DHS 75.59(6)(e)1.1. For each patient eligible for admission, the service shall arrange for a comprehensive physical examination and clinically indicated laboratory work-up. The comprehensive physical examination shall be ordered by the service physician on the day of admission and shall include a complete blood count and liver function testing. The service shall test for Hepatitis A, B, C and HIV if the patient gives informed consent in writing. If the patient declines permission to test shall be documented in the patient's record. An updated comprehensive physical examination including lab work shall be completed annually.
DHS 75.59(6)(e)2.
2. The service shall complete a psychosocial assessment and initial treatment plan within 3 days of admission.
DHS 75.59(6)(f)
(f)
Initial dose. If a person meets the admission criteria under par.
(a), an initial dose of an FDA-approved medication may be administered to the patient on the day of admission. For each new patient enrolled in a service, the initial dose of methadone shall not exceed 30 milligrams and the total dose for the first day shall not exceed 40 milligrams, unless the service physician documents in the patient's record that 40 milligrams did not suppress opioid abstinence symptoms.
DHS 75.59(6)(g)
(g)
Central registry. All facilities shall participate in the department's central registry, subject to all of the following requirements:
DHS 75.59(6)(g)1.
1. A patient shall be informed of the service's participation in the central registry, and prior to initiating a central registry inquiry the service shall obtain the patient's written consent.
DHS 75.59(6)(g)2.
2. To prevent simultaneous enrollment of a patient in more than one OTP, at the time of admission and prior to the dosing of a patient, the service shall initiate a clearance inquiry by submitting to the approved central registry the patient's name, date of birth, and relevant information as required for the clearance procedure. No patient who is reported by the central registry to be participating in another such service shall be admitted to an OTP. When a dual enrollment is found, the patient shall be discharged from one OTP in order to continue enrollment at another OTP. The SOTA shall be notified within 24 hours of any dual enrollment discovered.
DHS 75.59(6)(g)3.
3. 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 OTP to which a disclosure will be made.
DHS 75.59(6)(g)4.
4. Reports received by the central registry shall be treated as confidential and shall not be released except to a licensed service or its designated legal representative, as required by law or as part of continuity of operations in the case of an emergency. Information made available by the central registry shall also be treated as confidential.
DHS 75.59(6)(g)5.
5. If a service operates not more than 200 miles away from an OTP in an adjoining state, the SOTA may direct the service to share service recipient information with the OTP in the other state to prevent simultaneous enrollment of persons in more than one OTP service.
DHS 75.59(6)(g)6.
6. A patient shall not be dosed prior to a central registry check being conducted.
DHS 75.59(6)(g)7.
7. Documentation of the central registry check shall be kept in the patient's file.
DHS 75.59(6)(h)
(h)
Information provided at admission. A patient admitted to the OTP shall receive written copies of the following information at the time of admission:
DHS 75.59(6)(h)3.
3. The service must provide access to staff support 24 hours a day 7 days a week to ensure that the service provides a mechanism to address patient emergencies (which includes medication verification by any other OTP, Emergency Department, correctional institution, or jail) by establishing an emergency contact system. The purpose of the contact system is to obtain dosage levels and other pertinent patient information on a 24 hour, 7-day-a-week-basis, as appropriate under confidentiality regulations. This subdivision does not require staff to be on site at all times, but at least one designated staff member is available “on call” as the emergency contact.
DHS 75.59(6)(i)
(i)
Admissions protocol. The service shall have a written admissions protocol that accomplishes all of the following:
DHS 75.59(6)(i)1.
1. Identifies the patient on the basis of appropriate substantiated documents that contain the patient'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 75.59(6)(i)2.
2. Determines the patient'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 75.59(6)(i)3.
3. Determines and verifies the patient's age. If the patient is a minor, the policy shall require documentation as provided in par.
(a) 2. DHS 75.59(6)(i)4.
4. Identifies all substances being used. To the extent possible, service staff shall obtain information on all substances used, route of administration, length of time used and amount and frequency of use.
DHS 75.59(6)(i)5.
5. Obtains information about past treatment. To the extent possible, service staff shall obtain information on a patient's treatment history, use of secondary substances while in the treatment, dates and length of time in treatment and reasons for discharge.
DHS 75.59(6)(i)6.
6. Obtains personal information about the patient. Personal information includes history and current status regarding employment, education, legal status (including arrests and conviction history), military service, family and psychiatric and medical information.
DHS 75.59(6)(i)7.
7. Identifies the patient's reasons for seeking treatment. Reasons shall include why the patient chose the service and whether they fully understand the treatment options and the nature and requirements of medication assisted treatment are fully understood.
DHS 75.59(6)(i)8.
8. Completes an initial drug screening or analysis to detect the use of opiates, methadone, buprenorphine, synthetic opioids, amphetamines, methamphetamine, benzodiazepines, cocaine, alcohol, and THC. The analysis shall show positive for narcotics, or an adequate explanation for negative results shall be provided and noted in the prospective patient's record.
DHS 75.59(6)(i)9.
9. Refers a patient who also has a physical health problem that cannot be treated within the service to an appropriate agency for appropriate treatment.
DHS 75.59(6)(i)10.
10. Obtains the patient's written consent for the service to secure records from other agencies that may assist the service with treatment planning.
DHS 75.59(6)(i)11.
11. Refers prospective patients who are physiologically dependent on alcohol, sedatives, or to anxiolytics to hospital detoxification before initiating treatment. If prospective patient refuses hospital detoxification, the medical director shall determine if the risk of treating a patient with a history of use of alcohol, sedatives, or anxiolytics outweighs the risk of non-admission to the service.
DHS 75.59(6)(j)
(j)
First priority for services. A service shall offer priority admission either through immediate admission or priority placement on a waiting list in the following order:
DHS 75.59(6)(j)1.
1. Pregnant women who inject drugs. Pregnant women are to be assessed for appropriateness for admission by a physician within 24 hours of contacting the service.
DHS 75.59(6)(j)2.
2. Pregnant women who are drug or alcohol dependent and need treatment.
DHS 75.59(6)(j)4.
4. Others individuals who are drug or alcohol dependent and need treatment.
DHS 75.59(6)(k)1.1. `Capacity management.' An OTP must notify the SOTA within seven days of the program reaching both 90 and 100 percent of the program's capacity to care for clients. Each week, the service must report its capacity, currently enrolled dosing clients, and any waiting list. A service reporting 90 percent of capacity must also notify the SOTA when the program's census increases or decreases from the 90 percent level.
DHS 75.59(6)(k)2.
2. `Waiting list.' If the service is at capacity, it shall immediately advise a prospective patient of the service's waiting list and provide that person with a referral to another treatment service that can serve the person's treatment needs. The OTP shall provide the SOTA documentation of any waiting list and where prospective patients were referred for treatment upon request. An OTP must have a waiting list system. If the prospective patient seeking admission cannot be admitted within 14 days of the date of application, each person seeking admission must be placed on the waiting list, unless the person seeking admission is assessed by the service and found ineligible for admission according to this chapter,
42 CFR parts 2 to
11, or
45 CFR parts 160 to
164. The waiting list must assign a unique client identifier for each person seeking treatment while awaiting admission.
DHS 75.59(6)(L)
(L)
Appropriate and un-coerced treatment. Service staff shall determine through a screening process that an OTP is the most appropriate treatment modality for the prospective patient and that treatment is not coerced.
DHS 75.59(6)(m)
(m)
Non-admissions. The service shall maintain written logs that identify persons who were considered for admission or initially screened for admission but were not admitted. Such logs shall identify the reasons why the person was not admitted and what referrals were made for them by the service. These logs will be provided to the department upon request.
DHS 75.59(7)(a)
(a)
Orientation information. Within 3 days of admission, a patient shall receive an orientation to OTP services providing information on the following:
DHS 75.59(7)(a)9.
9. How to attain self-administered dose privileges and requirements to maintain those privileges.
DHS 75.59(7)(a)11.
11. Rules governing patient conduct and infractions that can lead to disciplinary action or discharge from the OTP.
DHS 75.59(7)(b)
(b)
Written materials. Information provided in the orientation shall be accompanied by the provision of written materials on all covered topics.
DHS 75.59(7)(c)
(c)
Proof of orientation. The OTP shall require a new patient to acknowledge in writing that the patient has received a full orientation to all requirements and responsibilities associated with service enrollment.
DHS 75.59(7)(d)
(d)
Additional orientation requirements for pregnant patients. For pregnant patients, the OTP shall explain the following:
DHS 75.59(7)(d)1.
1. The risks and benefits of opioid treatment medication during pregnancy.
DHS 75.59(7)(e)
(e)
Documentation. Documentation of the provision of the above information shall be included in the patient's record.
DHS 75.59(8)(a)(a)
Accommodation of all patients. A service's hours of operation shall accommodate patients involved in activities such as school, homemaking, child care and employment.
DHS 75.59(8)(b)
(b)
Availability of dosing and counseling. Dosing and counseling shall be available at a medically appropriate level to meet patient needs and shall offer non-traditional hours of operation that meet the majority of patient's schedule needs.
DHS 75.59(8)(c)
(c)
Daily operations. All clinics must be open for dosing and counseling at least 6 days per week and shall be open 7 days a week if they have any patients that do not meet criteria for take home medication if those patients cannot be served via guest dosing at other nearby clinics. Facilities shall notify the SOTA and patients of the date of any holiday when the service will be closed at least 7 days in advance of the holiday. Clinics may only close for a holiday if all patients are eligible for take-home medication. In the event that all patients are not eligible for take-home medication, the service may request to offer modified hours for the holiday.
DHS 75.59(8)(d)
(d)
Training day. Any service may also be closed for one mandatory training day, if required by the SOTA.
DHS 75.59(8)(e)
(e)
Comprehensive services. Facilities shall offer comprehensive services, including individual and group counseling, and referral services, at least six days per week. Medical exams shall be provided on days when new admissions are scheduled and as needed for current patients.
DHS 75.59(9)(a)(a)
Human subjects. An OTP conducting or permitting research involving human subjects shall establish a research and human rights committee in accordance with s.
51.61 (4), Stats., and
45 CFR part 46.
DHS 75.59(9)(c)
(c)
Written consent. No patient may be subjected to any experimental diagnostic or treatment technique or to any other experimental intervention unless the patient gives written informed consent and the research and human rights committee established under s.
51.61 (4), Stats., has determined that adequate provisions are made to do all of the following:
DHS 75.59(9)(c)3.
3. Ensure that no patient may be approached to participate in the research unless the patient's participation is approved by the person responsible for the patient's treatment plan.
DHS 75.59(10)(a)(a)
Primary medical services. An OTP may provide primary medical services for patients. The OTPs may use all FDA-approved medications and formulations for use in treating the patient with a substance use disorder.
DHS 75.59(10)(b)
(b)
Coordination with medical providers. For medical needs of a patient that exceed the scope of the service under this chapter, the service shall coordinate with appropriate medical providers.
DHS 75.59(10)(c)
(c)
Medical director responsibilities. The medical director of a service is responsible for all of the following:
DHS 75.59(10)(c)2.
2. Ensuring that the service complies with all federal, state, and local statutes, ordinances and regulations regarding medical treatment of an opioid use disorder.
DHS 75.59(10)(c)3.
3. Ensuring that evidence of current physiological or psychological dependence, length of history of addiction and exceptions as granted by the SOTA to criteria for admission are documented in the patient's case record before the initial dose is administered.
DHS 75.59(10)(c)4.
4. Ensuring that a medical evaluation including a medical history and a physical examination have been completed for a patient before the initial dose is administered.
DHS 75.59(10)(c)5.
5. Making a clinical judgment that treatment is medically justified for a person who has resided in a penal or chronic care institution for one month or longer, under the following conditions:
DHS 75.59(10)(c)5.a.
a. The patient is admitted to treatment within 14 days before release or discharge or within 6 months after release without documented evidence to support findings of physiological dependence.
DHS 75.59(10)(c)5.b.
b. The patient would be eligible for admission if he or she were not incarcerated or institutionalized before eligibility was established.
DHS 75.59(10)(c)5.c.
c. The admitting service physician or service personnel supervised by the service physician records in the patient's case record evidence of the person's prior residence in a penal or chronic care institution and evidence of all other findings of addiction.
DHS 75.59(10)(c)5.d.
d. The medical director signs and dates the recordings under subd.
5. c. before the initial dose is administered to the patient or within 48 hours after administration of the initial dose to the patient.
DHS 75.59(10)(c)6.
6. Ensuring that appropriate laboratory studies have been performed and reviewed.
DHS 75.59(10)(c)7.
7. Signing or countersigning all medical orders as required by federal or state law, including all of the following:
