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: DHS 75.59(10)(c)9.9. 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 75.59(10)(c)10.10. Ensuring the correct amount of medication is administered or dispensed, and for recording, signing and dating each change in the dosage schedule in a patient’s case record. DHS 75.59(10)(c)11.11. Ensuring that all physician orders are executed by the date given in the order or, if no date is specified, within 24 hours of the order being written. DHS 75.59(10)(c)12.12. Having a valid DEA registration for prescribing, administering, or dispensing controlled substances, and having a DEA waiver if they or any other healthcare professional they supervise prescribes, administers, or dispenses partial opioid agonists. DHS 75.59(10)(d)(d) Service physician responsibilities. A service physician is responsible for all of the following: DHS 75.59(10)(d)1.1. Determining the amount of the medication 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 75.59(10)(d)2.2. Approving, by signature and date, any request for an exception to the requirements under sub. (13) relating to take-home medications. DHS 75.59(10)(d)3.3. 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 75.59(10)(d)4.4. A history and physical examination of the patient determining that the patient is a suitable candidate for admission to an OTP. DHS 75.59(11)(a)(a) Dose determination. The dose determination for a patient is a matter of clinical judgment by a physician in consultation with the patient and appropriate clinical staff. DHS 75.59(11)(b)(b) Verbal orders. The service physician shall determine, on the basis of clinical judgment, the appropriate medication dose for the patient and may also use verbal orders pursuant to state, accreditation, and federal rules. Upon receiving the service physician’s order, the receiver shall record the order in the patient’s record, and then shall read back the written order to the issuing professional to assure that the order is understood clearly. Orders made orally or telephonically must be documented as such and staff recording must sign their name and title. Oral or telephone orders must be countersigned by the service physician no later than 72 hours after being given. DHS 75.59(11)(c)(c) Patient sanctioning. Any dose adjustment to sanction the patient, to reinforce the patient’s behavior, or for purposes of treatment contracting, is prohibited. DHS 75.59(11)(d)(d) Patients under the influence. The service shall delay administration of an FDA-approved medication for the treatment of an opioid use disorder to a patient under the influence of illicit drugs or alcohol until diminution of intoxication symptoms can be observed and 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 75.59(11)(e)(e) Sufficient dosing. The FDA-approved medication 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 75.59(11)(f)(f) Initial methadone dose. A patient’s initial dose shall be based on the service physician’s evaluation of the history and present condition of the patient. The initial dose of methadone may not exceed 30 milligrams except that the total dose for the first day may not exceed 40 milligrams. DHS 75.59(11)(g)(g) Withdrawal planning. A service shall incorporate withdrawal planning as a goal in a patient’s initial treatment plan and all subsequent treatment plans. A service physician shall determine the rate of withdrawal to prevent relapse or withdrawal symptoms. DHS 75.59(12)(a)1.1. The service may terminate a patient immediately, prior to a fair hearing and without provision for medically supervised withdrawal, when either of the following occurs: DHS 75.59(12)(a)1.a.a. The clinic director reasonably determines and documents that the patient’s continuance in the service presents an immediate and substantial threat of physical harm to other clients, service personnel or property. DHS 75.59(12)(a)1.b.b. The program’s medical director reasonably determines that continued treatment of a client presents a serious documented medical risk. DHS 75.59(12)(a)2.a.a. Immediately notify the patient of the decision and the reasons for the decision. DHS 75.59(12)(a)2.b.b. Schedule a hearing, to be held on the next business day and in accordance with par. (d), on the decision to terminate and provide notice of the hearing to the patient. DHS 75.59(12)(a)2.c.c. After a hearing is held in accordance with par. (d), notify the patient of the hearing officer’s decision within one business day of the hearing. DHS 75.59(12)(a)2.d.d. Provide referrals to ensure a continuum of care for the client, including continued counseling, medication, withdrawal management, and other services, including risk reduction and outreach. DHS 75.59(12)(a)3.3. Facilities that are in the process of termination are not required to provide medically supervised withdrawal services to clients who are discharged involuntarily on an emergency basis, but referrals for assistance elsewhere must be provided in such circumstances.
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administrativecode
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Department of Health Services (DHS)
Chs. DHS 30-100; Community Services
administrativecode/DHS 75.59(8)(a)
administrativecode/DHS 75.59(8)(a)
section
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