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)1.1. The medical director or other authorized program physician shall note this in the clinical record.

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)(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)(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.

DHS 75.59(20)(e)(e) Security. Adequate security shall be provided inside and outside the facility for the safety of the patients and to prevent loitering and illegal activities.

DHS 75.59(20)(g)(g) Accessibility. The facility and areas within the facility shall be accessible to persons with physical disabilities.

DHS 75.59(20)(h)(h) Physical environment. The physical environment within the facility shall be conducive to promoting improved functioning and a drug-free lifestyle.

DHS 75.59(20)(L)(L) Disaster plan. Have a disaster plan and facility evacuation plan that is updated annually and posted in an area accessible to staff and patients.

DHS 75.59(20)(m)(m) Accreditation body. The facility shall meet physical facility standards established by the services accreditation body.

DHS 75.59(21)(a)(a) Staff member responsibility. Each staff member of the OTP is responsible for being alert to potential diversion of medication by patients and staff.