PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
(Division of Alcohol and Substance Abuse)
Effective Date of Rule: Thirty-one days after filing.
Purpose: The division of alcohol and substance abuse (DASA) is amending, repealing and developing a new section of chapter 388-805 WAC, Certification requirements for chemical dependency service providers, establishing the level of quality and patient care standards for chemical dependency service providers seeking certification by DSHS/DASA.
DASA [is] amending chapter 388-805 WAC. The proposed new rule amendment revisions will include:
1. Adding and expanding definitions in WAC 388-805-005 for "critical incidents" and "screening and brief intervention."
2. Changing the definition in WAC 388-805-005 to "community relations plan and opiate substitution treatment program" to reflect the federal rule and the guidelines for accreditation reference changes.
3. Adding language for a new service in WAC 388-805-010 for "screening and brief intervention."
4. Correcting a typo in WAC 388-805-030 from SAMSHA to SAMHSA.
5. Further defining the legislative authority in WAC 388-805-030 to include "county, city, or tribal," so it is congruent with the rest of the chapter.
6. Expanding the requirements to maintain agency certification in WAC 388-805-100 to include "transfer summary," references for "transfer summary," and reformatting of the section.
7. Correcting the references for a "sample floor plan" in WAC 388-805-110.
8. Reformatting WAC 388-805-145, "key responsibilities required of an agency administrator."
9. Adding language in WAC 388-805-150 requiring an opiate substitution treatment program to report the death of a patient to the department.
10. Reformatting in WAC 388-805-205, "agency personnel file requirements."
11. Adding new language in WAC 388-805-300, "agency clinical manual," that requires that clinical supervisors have documentation of their competency, to document record reviews, allows record reviews to be done semi-annually instead of quarterly, and to ensure continued competency of each chemical dependency professional (CDP).
12. Adding language in WAC 388-805-310, "requirements for chemical dependency assessments," to include evaluation of parental and sibling alcohol and other drug use in youth assessments, moves WAC 388-805-815 requirements to WAC 388-805-310, and adds new language for persons charged with a violation under RCW 46.61.502 or 46.61.504. These requirements for persons with an initial finding other than substance dependence would include:
a. A criminal case history and police report or documentation of efforts to include this information.
b. Results of a urinalysis or drug test at the time of the assessment or documentation of efforts to include this information.
13. Removing the word "transfer" from WAC 388-805-315.
14. Adding language to WAC 388-805-620, requirements for outpatient services, to clarify requirements. An assessment is to be conducted prior to admission and the development [of] an individualized treatment plan prior to the patient's participation in treatment.
15. Removing the word "intensive" from WAC 388-805-625.
16. Adding language to WAC 388-805-710 to reflect the federal requirements in 42 C.F.R. Part 8.12 regarding periodic assessment.
17. Eliminating language from WAC 388-805-715 to reflect the federal notice regarding the use of levomethadyl acetate (LAAM).
18. Adding language to WAC 388-805-810 requirements for DUI assessment providers from WAC 388-805-815 to indicate that programs must limit persons who have been arrested under chapter 46.61 RCW.
19. Eliminating WAC 388-805-815 and moving content to WAC 388-805-310 and 388-805-810.
20. Adding new WAC 388-805-855 for the requirements for "screening and brief intervention services."
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?, 388-805-100 What do I need to do to maintain agency certification?, 388-805-110 What do I do to relocate or remodel a facility?, 388-805-130 How does the department suspend or revoke certification?, 388-805-145 What are the key responsibilities required of an agency administrator?, 388-805-150 What must be included in an agency administrative manual?, 388-805-205 What are agency personnel file requirements?, 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?, 388-805-620 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?, 388-805-710 What are the requirements for opiate substitution medical management?, 388-805-715 What are the requirements for opiate substitution medication management? and 388-805-810 What are the requirements for DUI assessment providers?; repealing WAC 388-805-815 What are the requirements for DUI assessment services?; and new WAC 388-805-855 What are the requirements for screening and brief intervention services?
Citation of Existing Rules Affected by this Order: Repealing WAC 388-805-815; and amending WAC 388-805-005, 388-805-010, 388-805-030, 388-805-100, 388-805-110, 388-805-130, 388-805-145, 388-805-150, 388-805-205, 388-805-300, 388-805-310, 388-805-315, 388-805-620, 388-805-625, 388-805-710, 388-805-715, and 388-805-810.
Statutory Authority for Adoption: RCW 70.96A.040.
Other Authority: Chapter 70.96A RCW and 42 C.F.R. Part 8.
Adopted under notice filed as WSR 08-15-106 on July 18, 2008.
A final cost-benefit analysis is available by contacting Deb Cummins, Certification, P.O. Box 45330, Olympia, WA 98504-5330, phone (360) 725-3716, toll free 1-877-301-4557, fax (360) 586-0343, e-mail cummida@dshs.wa.gov.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 1, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 16, Repealed 1.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 17, Repealed 1.
Date Adopted: December 1, 2008.
Robin Arnold-Williams
Secretary
4002.3"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 owner to another distinct 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 defined
by the Center for Substance Abuse Guidelines for the
Accreditation of Opioid Treatment Programs, section ((XVIII))
2.C.(4).
"County coordinator" means the person designated by the 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;
(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 theft of patient identifying information;
(7) Suicide attempt at the facility;
(8) An error in program administered medication at an outpatient facility that results in adverse effects requiring urgent medical intervention.
"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 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 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 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
medication as specified in ((212 CFR Part 291)) 42 CFR Part 8
for treatment or detoxification of opiate 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 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 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.
"Screening and brief intervention" means: a combination of services designed to screen for risk factors that appear to be related to alcohol and other drug use disorders, provide interventions to enhance patient motivation to change, and make appropriate referral as needed.
"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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-005, filed 5/17/06, effective 6/17/06. 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 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 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) Screening and brief intervention services, a combination of services designed to screen for risk factors that appear to be related to alcohol and other drug use disorders, provide interventions and make appropriate referral as needed. These services may be provided in a wide variety of settings.
(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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-010, filed 5/17/06, effective 6/17/06. 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 meets county, tribal or city land use ordinances.
(2) A completed community relations plan developed in consultation with the county, city or tribal 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:
(a) Obtain stakeholder input regarding the proposed location;
(b) Address any concerns identified by stakeholders; and
(c) Develop an ongoing community relations plan to address new concerns expressed by stakeholders as they arise.
(3) A copy of the application for a registration certificate from the Washington state board of pharmacy.
(4) A copy of the application for licensure to the Federal Drug Enforcement Administration.
(5) A copy of the application for certification to the Federal CSAT SAMHSA.
(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.
(7) Policies and procedures identified under WAC 388-805-700 through 388-805-750.
(8) Documentation that transportation systems will provide reasonable opportunities to persons in need of treatment to access the services of the program.
(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. The letters must demonstrate a relationship to the service area's existing health care system.
(10) A declaration to limit the number of individual program participants to three hundred fifty as specified in RCW 70.96A.410 (1)(e).
(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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-030, filed 5/17/06, effective 6/17/06. 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.]
(((a))) (1) Completion of an annual declaration of
certification((; and)).
(((b))) (2) Payment of certification fees, if applicable.
(((2))) (3) 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(11);
(iii) Documenting patient progress, as described in WAC 388-805-315 (1)(b) and 388-805-325(13);
(iv) Treatment plan reviews and updates, as described in WAC 388-805-315 (2)(a), 388-805-325(11) and 388-805-325 (13)(c);
(v) Patient compliance reports, as described in WAC 388-805-315 (4)(b), 388-805-325(17), and 388-805-330;
(vi) Continuing care, transfer summary and discharge planning, as described in WAC 388-805-315 (2)(c) and (d), (6)(a) and (b), and (7)(a), and 388-805-325 (18) and (19); and
(vii) Conducting individual and group counseling, as described in WAC 388-805-315 (2)(b) and 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))) (4) 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))) (5) The provider must post the notice of a
scheduled department on-site survey in a conspicuous place
accessible to patients and staff.
(((5))) (6) 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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-100, filed 5/17/06, effective 6/17/06. 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.]
(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.
(b) Submit a sample floor plan that includes information
identified under WAC 388-805-015 (2)(((f)))(j) through (((k)))
(l).
(c) Submit a completed facility accessibility self-evaluation form.
(d) Provide for department examination of nonresidential premises before approval, as described under WAC 388-805-060.
(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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-110, filed 5/17/06, effective 6/17/06. 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.]
(2) The department must revoke a provider's certification when the provider knowingly failed to report, as ordered by the court pursuant to chapter 46.61 RCW, within a continuous twelve-month period, three incidents of patient noncompliance with treatment ordered by the court.
(3) The department may suspend or revoke a provider's certification when any of the following provider deficiencies or circumstances occur:
(a) A provider fails to provide the essential
requirements of chemical dependency treatment as described in
WAC ((388-805-100(2))) 388-805-100(3), and one or more of the
following conditions occur:
(i) Violation of a rule threatens or results in harm to a patient;
(ii) A reasonably prudent provider should have been aware of a condition resulting in significant violation of a law or rule;
(iii) A provider failed to investigate or take corrective or preventive action to deal with a suspected or identified patient care problem;
(iv) Noncompliance occurs repeatedly in the same or similar areas;
(v) There is an inability to attain compliance with laws or rules within a reasonable period of time.
(b) The provider fails to submit an acceptable and timely plan of correction for cited deficiencies; or
(c) The provider fails to correct cited deficiencies.
(4) The department may suspend certification upon receipt of a providers written request. Providers requesting voluntary suspension must submit a written request for reinstatement of certification within one year from the effective date of the suspension. The department will review the request for reinstatement, determine if the provider is able to operate in compliance with certification requirements, and notify the provider of the results of the review for reinstatement.
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-130, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-130, 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:
(a) 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));
(b) 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)); and
(c) A formally designated ((a)) medical director is
appointed who shall assume responsibility for:
(((a))) (i) All medical services performed; and
(((b))) (ii) Ensuring the program is in compliance with
all applicable Federal, State and local laws and regulations.
[Statutory Authority: RCW 70.96A.090, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-145, filed 5/17/06, effective 6/17/06. 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 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; or
(c) The patient is enrolled in an opiate substitution treatment program.
(13) Patient grievance policy and procedures.
(14) A policy and procedures on reporting of critical incidents and actions taken to the 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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-150, filed 5/17/06, effective 6/17/06. 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.]
(2) The administrator must designate a person to be responsible for management of personnel files.
(3) Each person's file must contain:
(a) A copy of the results of a tuberculin skin test or evidence the person has completed a course of treatment approved by a physician or local health officer if the results are positive;
(b) Documentation of training on bloodborne pathogens, including HIV/AIDS and hepatitis B for all employees, volunteers, students, and treatment consultants on contract;
(i) At the time of staff's initial assignment to tasks where occupational exposure may take place;
(ii) Annually thereafter for bloodborne pathogens;
(c) A signed and dated commitment to maintain patient confidentiality in accordance with state and federal confidentiality requirements; and
(d) A record of an orientation to the agency as described in WAC 388-805-200(5).
(4) In addition, each personnel file for staff members providing patient care must contain:
(a) Verification of qualifications for their assigned position including:
(i) For a chemical dependency professional (CDP): A copy of the person's valid CDP certification issued by the department of health (DOH);
(ii) For approved supervisors: Documentation to substantiate the person meets the qualifications of an approved supervisor as defined in WAC 246-811-010;
(iii) For each person engaged in the treatment of chemical dependency, including counselors, physicians, nurses, and other registered, certified, or licensed health care professionals, evidence they comply with the credentialing requirements of their respective professions;
(b) A copy of a current job description, signed and dated by the employee and supervisor which includes:
(i) Job title;
(ii) Minimum qualifications for the position;
(iii) Summary of duties and responsibilities;
(iv) For contract staff, formal agreements or personnel contracts, which describe the nature and extent of patient care services, may be substituted for job descriptions.
(c) A written performance evaluation for each year of employment:
(i) Conducted by the immediate supervisor of each staff member; and
(ii) Signed and dated by the employee and supervisor.
(5) In addition, for residential ((facilities)) programs,
the personnel file for staff members providing patient care
must contain documentation ((of current cardiopulmonary
resuscitation (CPR) and first-aid training)) for at least one
person on each shift of training in:
(a) Cardiopulmonary resuscitation (CPR); and
(b) First aid.
(((5))) (6) Documentation of health department training
and approval for any staff administering or reading a TB test.
(((6))) (7) Employees who have been patients of the
agency must have personnel records:
(a) Separate from clinical records; and
(b) Have no indication of current or previous patient status.
(((7) In addition, each patient care staff member's
personnel file must contain:
(a) Verification of qualifications for their assigned position including:
(i) For a chemical dependency professional (CDP): A copy of the person's valid CDP certification issued by the department of health (DOH);
(ii) For approved supervisors: Documentation to substantiate the person meets the qualifications of an approved supervisor as defined in WAC 246-811-010;
(iii) For each person engaged in the treatment of chemical dependency, including counselors, physicians, nurses, and other registered, certified, or licensed health care professionals, evidence they comply with the credentialing requirements of their respective professions;
(iv))) (8) For probation assessment officers (PAO): Documentation that the person has met the education and experience requirements described in WAC 388-805-220;
(((v))) (a) For probation assessment officer trainees:
(((A))) (i) Documentation that the person meets the
qualification requirements described in WAC 388-805-225; and
(((B))) (ii) Documentation of the PAO trainee's
supervised experience as described in WAC 388-805-230
including an individual education and experience plan and
documentation of progress toward completing the plan.
(((vi))) (9) For information school instructors:
(((A))) (a) A copy of a certificate of completion of an
alcohol and other drug information school instructor's
training course approved by the department; and
(((B))) (b) Documentation of continuing education as
specified in WAC 388-805-250.
(((b) A copy of a current job description, signed and
dated by the employee and supervisor which includes:
(i) Job title;
(ii) Minimum qualifications for the position;
(iii) Summary of duties and responsibilities;
(iv) For contract staff, formal agreements or personnel contracts, which describe the nature and extent of patient care services, may be substituted for job descriptions.
(c) A written performance evaluation for each year of employment:
(i) Conducted by the immediate supervisor of each staff member; and
(ii) Signed and dated by the employee and supervisor.))
[Statutory Authority: RCW 70.96A.090, chapter 70.96A RCW, 2001 c 242, 42 C.F.R. Part 8. 03-20-020, § 388-805-205, filed 9/23/03, effective 10/25/03. Statutory Authority: RCW 70.96A.090 and chapter 70.96A RCW. 00-23-107, § 388-805-205, 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) Has documented competency in clinical supervision;
(c) Reviews and documents a sample of patient records of
each CDP ((quarterly)) semi annually; ((and))
(((c))) (d) Ensures implementation of assessment,
treatment, continuing care, transfer and discharge plans in
accord with WAC 388-805-315; and
(e) Ensures continued competency of each CDP in assessment, treatment, continuing care, transfer, and discharge plans in accord with WAC 388-805-310 and 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) 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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-300, filed 5/17/06, effective 6/17/06. 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 patient to obtain, review, evaluate, and document the following:
(a) A history of the 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 patient's self-assessment of use of alcohol and other drugs;
(d) A relapse history; ((and))
(e) A legal history; and
(f) In addition, for persons who have been charged with a violation under RCW 46.61.502 or 46.61.504 RCW, ensure the assessment includes an evaluation in the written summary of the patient's:
(i) Blood or breath alcohol level and other drug levels or documentation of the patient's refusal at the time of the arrest, if available;
(ii) Self reported driving record and the abstract of the patient's legal driving record; and
(iii) If the initial finding is other than substance dependence, the assessment must also include:
(A) The police report or documentation of efforts to include this information;
(B) A court originated criminal case history or documentation of efforts to include this information; and
(C) The results of a urinalysis or drug testing obtained at the time of the assessment or documentation of efforts to include this information.
(2) If the 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 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 alcohol and other 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 patient:
(i) Was notified of the assessment results; and
(ii) Documentation of treatment options provided, and the patient's choice; or
(iii) If the 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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-310, filed 5/17/06, effective 6/17/06. 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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-315, filed 5/17/06, effective 6/17/06. 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) Complete admission assessments ((within ten calendar
days of admission, or by the second visit)), prior to
admission unless participation in this outpatient treatment
service is part of the same provider's continuum of care.
(2) Complete an initial individualized treatment plan prior to the patient's participation in treatment.
(3) Conduct group or individual chemical dependency counseling sessions for each patient, each month, according to an individual treatment plan.
(((3))) (4) 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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-620, filed 5/17/06, effective 6/17/06. 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 patients who are assessed with insufficient evidence of substance dependence or substance abuse, a CDP must refer the patient to alcohol/drug information school.
[Statutory Authority: RCW 70.96A.090, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-625, filed 5/17/06, effective 6/17/06. 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.]
(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))) (2) A medical examination must be conducted on
each patient:
(a) By a program physician or other medical practitioner;
((and))
(b) Within fourteen days of admission; and
(c) Annually to update the medical examination of each patient by a program physician or other medical practitioner to include the patient's overall physical condition and response to medication.
(((5))) (3) 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))) (4) 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.
(((7))) (5) 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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-710, filed 5/17/06, effective 6/17/06. 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; and
(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, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-715, filed 5/17/06, effective 6/17/06. 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) 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))) (5), 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), (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), (8), (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; and
(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)).
(3) Providers must limit patients to persons who have been arrested for a violation of driving under the influence of intoxicating liquor or other drugs or in physical control of a vehicle as defined under chapter 46.61 RCW.
[Statutory Authority: RCW 70.96A.090, 70.96A.142, 70.96A.157, chapter 70.96A RCW, 2004 c 166, 2005 c 70 and 504, 42 C.F.R. Parts 2 and 8. 06-11-096, § 388-805-810, filed 5/17/06, effective 6/17/06. 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.]
(a) WAC 388-805-001 through 388-805-135, 388-805-205 and 388-805-640; and
(b) This section.
(2) The screening and brief intervention administrator must:
(a) Ensure a chemical dependency professional (CDP), or a CDP trainee under the supervision of a CDP, provides the services;
(b) Maintains a current list of local resources for legal, employment, education, interpreter, and social and health services;
(c) Ensure all staff completes forty hours of training that covers the following areas before assigning unsupervised duties:
(i) Chemical dependency screening and brief intervention techniques; and
(ii) Motivational interviewing.
(d) Have policies and procedures for the provision of screening and brief intervention services, such as:
(i) Screening;
(ii) Motivational interviewing; and
(iii) Referral.
(e) Ensure the individual patient records contain:
(i) A copy of a referral;
(ii) Demographic information;
(iii) Documentation the patient was informed and received a copy of the requirements under 42 C.F.R Part 2;
(iv) Documentation the patient received a copy of the counselor disclosure information;
(v) Documentation the patient received a copy of the patient rights;
(vi) Properly completed authorization for the release of information;
(vii) A copy of screening documents including outcome and referrals; and
(viii) Progress notes summarizing any contact with the patient.
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The following section of the Washington Administrative Code is repealed:
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