WSR 97-02-009

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Division of Alcohol and Substance Abuse)

(General Provisions)

[Filed December 20, 1996, 3:40 p.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 96-22-027.

Title of Rule: Certification requirements for chemical dependency treatment service providers.

Purpose: (1) Amend chapter 440-22 WAC sections and add new sections necessary to redefine the terms chemical dependency (CD) counselor and CD intern and add requirement to obtain "certification of qualification" and "letter of enrollment" respectively. (2) Amend chapter 440-22 WAC sections necessary to add the requirement for certified CD programs to adopt the patient placement criteria published by the American Society of Addition Medicine (ASAM) as the standard for patient admissions, continuing care, transfers, and discharges. (3) Amend WAC 440-22-005, 440-22-225, 440-22-230, 440-22-310, and 440-22-335 to correct language or further explain the current regulations.

Statutory Authority for Adoption: RCW 70.96A.040.

Statute Being Implemented: Chapter 70.96A RCW.

Summary: Same as Purpose above.

Reasons Supporting Proposal: (1) and (2) described in Purpose section are drafted and proposed at request of several chemical dependency provider associations.

Name of Agency Personnel Responsible for Drafting: Division of Alcohol and Substance Abuse, Gary Reynolds, Lacey, Washington, (360) 438-8054; Implementation and Enforcement: Division of Alcohol and Substance Abuse, Certification Section, Lacey, Washington, (360) 438-8052.

Name of Proponent: Margaret Jones, President, Association of Alcoholism and Addictions Programs; Don Thomas, President, Washington State Association of Independent Outpatient Programs; John Horngren, Chairman, Washington State Adolescent Chemical Dependency Treatment Providers; Leo Whiteford, Chairman, Northwest Indian Council on Chemical Dependency, and Northwest Indian Alcohol/Drug Specialist Certification Board; Diane Hall, President, Chemical Dependency Professionals of Washington State; Lanny Minuto, President, Chemical Dependency Counselor Certification Board; and Tom Armstrong, President, Northwest Chapter, National Association of Addiction Treatment Providers, private; and Department of Social and Health Services, Division of Alcohol and Substance Abuse, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: 1. Amendments will require CD counselor interns to obtain a "letter of enrollment" and CD counselors to obtain a "certificate of qualification" from the department which provides evidence that they meet the minimum respective standards described in chapter 440-22 WAC and are thereby qualified to work in state-approved CD programs. The changes will place responsibility for obtaining these credentials on the interns and counselors. This change will benefit all concerned (counselors, administrators, and DASA program auditors) by (a) reducing the large amount of paperwork currently required in agency personnel files to provide evidence interns and counselors meet the qualification requirements; and (b) will provide a single page credential that interns and counselors can provide to certified CD program employers attesting they are qualified to work in state-approved CD treatment facilities. New sections will be added to provide the rules for disqualification, denial, expiration, suspension, or revocation of CD counselor certificate of qualification. This is necessary for the provision of due process. The amendment to add the knowledge exam and supervisor/peer review will bring the WAC standard into agreement with standards currently used by this state's private CD certification boards and by national CD certification boards and, provide additional tools for professional quality assurance by asking CD counselors to pass a knowledge exam and provide supervisor and peer counselor's attestation to the counselor's competency. A grandparenting section is included excluding currently qualified counselors from the knowledge exam requirement.

2. Amendments add a requirement for all state certified CD treatment programs to adopt and use the patient placement criteria published by the American Society of Addition Medicine (ASAM) in making patient decisions for admission placement, continuing care, transfer, and discharge. This will provide Washington state's CD treatment programs with a nationally recognized, state of the art, criteria for making these decisions in line with several other states in the nation. Currently, there is no common standard being employed leaving patients and clinicians alike vulnerable to inappropriate placement, continuing care, transfer and discharge decisions. The ASAM standards are considered the most widely accepted criteria available within the CD field and will provide a "common language" for all professionals working in state-approved CD programs.

3. Amendment to WAC 440-222-005(47), (definition for "vulnerable adult") brings the definition into conformance with a recent change in this definition in RCW 43.43.830; WAC 440-22-225 adds wording to clarify acceptable training and work experience for probation assessment officers; WAC 440-22-230 removes a date reference for youth chemical dependency counselors that has passed; WAC 440-22-310 (2)(i) changes the current placement for the requirement for patient redisclosure statement" into its own subsection. This will help mitigate confusion that the current placement of this wording in the WAC has caused; and WAC 440-22-335(3) adds wording to clarify this requirement.

Proposal Changes the Following Existing Rules: 1. Amends chemical dependency (CD) counselor qualification standards in RCW 440-22-005, 440-22-180, 440-22-200, 440-22-220, 440-22-225, 440-22-230, 440-22-240, 440-22-250 WAC by adding a knowledge exam and supervisor/peer review process; amending the definitions sections for CD counselors and CD interns and other sections describing requirements and process for obtaining "certificate of qualification" and "letter of endorsement" for CD counselors and CD interns respectively; adds new sections WAC 440-22-253, 440-22-255, and 440-22-257 to the chapter describing disqualification, denial, expiration, suspension, or revocation of CD counselor certificate of qualification.

2. Amends WAC 440-22-005, 440-22-300, 440-22-320, 440-22-325, and 440-22-335 by adding a requirement for certified treatment agencies to use patient placement criteria published by the American Society of Addition Medicine (ASAM) as the standard for making admission placement, continuing care, transfer, and discharge decisions.

3. Amends the following sections of chapter 440-22 WAC to correct or clarify language; WAC 440-22-005(47), definition for "Vulnerable adult" to bring it into conformance with an amendment to this definition in RCW 43.43.830; WAC 440-22-225, adding clarification language; WAC 440-22-230, removing an effective date that has been passed; WAC 440-22-310 (2)(i), corrected to clarify rule; and WAC 440-22-335(3), additional explanatory language.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

Small Business Economic Impact Statement


Introduction: In August of this year, Kenneth D. Stark, director of the Division of Alcohol and Substance Abuse (DASA) received a letter cosigned by leaders of eight chemical dependency (CD) professional associations representing a majority of the CD treatment agencies and CD counselors in Washington state.1 The letter requested that DASA move to draft and initiate amendments to chapter 440-22 WAC to, (a) correct programmatic inefficiencies in determining CD counselor qualifications and, (b) adopt the nationally accepted patient placement criteria published by the American Society of Addiction Medicine (ASAM) as the standards for use in Washington state certified treatment agencies.

Mr. Stark presented this request, as an item of new business, at the August 15, 1996 meeting of the Citizens Advisory Council (CAC) on Alcoholism and Drug Addictions.2 The CAC agreed with the requests and appointed a subcommittee to work with DASA staff to draft proposed amendment language. Subsequently, a small workgroup, chaired by Patricia Stromberg of the CAC, drafted proposed amendments for chapter 440-22 WAC and presented them before a larger CD provider stakeholder group3 in a meeting held in Burien, September 25, 1996. The stakeholder group, composed of representatives from Washington's CD provider organizations directly impacted by the proposal, negotiated minor changes to the draft amendments and arrived at full consensus with its content. The proposed amendments were then presented back before the CAC wherein, on October 17, 1996, the council voted to recommend that DASA submit the proposed regulations, as written, for adoption.

description of impact of proposed regulations


Applicability of Proposed Regulations: The proposed amendments will apply to all CD treatment agencies certified by DASA. As of October 9, 1996, there were four hundred forty-two agencies certified by DASA as CD treatment agencies in the state of Washington. With the exception of three to five agencies, all of these businesses employ less than fifty individuals and therefore are considered small businesses. About two hundred ninety of the four hundred forty-two agencies are private for profit businesses.

Chemical Dependency Counselor and Intern Amendments - Compliance Requirements: The proposal amends the definitions sections for CD counselors and CD interns and amends language in other sections describing requirements and process for obtaining "certificate of qualification" and "letter of enrollment" for CD counselors and CD interns, respectively. The amendments will require counselors and interns to submit documentation substantiating they have completed all of the education and experience requirements for their respective positions in accordance with chapter 440-22 WAC through a review process approved by the department in order to obtain a "certificate of qualification" or "letter of enrollment" that attests to their qualification. Agencies will be required to include a copy of each counselor's "certificate of qualification" and CD intern's "letter of enrollment" in their personnel files. These documents will replace the large amount of documentation currently required by the regulations to confirm one's qualifications. The proposal, in effect, shifts the responsibility for proving counselor/intern qualification from the CD agency to the CD counselor or intern. Agency administrators will no longer be forced to review the large amount of documentation currently required in order to determine if an applicant or current intern/counselor employee meets the WAC qualification standards.

Chemical Dependency Counselor and Intern Amendments - Analysis of Cost of Compliance: This change will actually cut costs to some CD treatment agencies by:

1. Saving hours of employer administrative time currently devoted to obtaining and reviewing the large amount of documentation required to substantiate each counselor/intern's initial and ongoing qualification. The estimated time savings is 2.5 hours per employee in initial hiring and 1.5 hours per employee in every subsequent two-year period. At a $50 per hour administrative cost, this equates to a savings of $200 per each new employee over their first two years of employment and $75 per employee for each subsequent two-year period. As an example, in a small agency with a staff of three CD counselors, this could save an estimated $600 in administrative costs.

2. Reducing the large amount of paperwork currently required to be kept in personnel files to document the counselor/intern's qualification. It is estimated that approximately $15 per employee will be saved in copying and filing costs alone. Using our example from item 1., this would save $45.

3. Assist employers in recruiting qualified staff more efficiently when seeking new or replacement staff. An employer/administrator, by being able to ask for a "certificate of qualification" or "letter of enrollment" from prospective counselors or interns to determine their qualification status, will not waste time interviewing potentially unqualified persons. This benefit could save CD program administration hundreds of dollars in recruitment costs and costs associated with problems related to inappropriate hiring. Estimated average prorated savings, $75 per employee.

Total estimated average savings for example 1. agency = $870.

Patient Placement Criteria Amendments - Compliance Requirements: This proposal adds a requirement for certified treatment agencies to adopt patient placement criteria (PPC) published by the ASAM as the standard for making patient admission placement, continuing care, transfer, and discharge decisions. Agency clinical procedures will need to be updated to reflect how the ASAM PPC criteria is used within the program for determining proper patient admission, continuing care, transfer and discharge decisions. Patient records will be required to make reference to the PPC criteria in the documentation of these decisions.

Patient Placement Criteria Amendments - Analysis of Cost of Compliance: If an agency has not already adopted these criteria, the estimated costs for doing so includes:

1. A one-time expense of purchasing the PPC manual from the ASAM. ASAM manuals cost $100. Manuals have been made available at reduced cost ($85) at training sponsored by the Association of Alcoholism/Addictions Programs (AAP). Two manuals being purchased by our model agency (see item 1. in "Chemical Dependency Counselor And Intern Amendments - Analysis Of Cost Of Compliance" above) would total $170.

2. A one-time cost of updating the agency's clinical procedures manual to incorporate procedures necessary to describe how the agency will use the criteria. It is estimated that it will take ten hours of administrative time, at $50 per hour to accomplish this task. This equates to an estimated cost of $500.

3. Costs for training clinical supervisors in the use of the PPC varies. Training costs vary from $30 to $500. Most agencies have been sending one or two staff through the training. They in turn return to their agencies and provide in-service training to their peers or subordinates. Including travel and per diem costs, the costs for off-site training for two counselors is estimated to average $150.

Total estimated costs for example 1. agency = $820.

Impact on Provider Agency Revenues: Adoption of these amendments may have a positive impact on agency revenues, to the extent they can increase insurance reimbursement because of better documentation and use of national PPC with which insurance companies are familiar.

Determination of Disproportionate Impact and Mitigation of Costs: Over ninety-nine percent of all certified agencies in the chemical dependency treatment industry employ less than fifty staff. Therefore, for the purposes of this study we have considered all providers to be small businesses. As shown above, it is estimated that cost savings from the adoption of the CD counselor/intern proposal will offset the additional costs imposed by the ASAM PPC proposal and result in a net cost savings. Where agencies have already adopted the use of ASAM PPC, these amendments will result in an even greater overall cost benefit. Therefore, there is no disproportionate impact imposed by these regulations.

Again, both of the amendments to the regulations are being proposed at the request of the CD treatment industry's provider and counselor associations which represent both private-for-profit and private nonprofit treatment agencies and individual counselors in Washington state. Even though no disproportionate cost impact has been determined, DASA, in collaboration with the AAP plan to provide assistance in a variety of ways to mitigate implementation and ongoing costs.

CD Counselor/Intern Amendments - Cost Mitigation: As mentioned above, the CD counselor/CD intern amendments will result in agency administrative cost savings.

Patient Placement Criteria Amendments - Cost Mitigation: Many CD agencies in Washington state have already incorporated the use of the ASAM PPC as standard operating procedures. The AAP, with a membership of one hundred fifty certified agencies, has been providing training and consultation for member and nonmember organizations over the past four years. AAP reports that staff from two hundred forty-three agencies have already attended AAP sponsored ASAM PPC training and estimate two hundred agencies are either already using the ASAM PPC or are in the process of implementing procedures for its use. The majority of these agencies are private-for-profit agencies. Similarly, since October 1995, DASA has sponsored four separate ASAM PPC training events. Staff from 170 agencies have attended the DASA training events. It is likely that some of the agencies attending the AAP training events may have also attended a DASA training event.

To assist in further mitigating costs to both the private-for-profit and nonprofit agencies remaining to adopt these standards, DASA plans to:

1. Offer agencies the ASAM PPC manuals at reduced cost. DASA will purchase the manuals at a bulk rate and sell them to agencies at the reduced cost. This could save approximately $25 per manual.

2. Continue to provide training on using the ASAM criteria at low cost. The AAP reports it also plans to continue to provide ASAM PPC training and provide bulk rate discounts on the PPC manuals.

3. Consult with Washington state's community colleges to update CD counselor training curricula to include training on use of ASAM PPC in their CD course work. This would provide all new CD interns and counselors entering the field with information and clinical application skills regarding PPC as a part of their basic course work, thus reducing the need for future training.

4. A one-year moratorium from the date of adoption of the regulations will be instituted by DASA to give providers the time necessary to make the changes required to incorporate the ASAM PPC in their clinical processes. In this interim period, DASA certification staff will provide on-site technical assistance at the time of agency certification surveys for those agencies found out of compliance with the ASAM PPC requirements and given time to employ the corrective action necessary to institute the new standards.

1 Cosignors of August 5, 1996, letter to Kenneth D. Stark, Director, Division of Alcohol and Substance Abuse, requesting amendments to chapter 440-22 WAC: Margaret Jones, President, Association of Alcoholism and Addictions Programs; Don Thomas, President, Washington State Association of Independent Outpatient Programs; John Horngren, Chairman, Washington State Adolescent Chemical Dependency Treatment Providers; Leo Whiteford, Chairman, Northwest Indian Council on Chemical Dependency, and Northwest Indian Alcohol/Drug Specialist Certification Board; Diane Hall, President, Chemical Dependency Professionals of Washington State; Lanny Minuto, President, Chemical Dependency Counselor Certification Board; and Tom Armstrong, President, Northwest Chapter, National Association of Addiction Treatment Providers.

2 Citizens Advisory Council on Alcoholism and Drug Addiction: Thomas H. Cooke, Seattle; Law Risken, Olympia, Patricia Stromberg, Bellevue; George Henson, Sedro Woolley; Yvonne Rivers, Spokane; Mel Schulstad, Redmond; Steven Neumiller, Spokane; Cheryl Pfaff, Vancouver; Carolyn Hillery, Raymond; Arthur E. Krontz, Ellensburg; Larry Vital, Vancouver; Page Gilbert-Baenen, Greenbank; Ron Murphy, Tacoma; and Desiree Ferguson, Wellpinit.

3 Stakeholder representatives invited to participate in chapter 440-22 WAC amendment process: Linda Grant, Executive Director, Association of Alcoholism/Addictions Programs; Don Thomas, President, Washington State Association of Independent Outpatient Programs; Leo Whiteford, Chairman, Northwest Indian Alcohol/Drug Specialist Certification Board; Pat Knox, President (current), Association of Alcoholism/Addictions Programs; Margaret Jones, President (past), Association of Alcoholism/Addictions Programs; Patty Terry, C.D. Program Coordinator, Department of Corrections, Division of Offender Programs; Bill Cobb, Director, King County District Court Probation; Mel Schulstad, Citizens Advisory Council on Alcoholism and Drug Addiction; Cleve Thompson, Association of County Human Services; George Hensen, Citizens Advisory Council on Alcoholism and Drug Addiction; Marilyn Bordner, Coalition on Women's Substance Abuse Issues; Lanny Minuto, President, Chemical Dependency Counselors Certification Board; Luis Rosado, Jr., MA, CDSII, CCDCIII, Chemical Dependency Counselors Certification Board; Tom Armstrong, N.W. Chapter, President, National Association of Addiction Treatment Programs; John Horngren, Chairman, Washington State Adolescent Chemical Dependency Treatment Providers; Terry Schmidt-Whelan, TASC; Gary Schaub, Director, Seattle Municipal Court Probation; Yvonne Rivers, Citizens Advisory Council on Alcoholism and Drug Addiction; Patricia Stromberg, Citizens Advisory Council on Alcoholism and Drug Addiction; Gerry Conghlin, Alcohol/Drug 24-Hour Help Line; John Borders, Washington State Adolescent Chemical Dependency Treatment Providers; and Diane Hall, President, Chemical Dependency Professionals of Washington State.

A copy of the statement may be obtained by writing to Gary Reynolds, WAC Coordinator, Division of Alcohol and Substance Abuse, P.O. Box 45330, Olympia, WA 98504-5330, phone (360) 438-8054, FAX (360) 438-8057, e-mail/Internet reynogl@dshs.wa.gov.

Section 201, chapter 403, Laws of 1995, does not apply to this rule adoption. The Department of Social and Health Services is not a named agency under RCW 34.05.328.

Hearing Location: Lacey Government Center (behind Tokyo Bento restaurant), 1009 College Street S.E., Room 140-A, Lacey, WA 98503, on February 25, 1997, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Merry Kogut, Manager, by February 11, 1997, TDD (360) 902-8324, or (360) 902-8317.

Submit Written Comments to and Include WAC Numbers: Leslie Baldwin, Rules Coordinator, Rules and Policy Assistance Unit, Department of Social and Health Services, P.O. Box 45850, Olympia, WA 98504-5850, FAX (360) 902-8292, by February 25, 1997.

Date of Intended Adoption: February 26, 1997.

December 2, 1996

Merry A. Kogut, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-005 Definitions. Unless the context clearly indicates otherwise, the definitions in this section apply throughout this chapter:

(1) "Administrator" means the person designated responsible for the operation of the certified treatment service;

(2) "Adult" means a person eighteen years of age or older. "Young adult" means an adult who is not yet twenty-one years of age;

(3) "Alcoholic" means a person who has the disease of alcoholism;

(4) "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;

(5) "Authenticated" means written, permanent verification of an entry in a patient treatment record 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;

(6) "Authentication record" means a document which is part of a patient's treatment record, with legible identification of all persons initialing entries in the treatment record, and includes:

(a) Full printed name;

(b) Signature including the first initial and last name; and

(c) Initials and abbreviations indicating professional designation or job title.

(7) "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);

(8) "Branch service site" means a physically separate certified unit where qualified staff provide a certified treatment service and are governed by a parent organization;

(9) "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 440-22 WAC;

(10) "Chemical dependency" means a person's alcoholism or drug addiction or both;

(11) "Chemical dependency counseling" means face-to-face individual or group contact using therapeutic techniques and:

(a) Led by a chemical dependency counselor (CDC) or a CDC intern under direct CDC supervision;

(b) Directed toward patients and others who are harmfully affected by the use of mood-altering chemicals or are chemically dependent; and

(c) Directed toward a goal of abstinence for chemically dependent persons.

(12) "Chemical dependency counselor (CDC)" means a ((person registered, certified, or exempted by the state department of health, and qualified as a CDC as)) registered counselor who has obtained a certificate of qualification from the department affirming the person has met the counselor qualification requirements described under WAC 440-22-240. ((Categories of chemical dependency counselors include:

(a) "Assessment officer" which means a person employed at a certified district or municipal court treatment program who meets WAC 440-22-225 requirements or is grandparented as meeting those requirements;

(b))) A subcategory of CDC includes "youth chemical dependency counselor (YCDC)" which means a person who meets the requirements in WAC 440-22-230 ((requirements)).

(13) "Chemical dependency counselor (((CDC))) intern (CI)" means a person who ((meets the standards for CDC interns)) has obtained a letter of enrollment from the department or its designee affirming the person has met the CI qualification requirements described under WAC 440-22-200 and ((440-22-220, and)) is ((supervised by a CDC)) working under supervision in a certified treatment agency((,)) toward internship completion as described under WAC 440-22-210 and 440-22-220;

(14) "Child" means a person less than eighteen years of age, also known as adolescent, juvenile, or minor;

(15) "County coordinator" means the person designated by the chief executive officer of a county to carry out administrative and oversight responsibilities of the county chemical dependency program;

(16) "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;

(17) "Department" means the Washington state department of social and health services;

(18) "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;

(19) "Disability, person with a" means a person who:

(a) Has a physical or mental impairment that substantially limits one or more major life activities of the person;

(b) Has a record of such an impairment; or

(c) Is regarded as having such an impairment.

(20) "Discrete treatment service" means a chemical dependency treatment service that:

(a) Provides distinct chemical dependency supervision and treatment separate from other services provided within the facility;

(b) Provides a separate treatment area for ensuring confidentiality of chemical dependency treatment services; and

(c) Has separate accounting records and documents identifying the provider's funding sources and expenditures of all funds received for the provision of chemical dependency services.

(21) "Domestic violence" means:

(a) Physical harm, bodily injury, assault, or the infliction of fear of imminent physical harm, bodily injury, or assault between family or household members; ((or))

(b) Sexual assault of one family or household member by another;

(c) Stalking as defined in RCW 9A.46.110 of one family or household member by another family or household member; or

(d) As defined in RCW 10.99.020, RCW 26.50.010, or other Washington state statutes.

(22) "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;

(23) "First Steps" means a program available across the state for low-income pregnant women and their infants. First Steps provides maternal and child health care and support services;

(24) "Governing body" means the legal entity responsible for the operation of the chemical dependency treatment service;

(25) "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;

(26) "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;

(27) "Medical practitioner" means a physician, certified nurse practitioner, or certified physician's assistant. Nurse practitioners and midwives with prescriptive authority may perform practitioner functions related only to indicated specialty services;

(28) "Misuse" means use of alcohol or other drugs by a person in:

(a) Violation of any law; or

(b) Breach of agency policies relating to the drug-free work place.

(29) "Off-site treatment" means provision of treatment by a certified provider at a location where treatment is not the primary purpose of the site;

(30) "Opiate dependency treatment agency" means an organization that administers or dispenses an approved drug as specified in 212 CFR Part 291 for treatment or detoxification of opiate dependency. The agency is:

(a) Approved by the Federal Food and Drug Administration;

(b) Registered with the Federal Drug Enforcement Administration;

(c) Licensed by the county in which it operates; and

(d) Certified as an "opiate dependency treatment agency" by the department.

(31) "Patient" is a person receiving chemical dependency treatment services from a certified program;

(32) "Patient contact" means counselor time spent with a client or patient to do assessments, individual or group counseling, or education;

(33) "Patient placement criteria (PPC)" means the patient placement criteria for the Treatment of Substance-Related Disorders as published and revised by the American Society of Addiction Medicine (ASAM).

(34) "Probation assessment officer" means a person employed at a certified district or municipal court probation assessment service who meets WAC 440-22-225 requirements;

(35) "Probation assessment service" means a certified assessment service offered by a misdemeanant probation department or unit within a county or municipality;

(((34))) (36) "Progress notes" are a permanent record of ongoing assessments of a patient's participation in and response to treatment, and progress in recovery;

(((35))) (37) "Registered counselor" means a person registered, or certified by the state department of health as required by chapter 18.19 RCW;

(38) "Service provider" or "provider" means a legally operated entity certified by the department to provide chemical dependency treatment services. The components of a service provider are:

(a) Legal entity/owner;

(b) Facility; and

(c) Staff and services.

(((36))) (39) "Sexual abuse" means sexual assault, incest, or sexual exploitation;

(((37))) (40) "Sexual harassment" means unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when:

(a) Submission to such conduct is made either explicitly or implicitly a term or condition of employment or treatment;

(b) Such conduct interferes with work performance or creates an intimidating, hostile, or offensive work or treatment environment.

(((38))) (41) "Substance abuse" means a recurring pattern of alcohol or other drug use which substantially impairs a person's functioning in one or more important life areas, such as familial, vocational, psychological, physical, or social;

(((39))) (42) "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;

(((40))) (43) "Supervision" means:

(a) Regular monitoring of the administrative, clinical, or clerical work performance of a staff member, intern, student, volunteer, or employee on contract by a person with the authority to give directions and require change; and

(b) "Direct supervision" means the supervisor is on the premises and available for immediate consultation.

(((41))) (44) "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;

(((42))) (45) "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 which may be extended to alcoholics and other drug addicts and their families, persons incapacitated by alcohol or other drugs, and intoxicated persons;

(((43))) (46) "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:

(a) "Negative urine" is a urine sample in which the lab does not detect specific levels of alcohol or other specified drugs; and

(b) "Positive urine" is a urine sample in which the lab confirms specific levels of alcohol or other specified drugs.

(((44))) (47) "Vulnerable adult" means a person ((sixty years of age or older)) who ((has)) lacks the functional, mental, or physical ((in))ability to care for oneself.

(((45))) (48) "Youth" means a person seventeen years of age or younger.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-005, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-180 Personnel files. (1) The administrator shall ensure there is a current personnel file for each employee, intern, student, volunteer, and contract staff person providing or supervising patient care which includes:

(a) Verification of qualifications for the assigned position;

(b) A copy of the current job description or agreement;

(c) A record of orientation;

(d) Documentation of training on bloodborne pathogens, including HIV/AIDS and hepatitis B, except for contract employees;

(e) Documentation of current cardiopulmonary resuscitation (CPR) and first aid training for at least one person on each shift in a residential facility;

(f) Written performance evaluations for each year of employment;

(g) 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;

(h) Documentation of health department training and approval for any staff administering or reading a TB test; and

(i) A signed and dated commitment to maintain confidentiality.

(2) Each ((qualified)) chemical dependency counselor (CDC), probation assessment officer, intern, and information school instructor shall provide sufficient evidence to determine whether each person has the training and education necessary to meet and maintain qualified status required under WAC 440-22-200 through 440-22-280. The personnel file shall include:

(a) For CDCs: A copy of a current certificate of qualification issued by the department affirming the CDC meets the qualifying standards of WAC 440-22-240;

(b) For CDC interns (CI): A copy of a letter of enrollment issued by the department or its designee affirming the CI meets the qualifying standards of WAC 440-22-200;

(c) For probation assessment officers and information school instructors: Sufficient evidence to determine whether each probation assessment officer or intern, and information school instructor has the training and education necessary to meet the qualifying standards of WAC 440-22-240(2) and 440-22-270 respectively;

(d) The date the person became a ((qualified counselor,)) probation assessment officer, or information school instructor;

(((b))) (e) A copy of a current license, certificate, or registration with the department of health for all ((counselors and counselor interns, and all)) CDCs, CIs and other persons requiring such documentation to practice; and

(((c))) (f) If an employee is a ((counselor intern)) CI or probation assessment officer intern, the file shall also contain:

(i) The date training began;

(ii) The education and training plan;

(iii) A copy of the counselor intern's quarterly review;

(iv) Documentation of four hours tutoring per month; and

(v) The name of the supervising ((counselor)) CDC or probation assessment officer.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-180, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-200 Chemical dependency counselor (((CDC))) intern (CI) eligibility. To become a ((CDC intern)) CI, and before performing functions of a ((CDC intern)) CI, a person shall obtain a letter of enrollment from the department or its designee that affirms the person meets the following qualifications. The person:

(1) ((Not have a)) Has no history of alcohol or other drug misuse:

(a) For a period of two years immediately before the person ((is assigned as a CDC intern)) applies for CI enrollment; and

(b) Throughout the time of the internship.

(2) ((Have)) Has obtained nine quarter or six semester credits from an accredited college or university, with a minimum of three quarter or two semester credits in each of the following distinct course topic areas:

(a) Survey of chemical dependency;

(b) Physiological actions of alcohol and other drugs; and

(c) Chemical dependency counseling techniques.

(3) ((Be)) Is registered or certified as a counselor with the department of health((, or have a written statement of exemption from the department of health)).

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-200, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-220 Chemical dependency counselor internship completion. To complete chemical dependency counselor (CDC) internship, a person shall:

(1) Obtain an additional twenty-four quarter or sixteen semester credits from an accredited college or university which includes a minimum of three quarter or two semester credits in distinct courses in the following three topic areas:

(a) Group process in chemical dependency treatment;

(b) Chemical dependency in the family; and

(c) Case management and record keeping for chemically dependent patients.

(2) The remainder of the twenty-four quarter or sixteen semester credits noted in subsection (1) of this section shall include distinct courses in the following topic areas:

(a) Ethics in chemical dependency treatment;

(b) Chemical dependency and the laws;

(c) Human growth and development; and

(d) Introductory or general psychology.

(3) Obtain an additional one hundred eighty hours of state-approved training or equivalent credit from an accredited college or university in the following topic areas:

(a) Relapse prevention;

(b) Youth chemical dependency assessment and counseling;

(c) Cultural awareness;

(d) HIV/AIDS brief risk intervention for CDCs, as approved by the department; and

(e) Other courses that will enhance skills as a chemical dependency counselor.

(4) Have completed two thousand clock hours of directly supervised experience as a CDC intern in a state-certified chemical dependency treatment agency. The internship shall include a minimum of one hundred sixty hours in each of the following clinical areas:

(a) Conducting assessments;

(b) Individual counseling; and

(c) Group counseling.

(5) Have a two-year degree, or its academic equivalent, from an accredited college or university effective February 1, 1997. The CDC intern's course work shall include all WAC 440-20-200 and 440-22-220 academic requirements.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-220, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-225 Probation assessment officer interns. A probation assessment officer intern shall:

(1) Be employed as a probation officer at a misdemeanant probation department or unit within a county or municipality;

(2) Meet the requirements for a chemical dependency counselor, as described under WAC 440-22-200 and 440-22-220;

(3) Be considered as meeting WAC 440-22-220 (1) and (2) requirements if the probation assessment officer intern has a bachelor's or graduate degree in a social or health sciences field;

(4) Be considered as meeting WAC 440-22-220(3) by obtaining the one hundred eighty additional hours in training or courses in areas that will enhance skills as a probation assessment officer;

(5) Be considered as meeting WAC 440-22-220(4) by applying all probation officer work experience toward the required thousand hours, and four hundred eighty hours of assessment experience may be applied in lieu of one hundred sixty hours of individual and one hundred sixty hours of group counseling experience.

(6) Be directly supervised and tutored by a ((qualified)) probation assessment officer who shall:

(a) Develop and maintain an individualized education and training plan to bring the intern to ((qualified)) probation assessment officer status, including:

(i) Orientation to the various laws and regulations that apply to the delivery of chemical dependency assessment and treatment services;

(ii) Instruction in assessment methods;

(iii) Instruction on standards of professional conduct and ethics; and

(iv) Observation of the intern conducting assessments.

(b) Document an evaluation of the progress of each intern at least quarterly.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-225, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-230 Youth chemical dependency counselor (YCDC) interns. (1) ((Effective February 1, 1996, a youth)) A YCDC intern shall meet WAC 440-22-200 and 440-22-220 requirements; except, the ((youth)) YCDC intern shall obtain work experience as follows:

(a) If the person is not yet a CDC, one thousand of the two thousand hours of work experience shall be in a certified program where the majority of the experience is in providing youth chemical dependency treatment; or

(b) If the person is already a CDC and had two thousand hours of required CDC work experience, another one thousand hours in a counseling capacity in other youth settings may satisfy the youth experience requirement.

(2) In addition to the internship completion requirements of WAC 440-22-220, ((youth)) YCDC interns shall attain five quarter or three semester academic credits, or seventy-five department-approved clock hours of continuing education covering the following topic areas:

(a) Adolescent assessment;

(b) Adolescent and child development; and

(c) Assessing and treating culturally diverse youth.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-230, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-240 ((Maintaining)) Chemical dependency counselor (CDC), probation assessment officer, and ((youth)) YCDC qualification. (1) To be and remain a CDC, a person shall obtain a certificate of qualification from the department that affirms that the person:

(a) ((Not have a)) Has no history of alcohol or other drug misuse for a period of three years before ((employment as a)) application for CDC certificate of qualification;

(b) ((Not)) Displays no evidence of misuse of alcohol or other drugs while a CDC;

(c) ((Be)) Is registered or certified as a counselor with the department of health under chapter 18.19 RCW((, or have a written statement of exemption from the department of health));

(d) ((Have)) Has completed all requirements for a CDC ((or probation assessment officer)) intern; ((and))

(e) ((Have)) Has successfully passed a chemical dependency counselor knowledge exam and an oral interview approved by the department;

(f) Has provided the department or its designee one letter, completed by the person's present or past immediate supervisor, endorsing the person's competency and three competence evaluations prepared by chemical dependency counselors able to attest to the person's current competency as a counselor. These documents must be from four different persons; and

(g) Has completed sixty clock hours of continuing education:

(i) During each two calendar-year period beginning ((in January of the year)) on the day following the ((initial qualification)) CDC's birth date; and

(ii) In subject areas that increase knowledge and skills in counseling and aiding chemically dependent persons and their families in recovery, and increase knowledge of special populations and their issues.

(2) ((A)) (a) To be and remain a probation assessment officer, the person shall complete all requirements for a probation assessment officer ((shall)) intern; and

(b) Have completed sixty clock hours of continuing education:

(i) During each two calendar year period beginning on the day following the probation assessment officer's birthdate; and

(ii) Obtain continuing education in subject areas intended to increase knowledge and skills in assessing, diagnosing, and referring a chemically dependent person and the person's family.

(3) A ((youth)) YCDC shall include youth specific or related training as twenty or more of the required sixty hours of continuing education.

(4) Effective date. Chemical dependency counselors, probation assessment officers and interns must meet these standards by January 1, 1998 to remain qualified.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-240, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-250 Grandparenting. (1) For chemical dependency counselors. The department ((shall deem a chemical dependency counselor (CDC), probation assessment officer, or youth CDC as having fulfilled respective)) may issue a certificate of qualification to an applicant CDC if the person fulfills the requirements ((when a person was)) for grandparented qualification in accord with procedures established by the department. Grandparented certificates of qualification are available to persons:

(((1))) (a) Qualified as a CDC ((or probation assessment officer)) by January 31, 1996, under WAC 275-19-145 requirements which were repealed with the adoption of chapter 440-22 WAC.

(((2))) (b) Qualified as a CDC ((or probation assessment officer)) by January 31, 1997, under WAC 440-22-200 and WAC 440-22-220(1) through 440-22-220(4) requirements; or

(((3))) (c) Qualified as a ((youth)) YCDC by January 31, 1997, when a person was qualified as a CDC under subsection (1) or (2) of this section and had:

(((a))) (i) One thousand hours of the two thousand required hours of work experience in a certified program where the majority of the experience was in providing youth chemical dependency treatment; or

(((b))) (ii) In addition to the two thousand hours of required CDC work experience, one thousand hours in a counseling capacity in other youth settings.

(2) Grandparented certificates of qualification shall be available only to CDCs who apply for such on applications postmarked prior to January 1, 1998.

(3) For probation assessment officers: The department may deem a probation assessment officer as having fulfilled respective qualification requirements when a person was:

(a) Qualified as a probation assessment officer by January 31, 1996, under WAC 275-19-145 requirements which were repealed with the adoption of chapter 440-22 WAC;

(b) Qualified as a probation assessment officer by January 31, 1997, under WAC 440-22-200 and 440-22-220(1) through 440-22-220(4) requirements.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-250, filed 12/22/93, effective 2/1/94.]

NEW SECTION

WAC 440-22-253 Disqualification, denial of chemical dependency intern (CI) enrollment or counselor (CDC) certificate of qualification. (1) The department shall consider the ability of each person making application for CI enrollment or CDC certificate of qualification to perform in accord with this chapter before the department enrolls a CI or grants or renews the certificate for a CDC.

(2) The department may deny or place restrictions on an applicant's letter or certificate when any of the following conditions occur and are not satisfactorily resolved, or when any applicant:

(a) Had a license, certification or registration for practicing as a counselor or other health care professional denied, revoked, or suspended;

(b) Obtained or attempted to obtain a license, certification, or registration by fraudulent means or misrepresentation;

(c) Committed, permitted, aided, or abetted the commission of an illegal act or unprofessional conduct as defined under RCW 18.130.180;

(d) Demonstrated cruelty, abuse, negligence, misconduct, or indifference to the welfare of a patient;

(e) Misappropriated patient property or resources;

(f) Has a history of noncompliance with state or federal regulations in an agency with which the applicant has been affiliated;

(g) Knowingly, or with reason to know, made a false statement of fact or failed to submit necessary information in:

(i) The application or attached materials ((attached)); and

(ii) Any matter under department investigation.

(h) Willfully interfered with the preservation of material information or attempted to impede the work of an authorized department representative;

(3) The department may deny CI enrollment or a CDC certificate of qualification when an applicant:

(a) Fails to provide satisfactory application materials;

(b) Fails to pay required fees; or

(c) Advertises him or herself as being in possession of a state certificate of qualification when a certificate of qualification has not been granted, or has been denied, revoked, or has expired.

(4) The department may disqualify a CDC if the certificate of qualification is not renewed prior to the expiration date.

(5) The applicant may appeal department decisions in accord with chapter 34.05 RCW, the Washington Administrative Procedure Act.

[]

Reviser's note: The unnecessary underscoring 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.

NEW SECTION

WAC 440-22-255 Expiration of chemical dependency counselor (CDC) certificate of qualification. (1) Certificate of qualification shall be valid for two years. It is the responsibility of the CDC to renew the certificate of qualification in accord with procedures established by the department.

(2) Certificate of qualification shall expire on the CDC's first birthdate following the date of initial issue, at which time it is subject to renewal. If the CDC's next birth date is within one year of the initial date of issue, the certificate of qualification shall expire on the CDC's second birth date following original issue.

(4) Practicing counseling with an expired certificate of qualification is in violation of requirements in WAC 440-22-175 (1) and (2), and 440-22-180(2).

[]

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.

NEW SECTION

WAC 440-22-257 Chemical dependency counselor (CDC) suspension or revocation of certificate of qualification. (1) The department may suspend or revoke a CDC's certificate of qualification when a disqualifying situation described under WAC 440-22-253 applies to a CDC holding a current certificate or when any of the following circumstances occur:

(a) Violation of a rule threatens or results in harm to a patient;

(b) A reasonably prudent CDC should have been aware of a condition resulting in significant violation of a law or rule;

(c) A CDC failed to investigate or take corrective or preventive action to deal with a suspected or identified patient care problem;

(d) The CDC fails to satisfactorily comply with a findings of fact and conclusion of law order issued by the department of health pursuant to chapter 18.19 RCW.

(2) Practicing counseling with a suspended or revoked certificate of qualification is in violation of requirements under WAC 440-22-175 (1) and (2), and 440-22-180(2).

[]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-260 Students. (1) The treatment provider shall have a written agreement with each education agency wanting to use the treatment agency as a setting for student practice.

(2) The treatment provider shall ensure the written agreement describes the nature and scope of student activity at the treatment setting and ensures supervision of student activities.

(3) Each student and academic supervisor shall sign a confidentiality statement which the provider shall retain.

(4) A student may serve as a chemical dependency counselor intern provided the student meets WAC 440-22-200 and 440-22-210 requirements.

(5) When a student is under supervision of a college, the department shall apply both the academic credits and supervised field experience toward the requirements of WAC 440-22-200 and 440-22-220.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-260, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-280 Volunteers. (1) Each volunteer offering assistance to a provider shall be oriented as required under WAC 440-22-175 (13), (14), and (15), of the personnel manual.

(2) A volunteer shall meet the qualifications of the position to which the person is assigned.

(3) A volunteer may provide counseling services when the person meets the requirements for a chemical dependency counselor intern or is a chemical dependency counselor.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-280, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-300 Clinical manual. Each chemical dependency service provider shall have and adhere to a clinical manual containing patient care policies and procedures, including:

(1) How the provider meets WAC 440-22-310 through 440-22-335 requirements;

(2) How the provider will meet applicable certified treatment service requirements of WAC 440-22-350 through 440-22-620, including a description of each service offered, detailing:

(a) The number of hours of treatment and education for each certified treatment service; and

(b) 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 the clinical supervisor:

(a) Is a chemical dependency counselor (CDC);

(b) Reviews a sample of patient records of each CDC quarterly; and

(c) Implements treatment, continuing care, transfer and discharge plans in accord with WAC 440-22-325.

(5) Patient admission and discharge criteria in accord with patient placement criteria (PPC):

(a) The administrator shall not admit or retain a person unless the person's treatment needs can be met;

(b) A chemical dependency counselor (CDC) shall assess and refer each patient to the appropriate treatment service; and

(c) A person needing detoxification shall immediately be referred to a detoxification provider, unless the person needs acute care in a hospital.

(6) 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.

(7) HIV/AIDS information, brief risk intervention, and referral;

(8) Limitation of group counseling sessions to twelve patients or less;

(9) Counseling sessions with nine to twelve youths to include a second adult staff member;

(10) Provision of education to each patient on:

(a) Alcohol and alcoholism;

(b) Drugs and drug addiction;

(c) Relapse prevention; and

(d) HIV/AIDS, hepatitis, and TB.

(11) 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.

(12) 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;

(13) Assigning of work to a patient by a CDC when the assignment:

(a) Is part of the treatment program; and

(b) Has therapeutic value.

(14) Use of self-help groups;

(15) Patient rules and responsibilities, including disciplinary sanctions for noncomplying patients;

(16) If youth are admitted, a policy and procedure for assessing the need for referral to child welfare services;

(17) Implementation of the deferred prosecution program;

(18) Policy and procedures for reporting status of persons convicted under chapter 46.61 RCW to the department of licensing; and

(19) Nonresidential providers shall have policies and procedures on:

(a) Medical emergencies;

(b) Suicidal and mentally ill patients;

(c) Medical oversight, including provision of a physical examination by a medical practitioner, on a person who:

(i) Is dependent on barbiturates or benzodiazepines; or

(ii) Used intravenous drugs in the thirty days before admission.

(d) Laboratory tests;

(e) Services and resources for pregnant women:

(i) A pregnant women who is not seen by a private physician shall 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.

(f) If using medication services:

(i) A medical practitioner shall evaluate each patient who is taking disulfiram at least once every ninety days;

(ii) Patient medications are stored, disbursed, and recorded in accord with chapter 246-326 WAC; and

(iii) Only a licensed nurse or medical practitioner may administer medication.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-300, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-310 Patients' rights. (1) Each service provider shall ensure each patient:

(a) Is admitted to treatment without regard to race, color, creed, national origin, religion, sex, sexual orientation, age, or disability, except for bona fide program criteria;

(b) Is reasonably accommodated in the event of sensory or physical disability, limited ability to communicate, limited English proficiency, and cultural differences;

(c) Is treated in a manner sensitive to individual needs and which promotes dignity and self-respect;

(d) Is protected from invasion of privacy except that staff may conduct reasonable searches to detect and prevent possession or use of contraband on the premises;

(e) Has all clinical and personal information treated in accord with state and federal confidentiality regulations;

(f) Has the opportunity to review the patient's own treatment records in the presence of the administrator or designee;

(g) Has the opportunity to have clinical contact with a same gender counselor, if requested and determined appropriate by the supervisor, either at the agency or by referral;

(h) Is fully informed regarding fees charged, including fees for copying records to verify treatment and methods of payment available;

(i) Is provided reasonable opportunity to practice the religion of choice as long as the practice does not infringe on the rights and treatment of others or the treatment service. The patient has the right to refuse participation in any religious practice;

(j) Is allowed necessary communication:

(i) Between a minor and a custodial parent or legal guardian;

(ii) With an attorney; and

(iii) In an emergency situation.

(k) Is protected from abuse by staff at all times, or from other patients who are on agency premises, including:

(i) Sexual abuse or harassment;

(ii) Sexual or financial exploitation;

(iii) Racism or racial harassment; and

(iv) Physical abuse or punishment.

(l) Is fully informed and receives a copy of counselor disclosure requirements described under RCW 18.19.060;

(m) Receives a copy of patient grievance procedures upon request; and

(n) In the event of an agency closure or treatment service cancellation, each patient shall be:

(i) Given thirty days notice;

(ii) Assisted with relocation;

(iii) Given refunds to which the person is entitled; and

(iv) Advised how to access records to which the person is entitled.

(2) A service provider shall obtain patient consent for each release of information to any other person or entity. This consent for release of information shall include:

(a) Name of the consenting patient;

(b) Name or designation of the provider authorized to make the disclosure;

(c) Name of the person or organization to whom the information is to be released;

(d) Nature of the information to be released, as limited as possible;

(e) Purpose of the disclosure, as specific as possible;

(f) Specification of the date or event on which the consent expires;

(g) Statement that the consent can be revoked at any time, except to the extent that action has been taken in reliance on it;

(h) Signature of the patient or parent, guardian, or authorized representative, when required, and the date((; and

(i))).

(3) Any disclosure made with written patient consent shall be accompanied by a statement prohibiting further disclosure unless expressly permitted by the written consent of the person to whom it pertains.

(((3))) (4) A service provider shall notify patients that outside persons or organizations which provide services to the agency are required by written agreement to protect patient confidentially.

(((4))) (5) A service provider shall notify an ADATSA recipient of the recipient's additional rights to:

(a) Report back to the department's community service office in case of a patient's disciplinary discharge from the program; and

(b) Request a fair hearing to challenge any departmental action which affects a patient's eligibility for ADATSA treatment or shelter assistance.

(((5))) (6) The administrator shall ensure a copy of patients' rights is given to each patient receiving services, both at admission and in case of disciplinary discharge.

(((6))) (7) The administrator shall post a copy of patients' rights in a conspicuous place in the facility accessible to patients and staff.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-310, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-320 Chemical dependency assessments. A chemical dependency counselor (CDC), or a CDC intern under supervision of a CDC, shall conduct and document an assessment of each client's involvement with alcohol and other drugs. The counselor's assessment shall include:

(1) A face-to-face diagnostic interview with each client to obtain, review, evaluate, and document the following:

(a) A history of the client'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 self-assessment of use of alcohol and other drugs; and

(d) A relapse history.

(2) If the client is in need of treatment, an assessment of the person's:

(a) Motivation for recovery;

(b) Ability to attain and maintain abstinence;

(c) Risk of relapse; and

(d) Strengths and needs.

(3) If the client is found to be in need of treatment, an assessment of other factors affecting treatment, including:

(a) Current and historical psychosocial data;

(b) Issues relating to personal safety;

(c) Medical history, including:

(i) Physical status;

(ii) Mental status; and

(iii) Availability and use of medical care.

(d) For women, likelihood of a current pregnancy; and

(e) Legal history, including:

(i) Past charges; and

(ii) Current charges and courts of jurisdiction.

(4) If an assessment is conducted on a youth and the client is in need of treatment, the counselor shall also assess the following elements:

(a) Parental use of drugs;

(b) The developmental stage of the youth;

(c) Ability to understand written materials;

(d) Psychological and emotional stability;

(e) Child or adolescent developmental problems associated with the use of chemicals;

(f) Identification of school assessments and referrals;

(g) Historical and current parental or custodial status;

(h) History of learning disabilities and special education;

(i) Running away, out-of-home placements, and institutional care or custody;

(j) Support from significant adults and extended family; and

(k) Attempts shall be made to obtain information from parents and legal guardians, and from prior medical records and psychological evaluations with proper consent.

(5) Documentation of the information collected, including:

(a) A written summary of the assessment;

(b) A diagnostic assessment statement including signs, symptoms, and progression of client involvement with alcohol and other drugs;

(c) A statement regarding provision of an HIV/AIDS brief risk intervention, and referrals made; and

(d) Evidence the client:

(i) Was notified of the assessment results; and

(ii) Signed a document showing treatment options provided, and indicating the client's choice; or

(iii) If the client was not notified of the results and advised of referral options, the reason shall be documented.

(6) Documentation of the type and length of treatment recommended, in accord with patient placement criteria (PPC);

(7) Completion and submission of all reports required by the courts, department of licensing, and department of social and health services in a timely manner; and

(8) Referral of an adult or minor who requires assessment for involuntary chemical dependency treatment to the county-designated chemical dependency specialist.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-320, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-325 Treatment, continuing care, transfer and discharge plans. (1) A chemical dependency counselor (CDC) shall be responsible for assessments and the overall treatment plan for each patient, including:

(a) Patient participation;

(b) Completeness of patient records; and

(c) Documentation of progress toward patient attainment of goals.

(2) A CDC or an intern under direct supervision of a CDC shall:

(a) Develop the individualized treatment plan;

(b) Evaluate the patient and conduct ongoing assessments in accord with PPC. In cases where it is not possible to place or provide the patient with the clinically indicated treatment, the reason shall be documented as well as whether other treatment will be provided;

(c) Conduct individual and group counseling;

(d) Update the treatment plan as problems arise or are resolved, including domestic violence and abuse issues if applicable;

(e) Develop the continuing care plan using PPC; and

(f) Complete the discharge summary.

(3) A CDC shall also include in the treatment plan for youth:

(a) Structured drug free social and recreational activities;

(b) Developmental concerns, including education on sexuality and safer sex;

(c) Referral for identification and treatment of sexually transmitted diseases and other services as needed; and

(d) Referral to school and community support services.

(4) A CDC shall 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 CDC shall 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 CDC shall:

(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. In detox, this may be done by a nurse or physician.

(7) Except in detox and for a patient who leaves treatment without notice, staff shall meet with each patient at the time of discharge from any treatment agency, to:

(a) Finalize a continuing care plan using PPC 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 shall 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 or agency-recommended follow-up treatment.

(c) Discharge summary; and

(d) The plan for continuing care or treatment.

(9) A CDC shall complete a discharge summary, within seven days of each patient's discharge from the agency, which includes:

(a) The date of discharge or transfer;

(b) A summary of the patient's progress toward each treatment goal, except in detox; and

(c) In detox, a summary of the patient's physical condition.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-325, filed 12/22/93, effective 2/1/94.]

AMENDATORY SECTION (Amending Order 3672, filed 12/22/93, effective 2/1/94 WAC 440-22-335 Patient record content. The provider shall ensure patient record content includes:

(1) Demographic information;

(2) A chemical dependency assessment and history of involvement with alcohol and other drugs;

(3) Documentation the patient was informed of the diagnostic assessment and options for referral or the reason not informed;

(4) A report of a physical examination by a medical practitioner in accord with a nonresidential provider's policy on medical oversight, when a patient was dependent on barbiturates or benzodiazepines, or used intravenous drugs within thirty days of admission;

(5) Documentation the patient was informed of federal ((confidentially)) confidentiality requirements and received a copy of the patient notice required under 42 CFR, Part 2;

(6) Treatment service rules, translated when needed, signed and dated by the patient before beginning treatment;

(7) Voluntary consent to treatment signed and dated by the patient, parent or legal guardian, except as authorized by law for protective custody and involuntary treatment;

(8) Evidence of counselor disclosure information, acknowledged by the provider and patient by signature and date;

(9) Evidence of a tuberculosis test and results;

(10) Evidence of the HIV/AIDS brief risk intervention;

(11) Initial and updated individual treatment plans, including results of the initial assessment and periodic reviews, addressing:

(a) Patient biopsychosocial problems;

(b) Short- and long-range treatment goals;

(c) Estimated dates 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; and

(g) Treatment plan reviews.

(12) Documentation of referrals made for specialized care or services;

(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, each shift in detox, and treatment plan reviews as specified under each treatment service of this WAC chapter; and

(d) Documentation of missed appointments.

(14) Medication records, if applicable;

(15) Laboratory reports, if applicable;

(16) Properly completed authorizations for release of information;

(17) Copies of all correspondence related to the patient, including reports of noncompliance;

(18) A copy of the continuing care plan signed and dated by the chemical dependency counselor and the patient; and

(19) The discharge summary.

[Statutory Authority: Chapter 70.96A RCW. 94-02-002 (Order 3672), 440-22-335, filed 12/22/93, effective 2/1/94.]

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