DHS 75.15(13)(e)3.
3. Ensure that staff appropriately address with the patient a positive test report within one week after the report is received and that the report and the patient's response is documented in the patient's case record.
DHS 75.15(13)(f)1.1. The frequency that a service shall require drug screening shall be clinically appropriate for each patient and allow for a rapid response to the possibility of relapse.
DHS 75.15(13)(f)2.
2. A service shall arrange for drug screens with sufficient frequency so that they can be used to assist in making informed decisions about take-home privileges.
DHS 75.15(14)(a)(a) Patient retention shall be a major objective of treatment. The service shall do all of the following to retain patients for the planned course of treatment:
DHS 75.15(14)(a)2.
2. Render treatment in a way that is least disruptive to the patient's travel, work, educational activities, ability to use supportive services and family life.
DHS 75.15(14)(a)5.
5. Ensure that a patient has ready access to staff, particularly to the patient's primary counselor.
DHS 75.15(14)(a)6.
6. Ensure that staff are adequately trained and are sensitive to gender-specific and culture-specific issues.
DHS 75.15(14)(a)7.
7. Provide services that incorporate good practice standards for substance abuse treatment.
DHS 75.15(14)(a)8.
8. Ensure that patients receive adequate doses of narcotic medication based on their individual needs.
DHS 75.15(14)(a)9.
9. Ensure that the attitude of staff is accepting of narcotic addiction treatment.
DHS 75.15(14)(a)10.
10. Ensure that patients understand that they are responsible for complying with all aspects of their treatment, including participating in counseling sessions.
DHS 75.15(14)(b)
(b) Since treatment duration and retention are directly correlated to rehabilitation success, a service shall make a concerted effort to retain patients within the first year following admission. Evidence of this concerted effort shall include written documentation of all of the following:
DHS 75.15(14)(b)4.
4. Continued treatment is medically necessary in the professional judgement of the service physician.
DHS 75.15(14)(c)
(c) A service shall refer an individual discharged from the service to a more suitable treatment modality when further treatment is required or is requested by that person and cannot be provided by the service.
DHS 75.15(14)(d)
(d) For services needed by a patient but not provided by the service, the service shall refer the individual to an appropriate service provider.
DHS 75.15(15)
(15) Multiple substance use and dual diagnosis treatment. DHS 75.15(15)(a)(a)
Assessment. A service shall assess an applicant for admission during the admission process and a patient, as appropriate, to distinguish substance use, abuse and dependence, and determine patterns of other substance use and self-reported etiologies, including non-prescription, non-therapeutic and prescribed therapeutic use and mental health problems.
DHS 75.15(15)(b)1.1. A service shall provide a variety of services that support cessation by a patient of alcohol and prescription and non-prescription substance abuse as the desired goal.
DHS 75.15(15)(b)2.
2. Service objectives shall indicate that abstinence by a patient from alcohol and prescription and non-prescription substance abuse should extend for increasing periods, progress toward long-term abstinence and be associated with improved life functioning and well-being.
DHS 75.15(15)(b)3.
3. Service staff shall instruct multiple substance use patients about their vulnerabilities to cross-tolerance, drug-to-drug interaction and potentiation and the risk of dependency substitution associated with self-medication.
DHS 75.15(15)(c)1.1. A service shall have the ability to provide concurrent treatment for a patient diagnosed with both a mental health disorder and a substance use disorder. The service shall arrange for coordination of treatment options and for provision of a continuum of care across the boundaries of physical sites, services and outside treatment referral sources.
DHS 75.15(15)(c)2.
2. When a dual diagnosis exists, a service shall develop with the patient a treatment plan that integrates measures for treating all alcohol, drug and mental health problems. For the treatment of a dually-diagnosed patient, the service shall arrange for a mental health professional to help develop the treatment plan and provide ongoing treatment services. The mental health professional shall be available either as an employee of the service or through a written agreement.
DHS 75.15(16)(a)(a) A service that provides narcotic addiction treatment to pregnant women shall provide that treatment within a comprehensive treatment service that addresses medical, prenatal, obstetrical, psychosocial and addiction issues.
DHS 75.15(16)(b)
(b) A diagnosis of opioid addiction and need of the patient to avoid use of narcotic antagonists shall be based on the same factors, such as medical and substance abuse history, psychosocial history, physical examination, test toxicology and signs and symptoms of withdrawal, that are used in diagnosing opiate addiction in non-pregnant opioid-dependent women. In this paragraph, "narcotic antagonist" means a drug primarily used to counter narcotic-induced respiratory depression.
DHS 75.15(16)(c)
(c) A pregnant woman seeking narcotic addiction treatment shall be referred to a perinatal specialist or obstetrician as soon as possible after initiating narcotic addiction treatment with follow up contact, to coordinate care of the woman's prenatal health status, evaluate fetal growth and document physiologic dependence.
DHS 75.15(16)(d)1.1. When withdrawal from narcotic medication is the selected treatment option, withdrawal shall be conducted under the supervision of a service physician experienced in perinatal addiction, ideally in a perinatal unit equipped with fetal monitoring equipment.
DHS 75.15(16)(d)2.
2. Withdrawal shall not be initiated before the 14th week of pregnancy or after the 32nd week of pregnancy.
DHS 75.15(16)(e)
(e) Pregnant women shall be monitored and their dosages individualized, as needed.
DHS 75.15(16)(f)
(f) A service shall not change the methadone dose that a pregnant woman was receiving before her pregnancy unless necessary to avoid withdrawal.
DHS 75.15(16)(g)
(g) A service shall increase the methadone dose for a patient, if needed, during the later stages of the patient's pregnancy to maintain the same plasma level and avoid withdrawal.
DHS 75.15(16)(h)
(h) A service shall arrange for appropriate assistance for pregnant patients, including education and parent support groups, to improve mother-infant interaction after birth and to lessen the behavioral consequences of poor mother-infant bonding.
DHS 75.15(17)(a)(a) A narcotic treatment service for opiate addiction shall screen patients immediately following admission and annually thereafter for tuberculosis (TB). Tuberculosis treatment may be provided by referral to an appropriate public health agency or community medical service.
DHS 75.15(17)(b)
(b) A service shall screen prospective new staff for TB, and shall annually test all service staff for TB.
DHS 75.15(17)(c)
(c) A service shall screen all patients at admission and annually thereafter for viral hepatitis and sexually transmitted diseases (STDs) and shall ensure that any necessary medical follow-up occurs, either on-site or through referral to community medical services.
DHS 75.15(17)(d)
(d) A service shall ensure that all service staff have been immunized against hepatitis B. Documentation of refusal to be immunized shall be entered in the staff member's case record.
DHS 75.15(18)
(18) Facility. A service shall provide a setting that is conducive to rehabilitation of the patients and that meets all of the following requirements:
DHS 75.15(18)(b)
(b) Waiting areas, dosing stations and all other areas for patients shall be provided with adequate ventilation and lighting.
DHS 75.15(18)(c)
(c) Dosing stations and adjacent areas shall be kept sanitary and ensure privacy and confidentiality.
DHS 75.15(18)(d)
(d) Patient counseling rooms, physical examination rooms and other rooms or areas in the facility that are used to meet with patients shall have adequate sound proofing so that normal conversations will be confidential.
DHS 75.15(18)(e)
(e) Adequate security shall be provided inside and outside the facility for the safety of the patients and to prevent loitering and illegal activities.
DHS 75.15(18)(f)
(f) Separate toilet facilities shall be provided for patient and staff use.
DHS 75.15(18)(g)
(g) The facility and areas within the facility shall be accessible to persons with physical disabilities.
DHS 75.15(18)(h)
(h) The physical environment within the facility shall be conducive to promoting improved functioning and a drug free lifestyle.
DHS 75.15(19)(a)(a) Each staff member of the narcotic treatment service for opiate addiction is responsible for being alert to potential diversion of narcotic medication by patients and staff.
DHS 75.15(19)(b)
(b) Service staff shall take all of the following measures to minimize diversion:
DHS 75.15(19)(b)1.
1. Doses of narcotic medication shall be dispensed only in liquid form.
DHS 75.15(19)(b)2.
2. Bottles of narcotic medication shall be labeled with the patient's name, the dose, the source service, the prescribing physician and the date by which the dose is to be consumed.
DHS 75.15(19)(b)3.
3. The service shall require a patient to return all empty take-home bottles on the patient's next day of service attendance following take-home dosing. Service staff shall examine the bottles to ensure that the bottles are received from the appropriate patient and in an intact state.
DHS 75.15(19)(b)4.
4. The service shall discontinue take-home medications for patients who fail to return empty take-home bottles in the prescribed manner.
DHS 75.15(19)(c)
(c) If a service receives reliable information that a patient is diverting narcotic medication, the patient's primary counselor shall immediately discuss the problem with the patient.
DHS 75.15(19)(d)
(d) Based on information provided by the patient or continuing reports of diversion, a service may revoke take-home privileges of the patient.
DHS 75.15(19)(e)
(e) The state methadone authority may, based on reports of diversion, revoke take-home privileges, exceptions or exemptions granted to or by the service for all patients.
DHS 75.15(19)(f)
(f) The state methadone authority may revoke the authority of a narcotic treatment service for opiate addiction to grant take-home privileges when the service cannot demonstrate that all requirements have been met in granting take-home privileges.
DHS 75.15(19)(g)
(g) A narcotic treatment service for opiate addiction shall have a written policy to discourage the congregation of patients at a location inside or outside the service facility for non-programmatic reasons, and shall post that policy in the facility.
DHS 75.15(20)(a)(a)
Approval of primary service. An applicant for approval to operate a narcotic treatment service for opiate addiction in Wisconsin with the intent of administering or dispensing a narcotic drug to narcotic addicts for maintenance or detoxification treatment shall submit all of the following to the state methadone authority:
DHS 75.15(20)(a)2.
2. A copy of the request for registration with the U.S. drug enforcement administration for the use of narcotic medications in the treatment of opiate addiction.
DHS 75.15(20)(a)3.
3. A narrative description of the treatment services that will be provided in addition to chemotherapy.
DHS 75.15(20)(a)6.
6. A copy of the policy and procedures manual for the service, detailing the operation of the service as follows:
DHS 75.15(20)(a)6.e.
e. A description of the service's use of testing or analysis to detect substances and the purposes for which the results of testing or analysis are used as well as the frequency of use.
DHS 75.15(20)(a)7.
7. Documentation that there are adequate physical facilities to provide all necessary services.
DHS 75.15(20)(a)8.a.a. Documentation that the service will have ready access to a comprehensive range of medical and rehabilitative services that will be available if needed.
DHS 75.15(20)(a)8.b.
b. The name, address, and a description of each hospital, institution, clinical laboratory or other facility available to provide the necessary services.
DHS 75.15(20)(a)9.
9. A list of persons working in the service who are licensed to administer or dispense narcotic drugs even if they are not responsible for administering or dispensing narcotic drugs.
DHS 75.15(20)(b)
(b)
Approval of service sites. Only service sites approved by the FDA, the U.S. drug enforcement administration and the state methadone authority may be used for treating narcotic addicts with a narcotic drug.
