DHS 75.59(17)(c)2.2. When a co-occurring disorder 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 patient with co-occurring disorders, 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. The mental health professional shall complete a mental health assessment within 3 business days of admission.

DHS 75.59(18)(a)(a) Risks. A requirement that each patient admitted to the OTP be informed of the possible risks to herself or to her unborn child from the use of medication-assisted treatment, and be informed that abrupt withdrawal from these medications may adversely affect the unborn child.

DHS 75.59(18)(b)(b) Medication-assisted treatment. A requirement that a pregnant patient who has a documented past opioid dependency and who may be in direct jeopardy of returning to opioid dependency with all of its attendant dangers during pregnancy, be informed that they may be placed on a medication-assisted treatment regimen. The service shall also provide a statement that for such pregnant women, evidence of current physiological dependence on opioid drugs is not needed if the medical director or other authorized program physician certifies the pregnancy, determines and documents that the woman may resort to the use of opioid drugs, and determines that medication-assisted treatment is justified in their clinical opinion.

DHS 75.59(18)(c)(c) Approval of admission. A requirement that the admission of each pregnant patient to an OTP be approved by the medical director or other authorized program physician prior to admitting the patient to the program.

DHS 75.59(18)(d)(d) Coordination of care. A requirement that OTPs develop a form for release of information between themselves and the healthcare provider in care of obstetrical care. This voluntary form should be offered to all pregnant patients for coordination of medical care.

DHS 75.59(18)(e)(e) Education. A requirement that each pregnant patient be given education on recognizing the symptoms of neonatal abstinence syndrome near the time of delivery.

DHS 75.59(18)(f)(f) Prenatal care. Procedures for prenatal care that include:

DHS 75.59(18)(f)1.1. Providing prenatal care by the service or by referral to an appropriate health care provider. If appropriate prenatal care is neither available on-site or by referral, or if the pregnant patient cannot afford care or refuses prenatal care services on-site or by referral, an OTP, at a minimum, should offer basic prenatal instruction on maternal, physical, and dietary care as part of its counseling services. If a pregnant patient refuses the offered on-site or referred prenatal services, the medical director or treating physician must use informed consent procedures to have the patient formally acknowledge, in writing, refusal of these services.

DHS 75.59(18)(f)2.2. A requirement that if a patient is referred to prenatal care outside the agency, the name, address and telephone number of the health care provider shall be recorded in the patient’s clinical record.

DHS 75.59(18)(f)3.3. A requirement that if prenatal care is provided by the OTP, the clinical record shall include documentation to reflect services provided.

DHS 75.59(18)(f)4.4. A requirement that if a patient is referred outside of the agency for prenatal services, the provider to whom she has been referred shall be notified that she is on medication-assisted treatment; however, such notice shall only be given after the patient has signed a release of information.

DHS 75.59(18)(f)5.5. A requirement that any changes in medication-assisted treatment be communicated to the appropriate healthcare provider if the woman has prenatal care outside the agency if the patient allows communication among providers.

DHS 75.59(18)(f)6.6. A requirement that the service monitor the medication dose carefully throughout the pregnancy, moving rapidly to supply increased or split dose if it becomes necessary.

DHS 75.59(18)(f)7.7. A recommendation that blood serum levels for methadone agonist be monitored once a trimester, and every three days for two weeks after delivery to ensure appropriate level of medication before and after delivery by the appropriate healthcare professional. The medical director shall request and review serum levels to determine whether any changes to treatment need to be made.

DHS 75.59(18)(f)8.8. A requirement that the service shall offer on-site parenting education and training to all patients who are parents or shall refer interested patients to appropriate alternative services for the training; and,

DHS 75.59(18)(g)(g) Pregnant patients that refuse prenatal services. Procedures for a patient who refuses prenatal service by the OTP or an outside provider, including that

DHS 75.59(18)(g)2.2. Requiring that the patient be asked to sign a statement that says “I have been offered the opportunity for prenatal care by the opioid treatment program or by a referral to a prenatal clinic or by a referral to the physician of my choice. I refuse prenatal counseling by the opioid treatment program. I refuse to permit the opioid treatment program to refer me to a physician or prenatal clinic for prenatal services.” If the patient refuses to sign the statement, the medical director or other authorized program physician shall indicate in the signature block that “patient refused to sign” and affix their signature and the date on the statement.

DHS 75.59(19)(a)(a) Tuberculosis - patients. An OTP shall screen patients for tuberculosis in a manner and frequency consistent with current CDC standard of practice. Tuberculosis treatment may be provided by referral to an appropriate public health agency or community medical service.

DHS 75.59(19)(b)(b) Tuberculosis - staff. A service shall screen prospective new staff and ongoing staff for tuberculosis in a manner and frequency consistent with current CDC standard of practice.

DHS 75.59(19)(c)(c) Screening. A service shall screen all patients via a risk factor assessment at admission and annually thereafter for viral hepatitis and sexually transmitted diseases and shall ensure that any necessary medical follow-up occurs, either on site or through referral to community medical services. Positive screening results or disease risks must have a management plan that is seen through to completion regardless of whether this is accomplished via services provided directly on-site or by referral and care coordination.

DHS 75.59(19)(d)(d) Hepatitis B. A service shall ensure that all clinical staff have been immunized against hepatitis B. Documentation of refusal to be immunized shall be entered in the staff member’s personnel record.

DHS 75.59(20)(20) Facility. A service shall provide a setting that is conducive to rehabilitation of the patients and that meets all of the following requirements:

DHS 75.59(20)(a)(a) Cleanliness. The waiting area, restrooms, dosing areas, and counseling offices shall be clean.

DHS 75.59(20)(b)(b) Ventilation and lighting. Waiting areas, dosing stations and all other areas for patients shall be provided with adequate ventilation and lighting.

DHS 75.59(20)(c)(c) Confidentiality. Dosing stations and adjacent areas shall be kept sanitary and ensure privacy and confidentiality.

DHS 75.59(20)(d)(d) Sound proofing. 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.