DHS 75.59(25)(b)4.4. When the PDMP data contains a recent history of multiple prescribers or multiple prescriptions for controlled substances, the physician’s review of the data and subsequent actions must be documented in the patient’s file within 72 hours and must contain the medical director’s determination of whether the prescriptions place the patient at risk of harm and the actions to be taken in response to the PDMP findings. The provider must conduct subsequent reviews of the PDMP in these circumstances on a monthly basis.

DHS 75.59(25)(b)5.5. If at any time the medical director believes the use of the controlled substances places the patient at risk of harm, the service must seek the patient’s consent to discuss the patient’s opioid treatment with other prescribers and for other prescribers to disclose to the OTP’s medical director of the client’s condition that formed the basis of the other prescriptions. If the information is not obtained within 7 days, the medical director must document whether or not changes to the client’s medication dose or number of unsupervised use doses are necessary until the information is obtained.

DHS 75.59(25m)(a)(a) Approval. To receive a guest dose, the patient must be enrolled in an OTP elsewhere in the state or country and be receiving the medication on a temporary basis because the client is not able to receive the medication at the program in which the client is enrolled. A patient may guest dose at a different OTP if prior approval is obtained from the patient’s medical director or program physician to receive services on a temporary basis from another OTP certified under this rule or by SAMHSA. The approval shall be noted in the patient’s record and shall include the following documentation:

DHS 75.59(25m)(a)1.1. The patient’s signed and dated consent for disclosing identifying information to the program which will provide services on a temporary basis.

DHS 75.59(25m)(a)2.2. A medication change order by the referring medical director or program physician permitting the patient to receive services on a temporary basis from the other program for a length of time not to exceed 30 days.

DHS 75.59(25m)(a)3.3. Evidence that the medical director or program physician for the program contacted to provide services on a temporary basis has accepted responsibility to treat the visiting patient, concurs with his or her dosage schedule, and supervises the administration of the medication.

DHS 75.59(25m)(c)(c) Patient requirement. Patients receiving guest dosing shall have been enrolled at the home clinic for a minimum of 30 days before being eligible for a guest dose. Patients enrolled less than 30 days at the home clinic shall be eligible for guest dosing only if approved by the SOTA.

DHS 75.59(25m)(d)(d) Drug screen requirement. Patients shall have two consecutive urine drug screens free of illicit substances or substances of abuse before being eligible for a guest dose, unless the medical director determines that the benefits of guest dosing outweigh the risks and documents the justification for granting guest dosing privileges in the patient’s record.

DHS 75.59(26)(a)(a) Naloxone. An OTP shall provide a patient with a naloxone kit or a prescription for naloxone at admission. The OTP shall provide instruction on the kits use including recognizing the signs and symptoms of overdose and calling 911 in overdose situations.

DHS 75.59(26)(b)(b) Use or expiration of Naloxone. The OTP shall provide a new naloxone kit or prescription upon expiration or use of the old kit.

DHS 75.59(26)(c)(c) Exemption. The OTP shall be exempt from this requirement for one year if the client refuses the naloxone kit or already has a naloxone kit.

DHS 75.59(26)(d)(d) Orientation training. Documentation that the patient has completed the orientation training on recognizing an overdose and how to use naloxone and received written information shall be completed and signed by service staff and the patient and maintained in the patient’s record.

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)(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: