible to patients and staff.
(5) The provider must correct compliance deficiencies found at such surveys immediately or as agreed by a plan of correction approved by the department.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-100, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-100, filed 11/21/00, effective 1/1/01.]
(((1))) (a) Submit a completed agency relocation approval
request form, or a request for approval in writing if
remodeling, sixty or more days before the proposed date of
relocation or change.
(((2))) (b) Submit a sample floor plan that includes
information identified under WAC 388-805-015 (2)(f) through
(k).
(((3))) (c) Submit a completed facility accessibility
self-evaluation form.
(((4))) (d) Provide for department examination of
nonresidential premises before approval, as described under
WAC 388-805-060.
(((5))) (e) Contact the department of health for approval
before relocation or remodel if a residential treatment
facility.
(2) Opiate substitution treatment provider must complete WAC 388-805-030, 388-805-035, and 388-805-040 requirements for a facility relocation.
[Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-110, filed 11/21/00, effective 1/1/01.]
(a) All administrative matters;
(b) Patient care services; and
(c) Meeting all applicable rules and ethical standards.
(2) When the administrator is not on duty or on call, a staff person must be delegated the authority and responsibility to act in the administrator's behalf.
(3) The administrator must ensure administrative, personnel, and clinical policy and procedure manuals:
(a) Are developed and adhered to; and
(b) Are reviewed and revised as necessary, and at least annually.
(4) The administrator must employ sufficient qualified personnel to provide adequate chemical dependency treatment, facility security, patient safety and other special needs of patients.
(5) The administrator must ensure all persons providing counseling services are registered, certified or licensed by the department of health.
(6) The administrator must ensure full-time chemical dependency professionals (CDPs), CDP trainees, or other licensed or registered counselors in training to become a CDP do not exceed one hundred twenty hours of patient contact per month.
(7) The administrator must assign the responsibilities for a clinical supervisor to at least one person within the organization.
(8) The administrator of a certified opiate substitution treatment program must ensure that the number of patients will not exceed three hundred and fifty unless authorized by the county in which the program is located.
(9) The administrator or program sponsor of a certified opiate substitution treatment program must ensure that treatment is provided to patients in compliance with 42 Code of Federal Regulations, Part 8.12.
(10) The administrator or program sponsor of a certified opiate substitution treatment program shall formally designate a medical director who shall assume responsibility for:
(a) All medical services performed;
(b) Ensuring the program is in compliance with all applicable Federal, State and local laws and regulations.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-145, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-145, filed 11/21/00, effective 1/1/01.]
(1) The organization's:
(a) Articles and certificate of incorporation if the owner is a corporation;
(b) Partnership agreement if the owner is a partnership; or
(c) Statement of sole proprietorship.
(2) The agency's bylaws if the owner is a corporation.
(3) Copies of a current master license and state business licenses or a current declaration statement that they are updated as required.
(4) The provider's philosophy on and objectives of chemical dependency treatment with a goal of total abstinence, consistent with RCW 70.96A.011.
(5) A policy and procedures describing how services will be made sensitive to the needs of each patient, including assurance that:
(a) Certified interpreters or other acceptable alternatives are available for persons with limited English-speaking proficiency and persons having a sensory impairment; and
(b) Assistance will be provided to persons with disabilities in case of an emergency.
(6) A policy addressing special needs and protection for youth and young adults, and for determining whether a youth or young adult can fully participate in treatment, before admission of:
(a) A youth to a treatment service caring for adults; or
(b) A young adult to a treatment service caring for youth.
(7) An organization chart specifying:
(a) The governing body;
(b) Each staff position by job title, including volunteers, students, and persons on contract; and
(c) The number of full- or part-time persons for each position.
(8) A delegation of authority policy.
(9) A copy of current fee schedules.
(10) A policy and procedures implementing state and federal regulations on patient confidentiality, including provision of a summary of 42 CFR Part 2.22 (a)(1) and (2) to each patient.
(11) A policy and procedures for reporting suspected child abuse and neglect.
(12) A policy and procedures for reporting the death of a
patient to the ((department)) division of alcohol and
substance abuse within one business day when:
(a) The patient is in residence; or
(b) An outpatient dies on the premises.
(13) Patient grievance policy and procedures.
(14) A policy and procedures on reporting of critical
incidents and actions taken to the ((department)) division of
alcohol and substance abuse within two business days when an
unexpected event occurs.
(15) A smoking policy consistent with the Washington Clean Indoor Air Act, chapter 70.160 RCW.
(16) For a residential provider, a facility security policy and procedures, including:
(a) Preventing entry of unauthorized visitors; and
(b) Use of passes for leaves of patients.
(17) For a nonresidential provider, an evacuation plan for use in the event of a disaster, addressing:
(a) Communication methods for patients, staff, and visitors including persons with a visual or hearing impairment or limitation;
(b) Evacuation of mobility-impaired persons;
(c) Evacuation of children if child care is offered;
(d) Different types of disasters;
(e) Placement of posters showing routes of exit; and
(f) The need to mention evacuation routes at public meetings.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-150, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-150, filed 11/21/00, effective 1/1/01.]
(1) How the provider meets WAC 388-805-305 through 388-805-350 requirements.
(2) How the provider will meet applicable certified service standards for the level of program service requirements:
Allowance of up to twenty percent of education time to consist of film or video presentations.
(3) Identification of resources and referral options so staff can make referrals required by law and as indicated by patient needs.
(4) Assurance that there is an identified clinical supervisor who:
(a) Is a chemical dependency professional (CDP);
(b) Reviews a sample of patient records of each CDP quarterly; and
(c) Ensures implementation of assessment, treatment, continuing care, transfer and discharge plans in accord with WAC 388-805-315.
(5) Patient admission, continued service, and discharge criteria using PPC.
(6) Policies and procedures to implement the following requirements:
(a) The administrator must not admit or retain a person unless the person's treatment needs can be met;
(b) A chemical dependency professional (CDP), or a CDP trainee under supervision of a CDP, must assess and refer each patient to the appropriate treatment service; and
(c) A person needing detoxification must immediately be referred to a detoxification provider, unless the person needs acute care in a hospital.
(7) Additional requirements for opiate substitution treatment programs:
(a) A program physician must ensure that a person is currently addicted to an opioid drug and that the person became addicted at least one year before admission to treatment;
(b) A program physician must ensure that each patient voluntarily chooses maintenance treatment and provides informed written consent to treatment;
(c) A program physician must ensure that all relevant facts concerning the use of the opioid drug are clearly and adequately explained to the patient;
(d) A person under eighteen years of age needing opiate substitution treatment is required to have had two documented attempts at short-term detoxification or drug-free treatment within a twelve-month period. A waiting period of no less than seven days is required between the first and second short-term detoxification treatment;
(e) No person under eighteen years of age may be admitted to maintenance treatment unless a parent, legal guardian, or responsible adult designated by the relevant state authority consents in writing to treatment;
(f) A program physician may waive the requirement of a one year history of addiction under subsection (7)(a) of this section, for patients released from penal institutions (within six months after release), for pregnant patients (program physician must certify pregnancy), and for previously treated patients (up to two years after discharge);
(g) Documentation in each patient's record that the service provider made a good faith effort to review if the patient is enrolled in any other opiate substitution treatment service;
(h) When the medical director or program physician of an opiate substitution treatment program provider in which the patient is enrolled determines that exceptional circumstances exist, the patient may be granted permission to seek concurrent treatment at another opiate substitution treatment program provider. The justification for finding exceptional circumstances for double enrollment must be documented in the patient's record at both treatment program providers.
(8) Tuberculosis screening for prevention and control of TB in all detox, residential, and outpatient programs, including:
(a) Obtaining a history of preventive or curative therapy;
(b) Screening and related procedures for coordinating with the local health department; and
(c) Implementing TB control as provided by the department of health TB control program.
(9) HIV/AIDS information, brief risk intervention, and referral.
(10) Limitation of group counseling sessions to twelve or fewer patients.
(11) Counseling sessions with nine to twelve youths to include a second adult staff member.
(12) Provision of education to each patient on:
(a) Alcohol, other drugs, and chemical dependency;
(b) Relapse prevention; and
(c) HIV/AIDS, hepatitis, and TB.
(13) Provision of education or information to each patient on:
(a) The impact of chemical use during pregnancy, risks to the fetus, and the importance of informing medical practitioners of chemical use during pregnancy;
(b) Emotional, physical, and sexual abuse; and
(c) Nicotine addiction.
(14) An outline of each lecture and education session included in the service, sufficient in detail for another trained staff person to deliver the session in the absence of the regular instructor.
(15) Assigning of work to a patient by a CDP when the assignment:
(a) Is part of the treatment program; and
(b) Has therapeutic value.
(16) Use of self-help groups.
(17) Patient rules and responsibilities, including disciplinary sanctions for noncomplying patients.
(18) If youth are admitted, a policy and procedure for assessing the need for referral to child welfare services.
(19) Implementation of the deferred prosecution program.
(20) ((Policy and procedures for)) Reporting status of
persons convicted under chapter 46.61 RCW to the department of
licensing.
(21) Asking at intake or next counseling session if the patient has been court ordered to chemical dependency or mental health treatment and is under supervision by the department of corrections, and documenting the patient's response in the clinical record.
(22) For patients that are court ordered to receive chemical dependency or mental health treatment and under department of corrections supervision, the provider must request:
(a) Authorizations to share information with the department of corrections, the county designated chemical dependency specialist and any other court ordered treatment provider; or
(b) A copy of the court order that exempts the patient from the reporting requirements with the department of corrections and mental health provider.
(c) If a patient refuses to sign a release, document attempt in the patient record.
(23) Nonresidential providers must have policies and procedures on:
(a) Medical emergencies;
(b) Suicidal and mentally ill patients;
(c) Laboratory tests, including UA's and drug testing;
(d) Services and resources for pregnant women:
(i) A pregnant woman who is not seen by a private physician must be referred to a physician or the local first steps maternity care program for determination of prenatal care needs; and
(ii) Services include discussion of pregnancy specific issues and resources.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-300, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-300, filed 11/21/00, effective 1/1/01.]
(1) A face-to-face diagnostic interview with each
((client)) patient to obtain, review, evaluate, and document
the following:
(a) A history of the ((client's)) patient's involvement
with alcohol and other drugs, including:
(i) The type of substances used;
(ii) The route of administration; and
(iii) Amount, frequency, and duration of use.
(b) History of alcohol or other drug treatment or education;
(c) The ((client's)) patient's self-assessment of use of
alcohol and other drugs;
(d) A relapse history; and
(e) A legal history.
(2) If the ((client)) patient is in need of treatment, a
CDP or CDP trainee under supervision of a CDP must evaluate
the assessment using PPC dimensions for the patient placement
decision.
(3) If an assessment is conducted on a youth, and the
((client)) patient is in need of treatment, the CDP, or CDP
trainee under supervision of a CDP, must also obtain the
following information:
(a) Parental and sibling use of drugs;
(b) History of school assessments for learning disabilities or other problems, which may affect ability to understand written materials;
(c) Past and present parent/guardian custodial status, including running away and out-of-home placements;
(d) History of emotional or psychological problems;
(e) History of child or adolescent developmental problems; and
(f) Ability of parents/guardians to participate in treatment.
(4) Documentation of the information collected, including:
(a) A diagnostic assessment statement including sufficient data to determine a patient diagnosis supported by criteria of substance abuse or substance dependence;
(b) A written summary of the data gathered in subsections (1), (2), and (3) of this section that supports the treatment recommendation;
(c) A statement regarding provision of an HIV/AIDS brief risk intervention, and referrals made; and
(d) Evidence the ((client)) patient:
(i) Was notified of the assessment results; and
(ii) Documentation of treatment options provided, and the
((client's)) patient's choice; or
(iii) If the ((client)) patient was not notified of the
results and advised of referral options, the reason must be
documented.
(5) Completion and submission of all reports required by the courts, department of corrections, department of licensing, and department of social and health services in a timely manner.
(6) Referral of an adult or minor who requires assessment for involuntary chemical dependency treatment to the county-designated chemical dependency specialist.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-310, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-310, filed 11/21/00, effective 1/1/01.]
(a) Patient involvement in treatment planning;
(b) Documentation of progress toward patient attainment of goals; and
(c) Completeness of patient records.
(2) A CDP or a CDP trainee under supervision of a CDP must:
(a) Develop the individualized treatment plan based upon the assessment and update the treatment plan based upon achievement of goals, or when new problems are identified;
(b) Conduct individual and group counseling;
(c) Develop the continuing care plan; and
(d) Complete the discharge summary.
(3) A CDP, or CDP trainee under supervision of a CDP, must also include in the treatment plan for youth problems identified in specific youth assessment, including any referrals to school and community support services.
(4) A CDP, or CDP trainee under supervision of a CDP, must follow up when a patient misses an appointment to:
(a) Try to motivate the patient to stay in treatment; and
(b) Report a noncompliant patient to the committing authority as appropriate.
(5) A CDP, or CDP trainee under supervision of a CDP, must involve each patient's family or other support persons, when the patient gives written consent:
(a) In the treatment program; and
(b) In self-help groups.
(6) When transferring a patient from one certified treatment service to another within the same agency, at the same location, a CDP, or a CDP trainee under supervision of a CDP, must:
(a) Update the patient assessment and treatment plan; and
(b) Provide a summary report of the patient's treatment and progress, in the patient's record.
(7) A CDP, or CDP trainee under supervision of a CDP, must meet with each patient at the time of discharge from any treatment agency, unless in detox or when a patient leaves treatment without notice, to:
(a) Finalize a continuing care plan to assist in determining appropriate recommendation for care;
(b) Assist the patient in making contact with necessary agencies or services; and
(c) Provide the patient a copy of the plan.
(8) When transferring a patient to another treatment provider, the current provider must forward copies of the following information to the receiving provider when a release of confidential information is signed by the patient:
(a) Patient demographic information;
(b) Diagnostic assessment statement and other assessment information, including:
(i) Documentation of the HIV/AIDS intervention;
(ii) TB test result;
(iii) A record of the patient's detox and treatment history;
(iv) The reason for the transfer; and
(v) Court mandated, department of correction supervision status or agency recommended follow-up treatment.
(c) Discharge summary; and
(d) The plan for continuing care or treatment.
(9) A CDP, or CDP trainee under supervision of a CDP, must complete a discharge summary, within seven days of each patient's discharge from the agency, which includes:
(a) The date of discharge or transfer; and
(b) A summary of the patient's progress toward each treatment goal, except in detox.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-315, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-315, filed 11/21/00, effective 1/1/01.]
(1) Demographic information;
(2) A chemical dependency assessment and history of involvement with alcohol and other drugs;
(3) Documentation of the patient's response when asked if the patient is under:
(a) Department of corrections supervision; and
(b) Civil or criminal court ordered mental health or chemical dependency treatment; or
(c) A copy of the court order exempting patient from reporting requirements.
(4) Documentation the patient was informed of the diagnostic assessment and options for referral or the reason not informed;
(((4))) (5) Documentation the patient was informed of
federal confidentiality requirements and received a copy of
the patient notice required under 42 CFR, Part 2 and 45 CFR,
Part 160 through 164;
(((5))) (6) Documentation the patient was informed of
treatment service rules, translated when needed, signed and
dated by the patient before beginning treatment;
(((6))) (7) Voluntary consent to treatment signed and
dated by the patient, parent or legal guardian, except as
authorized by law for protective custody, involuntary
treatment, or the department of corrections;
(((7))) (8) Documentation the patient received counselor
disclosure information, acknowledged by the provider and
patient by signature and date;
(((8))) (9) Documentation of the patient's tuberculosis
test and results;
(((9))) (10) Documentation the patient received the
HIV/AIDS brief risk intervention;
(((10))) (11) Initial and updated individual treatment
plans, including results of the initial assessment and
periodic reviews, addressing:
(a) Patient biopsychosocial problems;
(b) Treatment goals;
(c) Estimated dates or conditions for completion of each treatment goal;
(d) Approaches to resolve the problems;
(e) Identification of persons responsible for implementing the approaches;
(f) Medical orders, if appropriate.
(((11))) (12) Documentation of referrals made for
specialized care or services;
(((12))) (13) At least weekly individualized
documentation of ongoing services in residential services, and
as required in intensive outpatient and outpatient services,
including:
(a) Date, duration, and content of counseling and other treatment sessions;
(b) Ongoing assessments of each patient's participation in and response to treatment and other activities;
(c) Progress notes as events occur, and treatment plan reviews as specified under each treatment service of chapter 388-805 WAC; and
(d) Documentation of missed appointments.
(((13))) (14) Medication records, if applicable;
(((14))) (15) Laboratory reports, if applicable;
(((15))) (16) Properly completed authorizations for
release of information;
(((16))) (17) Copies of all correspondence related to the
patient, including any court orders and reports of
noncompliance;
(((17))) (18) A copy of the continuing care plan signed
and dated by the CDP and the patient; and
(((18))) (19) The discharge summary.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-325, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-325, filed 11/21/00, effective 1/1/01.]
(1) Reporting patient noncompliance is contingent upon obtaining a properly completed authorization to release confidential information form meeting the requirements of 42 CFR Part 2 and 45 CFR Parts 160 and 164 or through a court order authorizing the disclosure pursuant to 42 CFR Part 2, Section 2.63 through 2.67.
(2) Chemical dependency service providers failing to report patient noncompliance with court ordered or deferred prosecution treatment requirements may be considered in violation of chapters 46.61, 70.96A.142 or 10.05 RCW reporting requirements and be subject to penalties specified in WAC 388-805-120, 388-805-125, and 388-805-130.
(3) For patients under the department of corrections supervision and court ordered to treatment, the provider must notify the designated chemical dependency specialist within three working days from obtaining information of any violation of the terms of the court order for purposes of revocation of the patient's conditional release.
(((1))) (4) For emergent noncompliance: The following
noncompliance is considered emergent noncompliance and must be
reported to the appropriate court within three working days
from obtaining the information:
(a) Patient failure to maintain abstinence from alcohol and other nonprescribed drugs as verified by patient self-report, identified third party report confirmed by the agency, or blood alcohol content or other laboratory test;
(b) Patient reports a subsequent alcohol/drug related arrest;
(c) Patient leaves program against program advice or is discharged for rule violation.
(((2))) (5) For nonemergent noncompliance: The following
noncompliance is considered nonemergent noncompliance and must
be reported to the appropriate court as required by subsection
(((3))) (6) and (((4))) (7) of this section:
(a) Patient has unexcused absences or failure to report. Agencies must report all patient unexcused absences, including failure to attend self-help groups. Report failure of patient to provide agency with documentation of attendance at self-help groups if under a deferred prosecution order or required by the treatment plan. In providing this report, include the agency's recommendation for action.
(b) Patient failure to make acceptable progress in any part of the treatment plan. Report details of the patient's noncompliance behavior along with a recommendation for action.
(((3))) (6) If a court accepts monthly progress reports,
nonemergent noncompliance may be reported in monthly progress
reports, which must be mailed to the court within ten working
days from the end of each reporting period.
(((4))) (7) If a court does not wish to receive monthly
reports and only requests notification of noncompliance or
other significant changes in patient status, the reports
should be transmitted as soon as possible, but in no event
longer than ten working days from the date of the
noncompliance.
[Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-330, filed 11/21/00, effective 1/1/01.]
(1) Complete admission assessments within ten calendar days of admission, or by the second visit, unless participation in this outpatient treatment service is part of the same provider's continuum of care.
(2) Conduct group or individual chemical dependency counseling sessions for each patient, each month, according to an individual treatment plan.
(3) ((Assess and document the adequacy of each patient's
treatment and attainment of goals)) Conduct and document a
treatment plan review for each patient:
(a) Once a month for the first three months; and
(b) Quarterly thereafter or sooner if required by other laws.
[Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-620, filed 11/21/00, effective 1/1/01.]
(2) A chemical dependency professional (CDP), or a CDP trainee under supervision of a CDP, must:
(a) For the first sixty days of treatment:
(i) Conduct group or individual chemical dependency counseling sessions for each patient, each week, according to an individual treatment plan.
(ii) Conduct at least one individual chemical dependency counseling session of no less than thirty minutes duration excluding a chemical dependency assessment for each patient, according to an individual treatment plan.
(iii) Conduct alcohol and drug basic education for each patient.
(iv) Document patient participation in self-help groups described in WAC 388-805-300(16) for patients with a diagnosis of substance dependence.
(v) For patients with a diagnosis of substance dependence who received intensive inpatient chemical dependency treatment services, the balance of the sixty-day time period will consist, at a minimum, of weekly outpatient counseling sessions according to an individual treatment plan.
(b) For the next one hundred twenty days of treatment:
(i) Conduct group or individual chemical dependency counseling sessions for each patient, every two weeks, according to an individual treatment plan.
(ii) Conduct at least one individual chemical dependency counseling session of no less than thirty minutes duration every sixty days for each patient, according to an individual treatment plan.
(c) Upon completion of one hundred eighty days of intensive treatment, a CDP, or a CDP trainee under the supervision of a CDP, must refer each patient for ongoing treatment or support, as necessary, using PPC.
(3) For ((client's that)) patients who are assessed with
insufficient evidence of substance dependence or substance
abuse, a CDP must refer the ((client)) patient to alcohol/drug
information school.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-625, filed 9/23/03, effective 10/25/03.]
(a) Ensure off-site treatment services will be provided:
(i) In a private, confidential setting that is discrete from other services provided within the off-site location; and
(ii) By a chemical dependency professional (CDP) or CDP trainee under supervision of a CDP;
(b) Revise agency policy and procedures manuals to include:
(i) A description of how confidentiality will be maintained at each off-site location, including how confidential information and patient records will be transported between the certified facility and the off-site location;
(ii) A description of how services will be offered in a manner that promotes patient and staff member safety; and
(iii) Relevant administrative, personnel, and clinical practices.
(c) Maintain a current list of all locations where off-site services are provided including the name, address (except patient in-home services), primary purpose of the off-site location, level of services provided, and date off-site services began at the off-site location.
[Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-640, filed 11/21/00, effective 1/1/01.]
(2) The medical director must be responsible for ensuring that the opiate substitution treatment program is in compliance with all applicable federal, state, and local laws and regulations.
(3) A program physician or authorized health care professional under supervision of a program physician, must provide oversight for determination of opiate physical addiction and conducting a complete, fully documented physical evaluation for each patient before admission.
(4) A ((physical)) medical examination must be conducted
on each patient:
(a) By a program physician or other medical practitioner; and
(b) Within fourteen days of admission.
(5) Prior to initial prescribed dosage of opiate substitution medication, a program physician must ensure that all pregnant patients are provided written and verbal:
(a) Current health information concerning the possible addiction, health risks and benefits opiate substitution medication may have on them and their fetus;
(b) Current health information concerning the risks of not initiating opiate substitution medication may have on them and their fetus and;
(c) Referral options to address neonatal abstinence syndrome for their baby.
(6) Following the patient's initial dose of opiate substitution treatment, the physician must establish adequacy of dose, considering:
(a) Signs and symptoms of withdrawal;
(b) Patient comfort; and
(c) Side effects from over medication.
(((6))) (7) Prior to the beginning of detox, a program
physician must approve an individual detoxification schedule
for each patient being detoxified.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-710, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-710, filed 11/21/00, effective 1/1/01.]
(2) In addition, an opiate substitution treatment program who is fully compliant with the protocol of an investigational use of a drug and other conditions set forth in the application may administer a drug that has been authorized by the Food and Drug Administration under an investigational new drug application under section 505(i) of the Federal Food, Drug, and Cosmetic Act for investigational use in the treatment of opioid addiction. Currently the following opioid agonist treatment medications will be considered to be approved by the Food and Drug Administration for use in the treatment of opioid addiction:
(a) Methadone;
(b) Levomethadyl acetate (LAAM); and
(c) Buprenorphine distributed as subutex and suboxone.
(3) An opiate substitution treatment program must maintain current procedures that are adequate to ensure that the following dosage form and initial dosing requirements are met:
(a) Methadone must be administered or dispensed only in oral form and must be formulated in such a way as to reduce its potential for parenteral abuse;
(b) For each new patient enrolled in a program, the initial dose of methadone must not exceed thirty milligrams and the total dose for the first day must not exceed forty milligrams, unless the program physician documents in the patient's record that forty milligrams did not suppress opiate abstinence symptoms.
(4) An opiate substitution treatment program must maintain current procedures adequate to ensure that each opioid agonist treatment medication used by the program is administered and dispensed in accordance with its approved product labeling. Dosing and administration decisions must be made by a program physician familiar with the most up-to-date product labeling. These procedures must ensure that any significant deviations from the approved labeling, including deviations with regard to dose, frequency, or the conditions of use described in the approved labeling, are specifically documented in the patient's record.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-715, filed 9/23/03, effective 10/25/03.]
(a) Week, for the first ninety days, for a new patient or a patient readmitted more than ninety days since the person's most recent discharge from opiate substitution treatment;
(b) Week, for the first month, for a patient readmitted within ninety days of the most recent discharge from opiate substitution treatment; and
(c) Month, for a patient transferring from another opiate substitution treatment program where the patient stayed for ninety or more days.
(2) ((A CDP, or a CDP trainee under supervision of a CDP,
must conduct and document a continuing care review with each
patient to review progress, discuss facts, and determine the
need for continuing opiate substitution treatment:
(a) Between six and seven months after admission; and
(b) Once every six months thereafter)) Conduct a treatment plan review once every six months after the second year of continued enrollment in treatment.
(3) A CDP, or a CDP trainee under supervision of a CDP, must provide counseling in a location that is physically separate from other activities.
(4) A pregnant woman and any other patient who requests, must receive at least one-half hour of counseling and education each month on:
(a) Matters relating to pregnancy and street drugs;
(b) Pregnancy spacing and planning; and
(c) The effects of opiate substitution treatment on the woman and fetus, when opiate substitution treatment occurs during pregnancy.
(5) Staff must provide at least one-half hour of counseling on family planning with each patient through either individual or group counseling.
(6) The administrator must ensure there is one staff member who has training in family planning, prenatal health care, and parenting skills.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-740, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-740, filed 11/21/00, effective 1/1/01.]
(a) The medication is for a Sunday or legal holiday, as identified under RCW 1.16.050; or
(b) Travel to the facility presents a safety risk for patients or staff due to inclement weather.
(2) A service provider may permit take-home medications on other days for a stabilized patient who:
(a) Has received opiate substitution treatment medication for a minimum of ninety days; and
(b) Had negative urines for the last sixty days.
(3) The provider must meet 42 CFR, Part 8.12 (i)(1-5) requirements.
(4) The provider may arrange for opiate substitution treatment medication to be administered by licensed staff or self-administered by a pregnant woman receiving treatment at a certified residential treatment agency when:
(a) The woman had been receiving treatment medication for ninety or more days; and
(b) The woman's use of treatment medication can be supervised.
(5) All exceptions to take-home requirements must be authorized by the state methadone authority.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-750, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-750, filed 11/21/00, effective 1/1/01.]
(a) WAC 388-805-001 through 388-805-310;
(b) WAC 388-805-020 and 388-805-325 (1), (2), (3), (4), (5), (9), (15), (16), 388-805-330; and 388-805-350; and
(c) Chapter 388-800 WAC.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-800, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-800, filed 11/21/00, effective 1/1/01.]
(a) WAC 388-805-001 through 388-805-135,
(b) WAC 388-805-145 (4), (5), and (6);
(c) WAC 388-805-150, the administrative manual, subsections (4), (7) through (11), (13), and (14);
(d) WAC 388-805-155, facilities, subsections (1)(b), (c), (d), and (2)(b);
(e) WAC 388-805-200 (1), (4), and (5);
(f) WAC 388-805-205 (1), (2), (3)(a) through (d), (4), (6), and (7);
(g) WAC 388-805-220, 388-805-225, and 388-805-230;
(h) WAC 388-805-260, volunteers;
(i) WAC 388-805-300, clinical manual, subsections (1),
(2), (3), (9), ((and (20)(e))) (20), (21), and (22);
(j) WAC 388-805-305, patients' rights;
(k) WAC 388-805-310, assessments;
(l) WAC 388-805-320, patient record system, subsections (3)(a) through (f), and (5);
(m) WAC 388-805-325, record content, subsections (1),
(2), (3), (4), (5), (7), (((9))) (8), (((11))) (10), (15),
(16), and (17); and
(n) WAC 388-805-350, outcomes evaluation;
(o) WAC 388-805-815, DUI assessment services.
(2) If located in another certified chemical dependency treatment facility, the DUI service provider must meet the requirements of:
(a) WAC 388-805-001 through 388-805-260; 388-805-305 and 388-805-310;
(b) WAC 388-805-300, 388-805-320, 388-805-325 as noted in subsection (1) of this section, 388-805-350; and
(c) WAC 388-805-815.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-810, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-810, filed 11/21/00, effective 1/1/01.]
(2) A chemical dependency professional (CDP), or a CDP
trainee under the supervision of a CDP, or a probation
assessment officer must conduct each ((client)) patient
assessment and ensure the assessment includes, in addition to
the requirements under WAC 388-805-310:
(a) Evaluation of the ((client's)) patient's blood
alcohol level and other drug levels at the time of arrest, if
available; and
(b) Assessment of the ((client's)) patient's
self-reported driving record and the abstract of the
((client's)) patient's legal driving record.
[Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-815, filed 11/21/00, effective 1/1/01.]
(a) WAC 388-805-001 through 388-805-135; and
(b) This section.
(2) The provider must:
(a) Inform each student of fees at the time of enrollment; and
(b) Ensure adequate and comfortable seating in well-lit and ventilated rooms.
(3) A certified information school instructor or a chemical dependency professional must teach the course and:
(a) Advise each student there is no assumption the student is an alcoholic or drug addict, and this is not a therapy session;
(b) Discuss the class rules;
(c) Review the course objectives;
(d) Follow curriculum contained in "Alcohol and Other Drugs Information School Training Curriculum," published in 2001, or later amended;
(e) Ensure not less than eight and not more than fifteen hours of class room instruction;
(f) Administer the posttest from the above reference to each enrolled student after the course is completed;
(g) Ensure individual ((client)) student records include:
(i) Intake form;
(ii) Hours and date or dates in attendance;
(iii) Source of referral;
(iv) Copies of all reports, letters, certificates, and other correspondence;
(v) A record of any referrals made; and
(vi) A copy of the scored posttest.
(h) Complete and submit reports required by the courts and the department of licensing, in a timely manner.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-820, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-820, filed 11/21/00, effective 1/1/01.]
The following section of the Washington Administrative Code is repealed:
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