Tenn. Comp. R. & Regs. 0940-05-42-.06 - INTAKE, ADMISSIONS, AND DISCHARGES
(1) Prior to
admission to the Facility, each potential service recipient shall be evaluated
by the medical director or program physician and clinical staff who have been
determined to be qualified by education, training, and experience to perform or
coordinate the provision of such assessments. The purpose of such assessments
shall be to determine whether opioid substitution or detoxification will be the
most appropriate treatment modality for the service recipient. No prospective
service recipient shall be processed for admission until it has been verified
that the service recipient meets all applicable criteria.
(2) Except as otherwise authorized by law, no
person shall be admitted for treatment without written authorization from the
service recipient and, if applicable, parent, guardian or responsible party.
The following information shall be explained by a trained staff person to the
service recipient and other consenters and documented, in writing, in the
service recipient's file:
(a) The Facility's
services and treatment;
(b) The
specific conditions that will be treated;
(c) Explanation of treatment options,
detoxification rights, and clinic charges, including the fee agreement, signed
by the prospective service recipient or the service recipient's legal
representative; and
(d) The
Facility's rules regarding service recipient conduct and
responsibilities.
(3) No
standardized routines or schedules of increases or decreases of medications may
be established or used.
(4) A
Facility physician shall document that treatment is medically necessary. The
admissions and initial dosing decision ultimately rests with the medical
director or his or her designated program physician.
(5) A Facility shall only admit and retain
service recipients whose known needs can be met by the Facility in accordance
with its licensed program purpose and description and applicable federal and
state statutes, laws and regulations.
(6) Drug dependent pregnant females shall be
given priority for admission and services when a Facility has a waiting list
for admissions and it is determined that the health of the mother and/or unborn
child is more endangered than is the health of other service recipients waiting
for services.
(7) No Facility shall
provide a bounty, free services, medication or other reward for referral of
potential service recipients to the clinic.
(8) Initial Assessment. Within seven days of
admission, the Facility shall complete an initial assessment. The initial
assessment shall focus on the individual's eligibility and need for treatment
and shall provide indicators for initial dosage level, if admission is
determined appropriate. The initial assessment shall include:
(a) A physical examination;
(b) Relevant health history (e.g.,
determination of chronic or acute medical conditions such as diabetes, renal
disease, hepatitis, sickle cell anemia, tuberculosis (TB), HIV exposure,
sexually transmitted disease, chronic cardiopulmonary disease and
pregnancy);
(c) A personal and
family medical and mental health history;
(d) A determination of currently prescribed
medications;
(e) Personal and
family history of substance abuse;
(f) An evaluation of other substances of
abuse;
(g) Determination of current
opioid dependence;
(h)
Determination of length of addiction;
(i) A full toxicology screen to identify use
of drugs including, but not limited to, opioids, methadone, amphetamines,
cocaine, barbiturates, benzodiazepines and THC;
(j) A tuberculosis screen;
(k) A screening test for syphilis;
(l) Other tests as necessary or appropriate
(e.g., CBC, EKG, chest x-ray, hepatitis B surface antigen and hepatitis B
antibody, HIV testing). Tests not directly conducted by the Facility at
admission shall be conducted within seven days after admission. The Facility is
responsible for obtaining and maintaining documentation of required laboratory
tests performed by an alternative provider. Alternative providers may not
supply toxicology screens unless they meet the required quality guidelines,
content and timelines.
(9) Comprehensive Assessment. Within 30 days
of admission, the Facility shall have completed a comprehensive assessment to
include the following items. It shall be attached to the service recipient's
chart no later than five days after it is developed. It shall reflect that
detoxification is an option for treatment and supported by the Facility's
program and has been discussed with the service recipient. It shall also
integrate information obtained in the initial assessment. The Facility shall
obtain complete medical records from other providers with service recipient's
written consent.
(a) Whenever possible and
with service recipient consent, the intake process shall include a family
member or significant other to assist in provision of accurate information and
a full understanding and retention of instructions given to the service
recipient.
(b) The evaluation shall
include information obtained from:
1. The
service recipient;
2. Family
members, when applicable and permitted;
3. Friends and peers, when appropriate and
permitted; and
4. Other appropriate
and permitted collateral sources.
(c) The psychosocial evaluation shall include
information about the service recipient's:
1.
Personal strengths;
2.
Individualized needs;
3. Abilities
and/or interests;
4. Presenting
problems including a thorough analysis of the service recipient's addictive
behaviors such as:
(i) Licit and illicit drugs
used, including alcohol;
(ii)
Amount(s) and method(s) used;
(iii)
Frequency of use;
(iv) Duration of
use;
(v) Symptoms of physical
addiction;
(vi) History of
treatment for addictive behaviors;
(vii) Adverse consequences of use; and (viii)
Inappropriate use of prescribed substances;
5. Urgent needs, including suicide
risk;
6. Previous behavioral health
services, including:
(i) Diagnostic
information;
(ii) Treatment
information; and
(iii) Efficacy of
current or previously used medication;
7. Physical health history and current
status;
8. Diagnoses;
9. Mental status;
10. Current level of functioning;
11. Pertinent current and historical life
situation information, including his or her:
(i) Age;
(ii) Gender;
(iii) Employment history;
(iv) Legal involvement;
(v) Family history;
(vi) History of abuse; and
(vii) Relationships, including natural
supports.
12. Use of
alcohol and tobacco;
13. Need for,
and availability of, social supports;
14. Risk-taking behaviors;
15. Level of educational
functioning;
16. Medications
prescribed that are not a target of treatment or concern;
17. Medication allergies or adverse reactions
to medications;
18. Adjustment to
disabilities/disorders; and
19.
Motivation for treatment.
(d) The psychosocial assessment shall result
in the preparation of a concise interpretive multidisciplinary summary that:
1. Is based on the assessment data;
2. Describes and evaluates the level and
severity of the individual's addictive behaviors;
3. Is used in the development of the
individual plan of care; and
4.
Identifies any co-occurring disabilities or disorders that should be addressed
in the development of the individual plan of care.
(10) The following behavioral
signs which support the diagnosis shall be discussed and documented in the
service recipient's file, although none are required for admission:
(a) Unsuccessful efforts to control
use;
(b) Time spent obtaining drugs
or recovering from the effects of abuse;
(c) Continual use despite harmful
consequences;
(d) Obtaining opioids
illegally;
(e) Inappropriate use of
prescribed opioids;
(f) Giving up
or reducing important social, occupational or recreational
activities;
(g) Continuing use of
the opioids despite known adverse consequences to self, family or society;
and
(h) One or more unsuccessful
attempts at gradual removal of physical dependence on opioids (detoxification)
using methadone or other appropriate medications.
(11) Within 72 hours of admission, the
Facility shall conduct an inquiry with the Central Registry in accordance with
Rule 0940-05-42-.20.
(12)
Non-Admissions. The Facility 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 persons were not
admitted and what referrals were made for them by the Facility.
(13) Discharge and Aftercare Plans. A
Facility shall complete an individualized discharge and aftercare plan for
service recipients who complete their course of treatment.
(a) Upon admission a Facility shall begin
development of a service recipient's discharge plan.
(b) All discharge and aftercare plans shall
include documentation that the Facility's counseling and/or medical staff has
discussed with the service recipient an individualized detoxification program
appropriate to the service recipient as required in section 0940-05-42-.18
herein.
(c) The service recipient's
discharge planning shall include the development of a menu of treatment
resources available to the service recipient in his or her community. This menu
shall be developed in consultation with the service recipient. And shall be in
writing and made available to the service recipient upon discharge. The
Facility shall assist the service recipient in obtaining the appropriate
referral.
(d) The discharge plan
shall be completed within seven days of discharge by the person who has primary
responsibility for coordinating or providing for the care of the service
recipient. It shall include a final assessment of the service recipient's
status at the time of discharge and aftercare planning. If applicable, parents
or guardian, or responsible persons may participate in discharge and aftercare
planning. The reason for any service recipient not participating in discharge
and aftercare planning shall be documented in the service recipient's
record.
Notes
Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404.
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