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.
DHS 75.15(20)(c)1.1. To operate a medication unit, a service shall apply to the department for approval to operate the medication unit. A separate approval is required for each medication unit to be operated by the service. A medication unit is established to facilitate the needs of patients who are stabilized on an optimal dosage level. The department shall approve a medication unit before it may begin operation.
DHS 75.15(20)(c)2.
2. Approval of a medication unit shall take into consideration the distribution of patients and other medication units in a geographic area.
DHS 75.15(20)(c)3.
3. If a service has its approval revoked, the approval of each medication unit operated by the service is automatically revoked. Revocation of the approval of a medication unit does not automatically affect the approval of the primary service.
DHS 75.15 Note
Note: To apply for approval to operate a medication unit, contact the State Methadone Authority in the Bureau of Prevention, Treatment and Recovery at P.O. Box 7851, Madison, WI 53707-7851. Approvals of the Center for Substance Abuse Treatment and the U.S. Drug Enforcement Administration to operate a medication unit are also required. The State Methadone Authority will facilitate the application consideration by the Center for Substance Abuse Treatment and the U.S. Drug Enforcement Administration.
DHS 75.15(21)(a)(a) A person who sponsors a narcotic treatment service for opiate addiction and any personnel responsible for a particular service shall agree in writing to adhere to all applicable requirements of this chapter and
21 CFR Part 291 and
42 CFR Part 2.
DHS 75.15(21)(b)
(b) The service sponsor is responsible for all service staff and for all other service providers who work in the service at the primary facility or at other facilities or medication units.
DHS 75.15(21)(c)
(c) The service sponsor shall agree in writing to inform all service staff and all contracted service providers of the provisions of all pertinent state rules and federal regulations and shall monitor their activities to ensure that they comply with those rules and regulations.
DHS 75.15(21)(d)
(d) The service shall notify the designated federal agency and state methadone authority within 3 weeks after replacement of the service sponsor or medical director.
DHS 75.15(22)
(22) Death reporting. A narcotic treatment service for opiate addiction shall report the death of any of its patients to the state methadone authority within one week after learning of the patient's death.
DHS 75.15 History
History: Cr.
Register, July, 2000, No. 535, eff. 8-1-00; correction in (8) (b) 2. made under s.
13.92 (4) (b) 7., Stats.,
Register November 2008 No. 635;
CR 09-109: am. (4) (d) and (e), cr. (4) (dm)
Register May 2010 No. 653, eff. 6-1-10; correction in (4) (dm), (e) made under s.
13.92 (4) (b) 7., Stats.
Register November 2011 No. 671.
DHS 75.16(1)
(1)
Service description. Intervention services may include outreach; problem identification; referral; information; specialized education; case management; consultation; training; support or drop-in services; intensive supervision; alternative education; and intoxicated driver assessments under
ch. DHS 62.
DHS 75.16(2)(a)(a) To receive certification from the department under this chapter, an intervention service shall comply with the requirements included in
s. DHS 75.03 that apply to an intervention service, and 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 75.16(2)(b)
(b) If an intervention service is designated by a board under
s. DHS 62.04 (1) as an assessment facility, the intervention service shall also comply with the requirements under
ch. DHS 62.
DHS 75.16(3)
(3) Required personnel. In addition to the personnel required under
s. DHS 75.03 (4), an intervention service shall have the following personnel:
DHS 75.16(3)(a)
(a) Staff knowledgeable of the pharmacology of substances, addiction, and addiction intervention with training and experience in alcohol and drug problem outreach, detecting and identifying problems, screening under
s. DHS 75.03 (10) (c), family intervention, and referral. Staff shall have knowledge, training, and experience in the service which they are responsible for providing.
DHS 75.16(3)(b)
(b) A substance abuse counselor, employed by or under contract with an approved service under
ss. DHS 75.05 to
75.16, shall be available to conduct substance use evaluations and develop treatment recommendations as needed. A substance abuse counselor is not required for the assessment of drivers under
ch. DHS 62.
DHS 75.16(3)(c)
(c) Qualified staff, designated by the agency director, may conduct psychosocial evaluations, administer multidisciplinary screening tools, provide education, outreach, intervention and support, and make referrals as needed.
DHS 75.16(3)(d)
(d) Social workers, physicians, psychologists, and psychiatrists shall be available for referral as needed.
DHS 75.16(4)(a)(a) A plan for outreach and intervention services to various target populations shall be developed and implemented. Included in this plan shall be a provision of outreach and intervention services outside regular office hours and office location.
DHS 75.16(4)(b)
(b) Substance use screenings and evaluations shall be completed by qualified staff to determine the presence of alcohol and other drug use problems.
DHS 75.16(4)(c)
(c) Information shall be provided about alcohol and other drug use or abuse to assist clients in decision making.
DHS 75.16(4)(d)
(d) Assistance shall be provided to individuals regarding sources of help, referrals and arrangements for services.
DHS 75.16(4)(e)
(e) The service shall develop a system of referral that includes a current listing of agencies, organizations, and individuals to whom referrals may be made and a brief description of the range of services available from each referral resource.
DHS 75.16(4)(f)
(f) There shall be a written plan for and follow-up that includes qualified service organization agreements with treatment agencies to determine follow-through on referrals for service.
