DHS 75.59(27)(a)(a) The provision of interim maintenance with medication assisted treatment is prohibited under this rule unless the opioid treatment program has a waiver from the department in addition to authorization from SAMHSA in accordance with 42 CFR 8.11 (g). DHS 75.59(27)(b)(b) All of the requirements for comprehensive maintenance treatment apply to interim maintenance treatment with the following exceptions for patients receiving methadone: no take-home doses are permitted except on federal holidays if the program is closed on those days; an initial and periodic treatment plan are not required; a primary counselor is not required; and the rehabilitative and other services described in 42 CFR. 8.12 (f) (4), (f) (5) (i), and (f) (5) (iii) are not required. DHS 75.59(27)(c)(c) Interim maintenance cannot be provided to an individual for more than 120 days in any 12-month period. DHS 75.59(27)(d)(d) To receive interim maintenance, a patient must be fully eligible for admission to comprehensive maintenance. DHS 75.59(27)(e)(e) Interim maintenance treatment is for those patients who cannot be enrolled in comprehensive maintenance treatment in a reasonable geographic area within fourteen days of application for admission. DHS 75.59(27)(f)(f) During interim maintenance, the initial toxicology and at least two additional toxicology screening tests should be obtained. DHS 75.59(27)(g)(g) Programs offering interim maintenance must develop clear policies and procedures governing the admission to interim maintenance and transfer of patients to comprehensive maintenance. DHS 75.59(28)(a)(a) Emergency situations. Each OTP shall maintain an up-to-date disaster plan that addresses emergency situations including fire emergencies, tornadoes, earth quakes, flooding, winter storms, pandemics, and involuntary temporary or permanent facility closure. DHS 75.59(28)(b)(b) Committee. OTPs shall establish a health and safety committee that initiates planning actions for disaster scenarios. This committee shall: DHS 75.59(28)(b)1.1. Identify internal resources and areas of need that shall include, at minimum, considerations of: DHS 75.59(28)(b)2.2. Identify external resources and areas of need that shall include, at minimum: DHS 75.59(28)(b)3.3. Develop a communication plan for the disaster scenario to inform patients, the SOTA, SAMHSA, the DEA, and any other parties deemed necessary. DHS 75.59(28)(b)4.4. Develop disaster documentation procedures for guest patients that shall include at minimum: DHS 75.59(28)(c)(c) Emergency contact. Each OTP shall provide the SOTA with the emergency contact information for at least one member of the service. DHS 75.59(28)(d)(d) Medication supply. Each OTP shall keep at least a 10-day supply based on average caseload of methadone and buprenorphine products on site to prepare to receive clients from other facilities in disaster scenarios. DHS 75.59 HistoryHistory: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22; correction in (5) (b), (g) , (6) (a) 3. a., 4., (h), (k) 2., (7) (a) (intro.), (9) (a), (10) (c) 12., (12) (b) 2., (d) 2., 7., (h) 1. d. to f., 2. a. to e., (15) (a) 1., (21) (e), (f), (23) (a) made under s. 35.17, Stats., correction in numbering in (25m) made under s. 13.92 (4) (b) 1., Stats., correction in (6) (i) 3. made under s. 13.92 (4) (b) 4., Stats., and (10) (b) (title) created under s. 13.92 (4) (b) 2., Stats., Register October 2021 No. 790. DHS 75.60DHS 75.60 Office-based opioid treatment. DHS 75.60(1)(1) Applicability. This section shall not apply to office-based opioid treatment occurring in any of the following settings: DHS 75.60(1)(a)(a) A treatment service in which all patients receiving medication for addiction are enrolled in a service otherwise certified under this chapter. DHS 75.60(1)(e)(e) A service providing medication for addiction to less than 30 patients. DHS 75.60(2)(2) Service description. In this section, “office-based opioid treatment,” or “OBOT” service means pharmacotherapy for opioid use disorder, delivered in a stand-alone office-based opioid treatment clinic, a private office, or public sector clinic setting, excluding certified settings exempted in s. DHS 75.60 (1) or otherwise certified under this chapter, by practitioners authorized to prescribe outpatient supplies of medications approved by the FDA for the treatment of opioid addiction or dependence, prevention of relapse of opioid addiction or dependence, or both. An OBOT is subject to the oversight of the state opioid treatment authority. OBOT includes treatment with all medications approved by the FDA for such treatment. DHS 75.60(3)(3) Relationship to treatment service general requirements. A service that provides OBOT under this section shall be exempt from the treatment service general requirements in subchapter IV, unless otherwise indicated in this section. DHS 75.60(4)(a)(a) “Drug Addiction Treatment Act of 2000” (DATA 2000) means Title XXXV, Section 3502 of the Children’s Health Act, permits physicians who meet certain qualifications to treat opioid addiction with Schedule III, IV, and V narcotic medications that have been specifically approved by the FDA for that indication. DHS 75.60(4)(b)(b) “DATA 2000 waiver” means an authorization conveyed by SAMHSA and the DEA to a practitioner that permits them to prescribe or administer buprenorphine products to an individual with an opioid use disorder. DHS 75.60(4)(c)(c) “Primary care service” means outpatient general health care services provided by a clinic for regular health care services, preventive care, or for a specific health concern, and includes all of the following: DHS 75.60(4)(c)1.1. Care that promotes and maintains mental and physical health and wellness. DHS 75.60(4)(c)3.3. Screening, diagnosing, and treating acute or chronic conditions caused by disease, injury, or illness. DHS 75.60(4)(c)5.5. Provision of a broad spectrum of preventive and curative health care over a period of time. DHS 75.60(5)(5) State opioid treatment authority. The powers and duties of the SOTA include: DHS 75.60(5)(a)(a) Facilitating the development and implementation of rules, regulations, standards, and evidence-based practices, emerging best practices, or promising practices, to ensure the quality of services delivered by OBOT services. DHS 75.60(5)(b)(b) Acting as a liaison between relevant state and federal agencies. DHS 75.60(5)(c)(c) Reviewing opioid treatment guidelines and regulations developed by the federal government. DHS 75.60(5)(d)(d) Delivering technical assistance and informational materials to OBOT services as needed. DHS 75.60(5)(e)(e) Performing both scheduled and unscheduled site visits OBOTs in cooperation with department certification office or other oversight agencies, or as designated by the SOTA, when necessary and appropriate, and preparing reports as appropriate. DHS 75.60(5)(f)(f) Consulting with the federal government regarding approval or disapproval of requests for exceptions to federal regulations, where appropriate. DHS 75.60(5)(g)(g) Receiving and addressing service recipient appeals and grievances in partnership with the department’s client rights office. DHS 75.60(5)(h)(h) Issuing a list of required evidence-based practices, emerging best practices, and promising practices to be delivered by OBOT services, so long as the required practices are recognized by SAMHSA, Centers for Disease Control, or National Institute of Health. The SOTA may also provide a list of recommended evidence-based practices, emerging best practices, and promising practices. The SOTA may update the required practices list and the recommended practices list as needed to reflect advances in outcomes research and medical services for persons living with opioid use disorders. The SOTA shall take into consideration the adequacy of evidence to support the efficacy of the practice, the quality of workforce available, and the current availability of the practice in the state when updating the lists. At least 120 days before issuing the initial required practices list and any revisions to the required practices list, the SOTA shall provide stakeholders with an opportunity to comment and shall take those comments into consideration when updating the required practices list. DHS 75.60(6)(a)(a) Governing authority or entity owner. The governing authority or entity owner of an OBOT service shall do all of the following: DHS 75.60(6)(a)1.1. Designate a member or representative of the governing body that is legally responsible for the operation of a service that has the authority to conduct the policy, actions, and affairs of the service, to complete the entity owner background check and to be the entity owner responsible for a service. DHS 75.60(6)(a)2.2. Appoint a service director whose qualifications, authority, and duties are defined in writing. DHS 75.60(6)(a)3.3. Establish written policies and procedures for the operation of the service and exercise general direction over the service, to ensure the following: DHS 75.60(6)(a)3.b.b. That no person will be denied service or discriminated against on the basis of sex, race, color, creed, sexual orientation, disability, or age, in accordance with 45 CFR part 92 and Title VI of the Civil Rights Act of 1964, as amended, 42 USC. 2000d, Title XI of the Education Amendments of 1972, 20 USC 1681-1686 and s. 504 of the Rehabilitation Act of 1973, as amended, 29 USC 794, and the Americans with Disabilities Act of 1990, as amended, 42 USC 12101-12213. DHS 75.60(6)(b)(b) Caregiver background check. At the time of hire, employment, or contract, and every 4 years after, the service shall conduct and document a caregiver background check following the procedures in s. 50.065, Stats., and ch. DHS 12. A service shall not employ or contract with a person who has been convicted of a crime or offense, or has a governmental finding of misconduct, found in s. 50.065, Stats., and ch. DHS 12, Appendix A, unless the person has been approved under the department’s rehabilitation process as defined in ch. DHS 12. DHS 75.60(6)(c)(c) Personnel records. Employee records shall be available upon request at the service for review by the department. A separate record for each employee shall be maintained, kept current, and at a minimum, include: DHS 75.60(6)(c)1.1. A written job description including duties, responsibilities and qualifications required for the employee. DHS 75.60(6)(c)5.5. A copy of a signed statement regarding confidentiality of client information. DHS 75.60(6)(d)(d) Confidentiality. A service shall have written policies, procedures, and staff training to ensure compliance with confidentiality provisions of 42 CFR part 2, 45 CFR parts 164 and 170, s. 51.30, Stats., and ch. DHS 92. Each staff member shall sign a statement acknowledging responsibility to maintain confidentiality of personal information about persons served. DHS 75.60(7)(a)(a) An OBOT service shall perform and document an assessment of each patient. The assessment shall include all of the following: DHS 75.60(7)(a)5.5. Clinically appropriate physical examination at the time of admission and annually thereafter. DHS 75.60(7)(a)12.12. Consideration of screening for tuberculosis and sexually transmitted diseases in patients with known risk factors. DHS 75.60(7)(b)(b) A prescriber may satisfy the assessment requirements, other than toxicology testing, by reviewing records from a physical examination and laboratory testing of the patient that was conducted within a reasonable period of time prior to the visit. DHS 75.60(7)(c)(c) If any part of the assessment cannot be completed prior to the initiation of medication for opioid use disorder, the prescriber shall document the reasons in the patient’s record.
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