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DHS 75.15(5)(j)7. 7. Identifies the person's reasons for seeking treatment. Reasons shall include why the person chose the service and whether the person fully understands the treatment options and the nature and requirements of narcotic addiction treatment are fully understood.
DHS 75.15(5)(j)8. 8. Completes an initial drug screening or analysis of the person's urine to detect use of opiates, methadone, amphetamines, benzodiazepines, cocaine or barbiturates. The analysis shall show positive for narcotics, or an adequate explanation for negative results shall be provided and noted in the applicant's record. The primary counselor shall enter into the patient's case record the counselor's name, the content of a patient's initial assessment and the initial treatment plan. The primary counselor shall make these entries immediately after the patient is stabilized on a dose or within 4 weeks of admission, whichever is sooner.
DHS 75.15(5)(j)9. 9. If the service is at capacity, immediately advises the applicant of the existence of a waiting list and providing that person with a referral to another treatment service that can serve the person's treatment needs.
DHS 75.15(5)(j)10. 10. Refers a person who also has a physical health or mental health problem that cannot be treated within the service to an appropriate agency for appropriate treatment.
DHS 75.15(5)(j)11. 11. Obtains the person's written consent for the service to secure records from other agencies that may assist the service with treatment planning.
DHS 75.15(5)(j)12. 12. Arranges for hospital detoxification for patients seriously addicted to alcohol or sedatives or to anxiolytics before initiating outpatient treatment.
DHS 75.15(5)(k) (k) Priority admissions. A service shall offer priority admission either through immediate admission or priority placement on a waiting list in the following order:
DHS 75.15(5)(k)1. 1. Pregnant women.
DHS 75.15(5)(k)2. 2. Persons with serious medical or psychiatric problems.
DHS 75.15(5)(k)3. 3. Persons identified by the service through screening as having an infectious or communicable disease, including screening for risk behaviors related to human immunodeficiency virus infection, sexually transmitted diseases and tuberculosis.
DHS 75.15(5)(L) (L) Appropriate and uncoerced treatment. Service staff shall determine through a screening process that narcotic addiction treatment is the most appropriate treatment modality for the applicant and that treatment is not coerced.
DHS 75.15(5)(m) (m) Correctional supervision notification. A service shall require a person who is under correctional supervision to provide written information releases that are necessary for the service to notify and communicate with the patient's probation and parole officer and any other correctional authority regarding the patient's participation in the service.
DHS 75.15(6) (6)Orientation of new patients. A service shall provide new patients with an orientation to the service that includes all of the following:
DHS 75.15(6)(a) (a) A description of treatment policies and procedures.
DHS 75.15(6)(b) (b) A description of patient rights and responsibilities.
DHS 75.15(6)(c) (c) Provision of a copy of a patient handbook that covers treatment policies and procedures, and patient rights and responsibilities. The service shall require a new patient to acknowledge, in writing, receipt of the handbook.
DHS 75.15(7) (7)Research and human rights committee. A narcotic treatment service 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 75.15(8) (8)Research.
DHS 75.15(8)(a) (a) All proposed research involving patients shall meet the requirements of s. 51.61 (1) (j), Stats., 45 CFR Part 46 and this subsection.
DHS 75.15(8)(b) (b) 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 75.15(8)(b)1. 1. Protect the privacy of the patient.
DHS 75.15(8)(b)2. 2. Protect the confidentiality of treatment records in accordance with s. 51.30, Stats., and ch. DHS 92.
DHS 75.15(8)(b)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 75.15(9) (9)Medical services.
DHS 75.15(9)(b) (b) The medical director of a service is responsible for all of the following:
DHS 75.15(9)(b)1. 1. Administering all medical services provided by the service.
DHS 75.15(9)(b)2. 2. Ensuring that the service complies with all federal, state, and local statutes, ordinances and regulations regarding medical treatment of narcotic addiction.
DHS 75.15(9)(b)3. 3. Ensuring that evidence of current physiological or psychological dependence, length of history of addiction and exceptions as granted by the state methadone authority to criteria for admission are documented in the patient's case record before the initial dose is administered.
DHS 75.15(9)(b)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 75.15(9)(b)5. 5. Ensuring that appropriate laboratory studies have been performed and reviewed.
DHS 75.15(9)(b)6. 6. Signing or countersigning all medical orders as required by federal or state law, including all of the following:
DHS 75.15(9)(b)6.a. a. Initial medical orders and all subsequent medical order changes.
DHS 75.15(9)(b)6.b. b. Approval of all take-home medications.
DHS 75.15(9)(b)6.c. c. Approval of all changes in frequency of take-home medication.
DHS 75.15(9)(b)6.d. d. Prescriptions for additional take-home medication for an emergency situation.
DHS 75.15(9)(b)7. 7. Reviewing and countersigning each treatment plan 4 times annually.
DHS 75.15(9)(b)8. 8. Ensuring that justification is recorded in the patient's case record for reducing the frequency of service visits for observed drug ingesting and providing additional take-home medication under exceptional circumstances or when there is physical disability, as well as when any medication is prescribed for physical health or psychiatric problems.
DHS 75.15(9)(b)9. 9. The amount of narcotic drug administered or dispensed, and for recording, signing and dating each change in the dosage schedule in a patient's case record.
DHS 75.15(9)(c) (c) A service physician is responsible for all of the following:
DHS 75.15(9)(c)1. 1. Determining the amount of the narcotic drug to be administered or dispensed and recording, signing and dating each change in a patient's dosage schedule in the patient's case record.
DHS 75.15(9)(c)2. 2. Ensuring that written justification is included in a patient's case record for a daily dose greater than 100 milligrams.
DHS 75.15(9)(c)3. 3. Approving, by signature and date, any request for an exception to the requirements under sub. (11) relating to take-home medications.
DHS 75.15(9)(c)4. 4. Detoxification of a patient from narcotic drugs and administering the narcotic drug or authorizing an agent to administer it under physician supervision and physician orders in a manner that prevents the onset of withdrawal symptoms.
DHS 75.15(9)(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 75.15(9)(c)5.a. a. The person 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 75.15(9)(c)5.b. b. The person would be eligible for admission if he or she were not incarcerated or institutionalized before eligibility was established.
DHS 75.15(9)(c)5.c. c. The admitting service physician or service personnel supervised by the service physician records in the new 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 75.15(9)(c)5.d. d. The service physician 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 75.15(9)(d) (d) A patient's history and physical examination shall support a judgment on the part of the service physician that the patient is a suitable candidate for narcotic addiction treatment.
DHS 75.15(9)(e) (e) A service shall provide narcotic addiction treatment to a patient for a maximum of 2 years from the date of the person's admission to the service, unless clear justification for longer service provision is documented in the treatment plan and progress notes. Clear justification for longer service shall include documentation of all of the following:
DHS 75.15(9)(e)1. 1. The patient continues to benefit from the treatment.
DHS 75.15(9)(e)2. 2. The risk of relapse is no longer present.
DHS 75.15(9)(e)3. 3. The patient exhibits no side effects from the treatment.
DHS 75.15(9)(e)4. 4. Continued treatment is medically necessary in the professional judgment of the service physician.
DHS 75.15 Note Note: Be aware that federal law, including but not limited to 21 CFR 1306.07 and 42 CFR 8.12, does apply to this service. A service that holds both a s. DHS 75.15 Narcotic Treatment Service for Opiate Addiction certification and a s. DHS 75.13 CSAS Outpatient Treatment Service certification may issue prescription orders for buprenorphine products to a client who is only enrolled in the s. DHS 75.13 CSAS Outpatient Treatment Service, pursuant to the 2009 SAMHSA Dear Colleague letter https://www.samhsa.gov/sites/default/files/programs_campaigns/medication_assisted/dear_colleague_letters/2009-colleague-letter-prescribing-subutex-suboxone.pdf.
DHS 75.15(10) (10)Dosage.
DHS 75.15(10)(a) (a) Because methadone and other FDA-approved narcotics are medications, the dose determination for a patient is a matter of clinical judgment by a physician in consultation with the patient and appropriate staff of the service.
DHS 75.15(10)(b) (b) The service physician who has examined a patient shall determine, on the basis of clinical judgment, the appropriate narcotic dose for the patient.
DHS 75.15(10)(c) (c) Any dose adjustment, either up or down, to sanction the patient, to reinforce the patient's behavior or for purposes of treatment contracting, is prohibited, except as provided in par. (h).
DHS 75.15(10)(d) (d) The service shall delay administration of methadone to an objectively intoxicated patient until diminution of intoxication symptoms can be documented, or the patient shall be readmitted for observation for withdrawal symptoms while augmenting the patient's daily dose in a controlled, observable fashion.
DHS 75.15(10)(e) (e) The narcotic dose that a service provides to a patient shall be sufficient to produce the desired response in the patient for the desired duration of time.
DHS 75.15(10)(f) (f) A patient's initial dose shall be based on the service physician's evaluation of the history and present condition of the patient. The evaluation shall include knowledge of local conditions, such as the relative purity of available street drugs. The initial dose may not exceed 30 milligrams except that the total dose for the first day may not exceed 40 milligrams.
DHS 75.15(10)(g) (g) A service shall incorporate withdrawal planning as a goal in a patient's treatment plan, and shall begin to address it once the patient is stabilized. A service physician shall determine the rate of withdrawal to prevent relapse or withdrawal symptoms.
DHS 75.15(10)(h)1.1. A service physician may order the withdrawal of a patient from medication for administrative reasons, such as extreme antisocial behavior or noncompliance with minimal service standards.
DHS 75.15(10)(h)2. 2. The process of withdrawal from medication for administrative reasons shall be conducted in a humane manner as determined by the service physician, and referral shall be made to other treatment services.
DHS 75.15(11) (11)Take-home medication practices.
DHS 75.15(11)(a) (a) Granting take-home privileges. During treatment, a patient may benefit from less frequent required visits for dosing. This shall be based on an assessment by the treatment staff. Time in treatment is not the sole consideration for granting take-home privileges. After consideration of treatment progress, the service physician shall determine if take-home doses are appropriate or if approval to take home doses should be rescinded. Federal requirements that shall be adhered to by the state methadone authority and the service are as follows:
DHS 75.15(11)(a)1. 1. Take-home doses are not allowed during the first 90 days of treatment. Patients shall be expected to attend the service daily, except Sundays, during the initial 90-day period with no exceptions granted.
DHS 75.15(11)(a)2. 2. Take-home doses may not be granted if the patient continues to use illicit drugs and if the primary counselor and the treatment team determine that the patient is not making progress in treatment and has continued drug use or legal problems.
DHS 75.15(11)(a)3. 3. Take-home doses shall only be provided when the patient is clearly adhering to the requirements of the service. The patient shall be expected to show responsibility for security and handling of take-home doses.
DHS 75.15(11)(a)4. 4. Service staff shall go over the requirements for take-home privileges with a patient before the take-home practice for self-dosing is implemented. The service staff shall require the patient to provide written acknowledgment that all the rules for self-dosing have been provided and understood at the time the review occurs.
DHS 75.15(11)(a)5. 5. Service staff may not use the level of the daily dose to determine whether a patient receives take-home medication.
DHS 75.15(11)(b) (b) Treatment team recommendation. A treatment team of appropriate staff in consultation with a patient shall collect and evaluate the necessary information regarding a decision about take-home medication for the patient and make the recommendation to grant take-home privileges to the service physician.
DHS 75.15(11)(c) (c) Service physician review. The rationale for approving, denying or rescinding take-home privileges shall be recorded in the patient's case record and the documentation shall be reviewed, signed and dated by the service physician.
DHS 75.15(11)(d) (d) Service physician determination. The service physician shall consider and attest to all of the following in determining whether, in the service physician's reasonable clinical judgment, a patient is responsible in handling narcotic drugs and has made substantial progress in rehabilitation:
DHS 75.15(11)(d)1. 1. The patient is not abusing substances, including alcohol.
DHS 75.15(11)(d)2. 2. The patient keeps scheduled service appointments.
DHS 75.15(11)(d)3. 3. The patient exhibits no serious behavioral problems at the service.
DHS 75.15(11)(d)4. 4. The patient is not involved in criminal activity, such as drug dealing and selling take-home doses.
DHS 75.15(11)(d)5. 5. The patient has a stable home environment and social relationships.
DHS 75.15(11)(d)6. 6. The patient has met the following criteria for length of time in treatment starting from the date of admission:
DHS 75.15(11)(d)6.a. a. Three months in treatment before being allowed to take home doses for 2 days.
DHS 75.15(11)(d)6.b. b. Two years in treatment before being allowed to take home doses for 3 days.
DHS 75.15(11)(d)6.c. c. Three years in treatment before being allowed to take home doses for 6 days.
DHS 75.15(11)(d)7. 7. The patient provides assurance that take-home medication will be safely stored in a locked metal box within the home.
DHS 75.15(11)(d)8. 8. The rehabilitative benefit to the patient in decreasing the frequency of service attendance outweighs the potential risks of diversion.
DHS 75.15(11)(e) (e) Time in treatment criteria. The time in treatment criteria under par. (d) 6. shall be the minimum time before take-home medications will be considered unless there are exceptional circumstances and the service applies for and receives approval from the FDA and the state methadone authority for a particular patient for a longer period of time.
DHS 75.15(11)(f) (f) Individual consideration of request. A request for take-home privileges shall be considered on an individual basis. No request for take-home privileges may be granted automatically to any patient.
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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.