Alert! This chapter may be affected by an emergency order:
DHS 75.14(6)(e)2. 2. The service's patient capacity.
DHS 75.14(6)(e)3. 3. A statement concerning the type and physical condition of patients appropriate for the service.
DHS 75.14(6)(e)4. 4. Admission policy, including:
DHS 75.14(6)(e)4.a. a. Target group served, if any.
DHS 75.14(6)(e)4.b. b. Limitations on admission.
DHS 75.14(6)(e)5. 5. Procedures for screening for communicable disease.
DHS 75.14(6)(e)6. 6. Service goals and services defined and justified in terms of patient needs, including:
DHS 75.14(6)(e)6.a. a. Staff assignments to accomplish service goals.
DHS 75.14(6)(e)6.b. b. Description of community resources available to assist in meeting the service's treatment goals.
DHS 75.14(6)(f) (f) Documentation of review.
DHS 75.14(6)(f)1.1. A service shall maintain documentation that the governing body, director and representatives of the administrative and direct service staffs have annually revised, updated as necessary and approved the policy and procedures manual, including the service philosophy and objectives.
DHS 75.14(6)(f)2. 2. The service shall maintain documentation to verify that each staff member has reviewed a copy of the policy and procedures manual.
DHS 75.14(6)(g) (g) Emergency medical care. A service shall have a written agreement with a hospital or clinic for the hospital or clinic to provide emergency medical care to patients.
DHS 75.14(6)(h) (h) Emergency transportation. A service shall have arrangements for emergency transportation, when needed, of patients to emergency medical care services.
DHS 75.14(6)(i) (i) Treatment plan. The service's treatment staff shall prepare a written treatment plan for each patient referred from prior treatment service, which is designed to establish continuing contact for the support of the patient. A patient's treatment plan shall include information, unmet goals and objectives from the patient's prior treatment experience and treatment staff shall review and update the treatment plan every 30 days.
DHS 75.14(6)(j) (j) Support services. A service shall provide support services that promote self-care by the patient, which shall include all of the following:
DHS 75.14(6)(j)1. 1. Planned activities of daily living.
DHS 75.14(6)(j)2. 2. Planned development of social skills to promote personal adjustment to society upon discharge.
DHS 75.14(6)(k) (k) Employment related services. A service shall make job readiness counseling, problem-resolution counseling and prevocational and vocational training activities available to patients.
DHS 75.14(6)(L) (L) Recreational services. A service shall have planned recreational services for patients, which shall include all of the following:
DHS 75.14(6)(L)1. 1. Emphasis on recreation skills in independent living situations.
DHS 75.14(6)(L)2. 2. Use of both internal and community recreational resources.
DHS 75.14(7) (7)Admission. Admission to a transitional residential treatment service is appropriate only for one of the following reasons:
DHS 75.14(7)(a) (a) The person was admitted to and discharged from one or more services under s. DHS 75.10, 75.11, 75.12 or 75.13 within the past 12 months or is currently being served under either s. DHS 75.12 or 75.13.
DHS 75.14(7)(b) (b) The person has an extensive lifetime treatment history and has experienced at least two detoxification episodes during the past 12 months, and one of the following conditions is met:
DHS 75.14(7)(b)1. 1. The person to be admitted is determined appropriate for placement in this level of care by the application of approved placement criteria.
DHS 75.14(7)(b)2. 2. The person to be admitted is determined appropriate for this level of care through the alternative placement recommendations of WI-UPC or other approved placement criteria.
DHS 75.14 History History: Cr. Register, July, 2000, No. 535, eff. 8-1-00; correction in (3) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; CR 09-109: am. (5) Register May 2010 No. 653, eff. 6-1-10; correction in (5) (a), (b) made under s. 13.92 (4) (b) 7., Stats. Register November 2011 No. 671.
DHS 75.15 DHS 75.15 Narcotic treatment service for opiate addiction.
DHS 75.15(1)(1)Service description. A narcotic treatment service for opiate addiction provides for the management and rehabilitation of selected narcotic addicts through the use of methadone or other FDA-approved narcotics and a broad range of medical and psychological services, substance abuse counseling and social services. Methadone and other FDA-approved narcotics are used to prevent the onset of withdrawal symptoms for 24 hours or more, reduce or eliminate drug hunger or craving and block the euphoric effects of any illicitly self-administered narcotics while the patient is undergoing rehabilitation.
DHS 75.15(2) (2)Requirements. To receive certification from the department under this chapter, a narcotic treatment service for opiate addiction shall comply with all requirements included in s. DHS 75.03 and all requirements included in s. DHS 75.13 that apply to a narcotic treatment service for opiate addiction, as shown in Table 75.03, and, in addition, a narcotic treatment service for opiate addiction shall comply with the requirements of this section. If a requirement in this section conflicts with an applicable requirement in s. DHS 75.03, the requirement in this section shall be followed.
DHS 75.15(3) (3)Definitions. In this section:
DHS 75.15(3)(a) (a) “Biochemical monitoring" means the collection and analysis of specimens of body fluids, such as blood or urine, to determine use of licit or illicit drugs.
DHS 75.15(3)(b) (b) “Central registry" means an organization that obtains from 2 or more methadone programs patient identifying information about individuals applying for maintenance treatment or detoxification treatment for the purpose of preventing an individual's concurrent enrollment in more than one program.
DHS 75.15(3)(c) (c) “Clinical probation" means the period of time determined by the treatment team that a patient is required to increase frequency of service attendance.
DHS 75.15(3)(d) (d) “Initial dosing" means the first administration of methadone or other FDA-approved narcotic to relieve a degree of withdrawal and drug craving of the patient.
DHS 75.15(3)(e) (e) “Mandatory schedule" means the required dosing schedule for a patient and the established frequency that the patient must attend the service.
DHS 75.15(3)(f) (f) “Medication unit" means a facility established as part of a service but geographically separate from the service, from which licensed private practitioners and community pharmacists are:
DHS 75.15(3)(f)1. 1. Permitted to administer and dispense a narcotic drug.
DHS 75.15(3)(f)2. 2. Authorized to conduct biochemical monitoring for narcotic drugs.
DHS 75.15(3)(g) (g) “Objectively intoxicated person" means a person who is determined through a breathalyzer test to be under the influence of alcohol.
DHS 75.15(3)(h) (h) “Opioid addiction" means psychological and physiological dependence on an opiate substance, either natural or synthetic, that is beyond voluntary control.
DHS 75.15(3)(i) (i) “Patient identifying information" means the name, address, social security number, photograph or similar information by which the identity of a patient can be determined with reasonable accuracy and speed, either directly or by reference to other publicly available information.
DHS 75.15(3)(j) (j) “Phase" means a patient's level of dosing frequency.
DHS 75.15(3)(k) (k) “Service physician" means a physician licensed to practice medicine in the jurisdiction in which the program is located, who assumes responsibility for the administration of all medical services performed by the narcotic treatment service including ensuring that the service is in compliance with all federal, state and local laws relating to medical treatment of narcotic addiction with a narcotic drug.
DHS 75.15(3)(L) (L) “Service sponsor" means a person or a representative of an organization who is responsible for the operation of a narcotic treatment service and for all service employees including any practitioners, agents or other persons providing services at the service or at a medication unit.
DHS 75.15(3)(m) (m) “Take-homes" means medications such as methadone that reduce the frequency of a patient's service visits and with the approval of the service physician, are dispensed in an oral form and are in a container that discloses the treatment service name, address and telephone number and the patient's name, the dosage amount and the date on which the medication is to be ingested.
DHS 75.15(3)(n) (n) “Treatment contracting" means an agreement developed between the primary counselor or the program director and the patient in an effort to allow the patient to remain in treatment on condition that the patient adheres to service rules.
DHS 75.15(3)(o) (o) “Treatment team" means a team established to evaluate the progress of a patient and consisting of at least the primary counselor, the service staff nurse who administers doses and the program director.
DHS 75.15(4) (4)Required personnel.
DHS 75.15(4)(a) (a) A narcotic treatment service for opiate addiction shall designate a physician licensed under ch. 448, Stats., as its medical director. The physician shall be readily accessible and able to respond in person in a reasonable period of time, not to exceed 45 minutes.
DHS 75.15(4)(b) (b) The service shall have a registered nurse on staff to supervise the dosing process and perform other functions delegated by the physician.
DHS 75.15(4)(c) (c) The service may employ nursing assistants and related medical ancillary personnel to perform functions permitted under state medical and nursing practice statutes and administrative rules.
DHS 75.15(4)(d) (d) The service shall employ substance abuse counselors, substance abuse counselors-in training, or clinical substance abuse counselors who are under the supervision of a clinical supervisor on a ratio of at least one to 50 patients in the service or fraction thereof.
DHS 75.15(4)(dm) (dm) A narcotic treatment services for opiate addiction shall provide for ongoing clinical supervision of the counseling staff. Ongoing clinical supervision shall be provided as required as required in s. SPS 162.01.
DHS 75.15 Note Note: Section SPS 162.01 (1) states that a clinical supervisor shall provide a minimum of:
DHS 75.15 Note 1. Two hours of clinical supervision for every 40 hours of work performed by a substance abuse counselor-in-training.
DHS 75.15 Note 2. Two hours of clinical supervision for every 40 hours of counseling provided by a substance abuse counselor.
DHS 75.15 Note 3. One hour of clinical supervision for every 40 hours of counseling provided by a clinical substance abuse counselor.
DHS 75.15 Note 4. One in person meeting each calendar month with a substance abuse counselor-in-training, substance abuse counselor, or clinical substance abuse counselor. This meeting may fulfill a part of the requirements above.
DHS 75.15(4)(e) (e) The clinical supervisor shall provide supervision and performance evaluation of substance abuse counselors in the areas identified in s. SPS 162.01 (5).
DHS 75.15 Note Note: Section SPS 162.01 (5) states that the goals of clinical supervision are to provide the opportunity to develop competency in the transdisciplinary foundations, practice dimensions and care functions, provide a context for professional growth and development and ensure a continuance of quality patient care.
DHS 75.15(5) (5)Admission.
DHS 75.15(5)(a) (a) Admission criteria. For admission to a narcotic addiction treatment service for opiate addiction, a person shall meet all of the following criteria as determined by the service physician:
DHS 75.15(5)(a)1. 1. The person is physiologically and psychologically dependent upon a narcotic drug that may be a synthetic narcotic.
DHS 75.15(5)(a)2. 2. The person has been physiologically and psychologically dependent upon the narcotic drug not less than one year before admission.
DHS 75.15(5)(a)3. 3. In instances where the presenting drug history is inadequate to substantiate such a diagnosis, the material submitted by other health care professionals indicates a high degree of probability of such a diagnosis, based on further evaluation.
DHS 75.15(5)(a)4. 4. When the person receives health care services from outside the service, the person has provided names, addresses and written consents for release of information from each health care provider to allow the service to contact the providers, and agrees to update releases if changes occur.
DHS 75.15(5)(b) (b) Voluntary treatment. Participation in narcotic addiction treatment shall be voluntary.
DHS 75.15(5)(c) (c) Explanation. Service staff shall clearly and adequately explain to the person being admitted all relevant facts concerning the use of the narcotic drug used by the service.
DHS 75.15(5)(d) (d) Consent. The service shall require a person being admitted to complete the most current version of FDA form 2635, “Consent to Narcotic Addiction Treatment."
DHS 75.15 Note Note: For copies of FDA Form 2635, Consent to Narcotic Addiction Treatment, a service may write to Commissioner, Food and Drug Administration, Division of Scientific Investigations, 5600 Fishers Lane, Rockville, MD 20857.
DHS 75.15(5)(e) (e) Examination. For each applicant eligible for narcotic addiction treatment, the service shall arrange for completion of a comprehensive physical examination, clinically indicated laboratory work-up prescribed by the physician, psycho-social assessment, initial treatment plan and patient orientation during the admission process.
DHS 75.15(5)(f) (f) Initial dose. If a person meets the admission criteria under par. (a), an initial dose of narcotic medication may be administered to the patient on the day of application.
DHS 75.15(5)(g) (g) Distance of service from residence. A person shall receive treatment at a service located in the same county or at the nearest location to the person's residence, except that if a service is unavailable within a radius of 50 miles from the patient's residence, the patient may, in writing, request the state methadone authority to approve an exception. In no case may a patient be allowed to attend a service at a greater distance to obtain take-home doses.
DHS 75.15(5)(h) (h) Non-residents. A self-pay person who is not a resident of Wisconsin may be accepted for treatment only after written notification to the Wisconsin state methadone authority. Permission shall be obtained before initial dosing.
DHS 75.15(5)(i) (i) Central registry.
DHS 75.15(5)(i)1.1. The service shall participate in a central registry, or an alternative acceptable to the state methadone authority, in order to prevent multiple enrollments in detoxification and narcotic addiction treatment services for opiate addiction. The central registry may include services and programs in bordering states.
DHS 75.15(5)(i)2. 2. The service shall make a disclosure to the central registry whenever any of the following occurs:
DHS 75.15(5)(i)2.a. a. A person is accepted for treatment.
DHS 75.15(5)(i)2.b. b. The person is disenrolled in the service.
DHS 75.15(5)(i)3. 3. The disclosure shall be limited to:
DHS 75.15(5)(i)3.a. a. Patient-identifying information.
DHS 75.15(5)(i)3.b. b. Dates of admission, transfer or discharge from treatment.
DHS 75.15(5)(i)4. 4. A disclosure shall be made with the patient's written consent that meets the requirements of 42 CFR Part 2, relating to alcohol and drug abuse patient records, except that the consent shall list the name and address of each central registry or acceptable alternative and each known detoxification or narcotic treatment service for opiate addiction to which a disclosure will be made.
DHS 75.15(5)(j) (j) Admissions protocol. The service shall have a written admissions protocol that accomplishes all of the following:
DHS 75.15(5)(j)1. 1. Identifies the person on the basis of appropriate substantiated documents that contain the individual's name and address, date of birth, sex and race or ethnic origin as evidenced by a valid driver's license or other suitable documentation such as a passport.
DHS 75.15(5)(j)2. 2. Determines the person's current addiction, to the extent possible, the current degree of dependence on narcotics or opiates, or both, including route of administration, length of time of the patient's dependence, old and new needle marks, past treatment history and arrest record.
DHS 75.15(5)(j)3. 3. Determines the person's age. The patient shall verify that he or she is 18 years or older.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.