DEPARTMENT OF COMMUNITY HEALTH

                 MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES                      

                       PART 9. RESIDENTIAL PROGRAMS

                       SUBPART 1. GENERAL PROVISIONS


R  325.14901   Staffing.
  Rule 901. (1) A program shall have 1 full-time staff member or a  person
designated by the program director on the premises at all times.
  (2) The equivalent of 1 full-time counselor shall be available for every
10 residents.

  History:  1981 AACS.


R  325.14902   Admission procedures.
  Rule 902. (1)  Clearly  stated  written  criteria  for  determining  the
eligibility of  individuals  for  admission  shall  be  developed  by  the
residential program.
  (2) Information gathered in the course of the admission  and  assessment
process shall be recorded on internally standardized forms. The  completed
forms shall become part of the applicant's case record.
  (3) The program shall have written policies and procedures governing the
admission process which set forth both of the following:
  (a) The procedures to be followed when accepting referrals from  outside
agencies or organizations.
  (b) The procedures to be followed, including those for  referrals,  when
an applicant is found to be ineligible for admission.
  (4) All of the following information shall be collected and recorded for
all applicants before, or at the time of, admission:
  (a) Name, address, and telephone number, when applicable.
  (b) Date of birth and sex.
  (c) Family and social history.
  (d) Educational history.
  (e) Occupation.
  (f) Legal and court-related history.
  (g) Present substance abuse problem.
  (h) Date the information was gathered.
  (i) Signature of the staff member gathering the information.
  (j) Name of referring agency, when appropriate.
  (k) Address, telephone number, and name of nearest relative  to  contact
in case of emergency.
  (l) History of current and past  substance  abuse  or  other  counseling
services received. The agency, type of service, and the date  the  service
was received shall be indicated.
  (m) Name, address, and telephone number of the  most  recent  family  or
private physician.
  (n) A substance abuse history, including  information  about  prescribed
drugs and alcohol, which indicates, at a minimum,  all  of  the  following
information:
  (i) Substances used in the past, including prescribed drugs.
  (ii) Substances used recently, especially those used within the last  48
hours.
  (iii) Substances of preference.
  (iv) Frequency with which each substance is used.
  (v) Previous occurrences of overdose, withdrawal,  or  adverse  drug  or
alcohol reactions.
  (vi) History of previous substance abuse treatment received.
  (vii) Year of first use of each substance.
  (5) During the admission process, every effort shall be made  to  assure
that an applicant understands all of the following:
  (a) General nature and objectives of the program.
  (b) Rules that govern client conduct and infractions that  can  lead  to
disciplinary action or discharge from the program.
  (c) Hours during which services are available.
  (d) Costs to be borne by the client, if any.

  History:  1981 AACS.


R  325.14903   Withholding information.
  Rule 903. (1) An applicant  shall  retain  the  right  to  withhold  any
information that is not demonstrably necessary to the treatment process or
to essential program operations.
  (2) If a program finds it necessary to require  certain  information  in
addition to that described in R 325.14902 (4) and (5) as  a  condition  of
admission, there shall be a written policy delineating  such  information.
  (3) If an applicant is found to be ineligible for admission, the  reason
shall be recorded in  the  client  case  record  and,  if  appropriate,  a
referral to an appropriate agency or organization shall be attempted.

  History:  1981 AACS.


R  325.14904   Medical examination.
  Rule 904. (1) A client who has not had a medical  examination  within  6
months prior to admission shall have a medical examination performed under
the supervision of a licensed physician as soon as  practicable,  but  not
later than 14 days after admission.
  (2) Evidence  of  such  examination  and  information  relevant  to  the
client's health status shall be included in the client's record.

  History:  1981 AACS.


R  325.14905   Treatment plans.
  Rule 905. (1)  A  client's  social  and  psychological  needs  shall  be
assessed. The areas of concern shall include a determination of all of the
following:
  (a) Current emotional state.
  (b) Cultural background.
  (c) Vocational history.
  (d) Family relationships.
  (e) Educational background.
  (f) Socioeconomic status.
  (g) Any legal problems that may affect the treatment plan.
  (2) A written treatment  plan  based  upon  the  assessment  made  of  a
client's needs shall be  developed  and  recorded  in  the  client's  case
record. A treatment plan shall be developed as  soon  after  the  client's
admission as feasible, but before  the  client  is  engaged  in  extensive
therapeutic activities. The written treatment plan shall comply  with  all
of the following:
  (a) Be individualized based upon the assessment of  the  client's  needs
and, if applicable, the medical evaluation.
  (b) Specify those services planned for meeting the client's needs.
  (c) Include  referrals  for  services  that  are  not  provided  by  the
residential program.
  (d) Contain clear and concise statements of the  objectives  the  client
will be attempting to achieve, together with a realistic time schedule for
their achievement.
  (e) Define the services to be provided to the  client,  the  therapeutic
activities in which  the  client  is  expected  to  participate,  and  the
sequence in which services will be provided.
  (3) The client shall participate in the  development  of  the  treatment
plan and its  objectives.  The  nature  of  this  participation  shall  be
described in the client's record.
  (4) Review of, and changes in, the treatment plan shall be  recorded  in
the client's case record. The date of the review or change, together  with
the names of the  individuals  involved  in  the  review,  shall  also  be
recorded. The treatment plan shall be reviewed at least once every 90 days
by the program director or his or her designee.

  History:  1981 AACS.


R  325.14906   Client activities.
  Rule 906. Ten or more hours per week of scheduled  activities  shall  be
available to a client. Included in these activities shall  be  2  or  more
hours of formalized individual,  group,  or  family  counseling  for  each
client. The hours of counseling actually provided should vary according to
the needs of the client. There shall be documentation of  planned  social,
educational, and recreational activities consistent with the needs of  the
client. Activities shall include all clients and shall  take  place  days,
evenings, and weekends if clients are present during these times.

  History:  1981 AACS.


R  325.14907   Progress notes.
  Rule 907. (1) A client's progress and  current  status  in  meeting  the
objectives established in the treatment plan, together with a statement of
the efforts by staff members to  help  the  client  achieve  these  stated
objectives, shall be recorded in the client's case record for every formal
client counseling session. A progress note shall be dated  and  signed  by
the individual who makes the entry.
  (2) All progress notes shall be dated and signed by the  individual  who
makes the entry.
  (3) If a client is  receiving  services  at  an  outside  resource,  the
program shall attempt to secure a written case summary,  case  evaluation,
and other client records from that resource. These records shall be  added
to the client's case record.
  (4) The ongoing assessment of the  client's  progress  with  respect  to
achieving treatment plan objectives shall be used to update the  treatment
plan.

  History:  1981 AACS.


R  325.14908   Support and rehabilitative services.
  Rule 908. (1) All of the following support and  rehabilitation  services
shall be available  to  all  clients  either  internally  or  through  the
referral process:
  (a) Education.
  (b) Vocational counseling and training.
  (c) Job development and placement.
  (d) Financial counseling.
  (e) Legal counseling.
  (f) Spiritual counseling.
  (g) Nutritional education and counseling.
  (2) A program shall maintain a current  listing  of  services  available
on-site and by referral. This listing shall be reviewed with  each  client
as part of the program's orientation procedure.

  History:  1981 AACS.


R  325.14909   Client discharge and aftercare.
  Rule 909. (1) Within 2 weeks after discharge, there shall be entered  in
the client's case record a discharge summary describing the rationale  for
discharge, the client's treatment and rehabilitation status  or  condition
at discharge, and the instructions given to the client about aftercare and
follow-up.
  (2) Unless a client leaves voluntarily  before  his  or  her  course  of
treatment is completed, a client shall not be discharged  from  a  program
while physically dependent upon a drug prescribed for him or  her  by  the
program physician, unless the client is given an opportunity  to  withdraw
from the drug under medical supervision and at a rate  determined  by  the
program physician or the client is referred to an outside  resource  which
is willing to continue administering the drug.
  (3) The offer to provide withdrawal  or  referral  to  another  resource
shall be made both orally and in writing. If the client  refuses  such  an
offer, the program shall attempt to secure a  signed  statement  from  the
client which verifies that the offer was made to, and was rejected by, the
client. Failing that, a record shall be entered documenting  the  attempt.
  (4) If a program provides aftercare services, a written  aftercare  plan
shall be developed in partnership with the client before the completion of
treatment. The aftercare plan shall state the client's  objectives  for  a
reasonable period following discharge.  The  plan  shall  also  contain  a
description of the services the program will provide during the  aftercare
period, the procedure the client is to follow  in  reestablishing  contact
with the program, especially in times of crisis, and  the  frequency  with
which the program will attempt to  contact  the  client  for  purposes  of
follow-up.
  (5) The date, method, and  results  of  attempts  at  contact  shall  be
entered in the client's case record and shall be signed by the  individual
who makes the entry. If follow-up  information  cannot  be  obtained,  the
reason for failing to obtain the  information  shall  be  entered  in  the
client's case record.
  (6) Regardless of the method of  contact  utilized,  the  program  shall
protect the confidentiality of the  client.  Mailing  envelopes  that  are
identifiable as originating from the program shall  not  be  mailed  to  a
client. A post office box number may be used  to  determine  if  mail  was
undeliverable and to facilitate follow-up.
  (7) If the program wishes to determine the status of  clients  who  have
been discharged, such follow-up shall be limited to methods  which  either
assure client confidentiality or require formal  written  consent  of  the
client.

  History:  1981 AACS.


R  325.14910   Client records; content; maintenance.
  Rule 910. (1) There shall be a case record for each client. All  of  the
following items shall be filed in the case record, if applicable:
  (a)  Results  of  all  examinations,   tests,   and   other   assessment
information.
  (b) Reports from referring sources.
  (c) Treatment plans.
  (d) Records of referrals to outside resources.
  (e) Reports from outside resources, which shall include the name of  the
resource and the date of the report. These reports shall be signed by  the
person who makes the report or by the program staff  member  who  receives
the report.
  (f) Case conference and consultation notes, including the  date  of  the
conference or consultation, recommendations made, and actions taken.
  (g) Correspondence related to the  client,  including  all  letters  and
dated notations  of  telephone  conversations  relevant  to  the  client's
treatment.
  (h) Treatment consent forms.
  (i) Information release forms.
  (j) Progress notes. Entries shall be filed in  chronological  order  and
shall include the date any relevant observations were made, the  date  the
entry was made, and the signature and staff title of the person who  makes
the entry.
  (k) Records of services provided. Summaries of services  provided  shall
be sufficiently detailed so that a person who is  not  familiar  with  the
program can identify the  types  of  services  the  client  has  received.
General terms such as "counseling" or "activities"  shall  be  avoided  in
describing services.
  (l) Aftercare plans.
  (m) Discharge summary.
  (n) Follow-up information.
  (2) A program shall  provide  sufficient  facilities  for  the  storage,
processing, and handling of client case records.  These  facilities  shall
include suitably locked and secured rooms and files.
  (3) Appropriate records shall  be  readily  accessible  to  those  staff
members who provide services directly to the client.
  (4) Client case records shall be maintained for not less  than  3  years
after services are discontinued.
  (5) If a program stores client data on magnetic tape, computer files, or
other types of automated information systems, security measures  shall  be
developed to prevent inadvertent or unauthorized access to data files.

  History:  1981 AACS.


R  325.14911   Residential detoxification program.
  Rule 911. Residential programs which detoxify clients  from  alcohol  or
other drugs, but which are not designated as approved  services  programs,
shall comply with all rules in  subpart  2  of  this  part  applicable  to
approved  service  programs  with   the   exception   of   R 325.14921(2),
R 325.14927(8), R 325.14927(9), and R 325.14927(12).

  History:  1981 AACS.


                   SUBPART 2. APPROVED SERVICE PROGRAMS


R  325.14921   Approved service program licensing.
  Rule 921. (1) A program that is designated by the  administrator  as  an
approved service program shall be licensed by the office as a  residential
program and shall comply with R 325.14922 to R 325.14928.
  (2) An approved service program  shall  have  access  to  duly  licensed
laboratories to conduct chemical testing to determine blood alcohol level.

  History:  1981 AACS.


R  325.14922   Annual review; documentation.
  Rule 922. There shall be documentation of an  annual  review,  updating,
and approval of all of the following by the governing body of the program:
  (a) The triage process.
  (b) Procedures for medical evaluation.
  (c) Treatment protocol for incapacitated persons.
  (d) The transportation plan.
  (e) The plan for training staff and supportive personnel.

  History:  1981 AACS.


R  325.14923   Training; documentation; written plan.
  Rule 923. (1) There shall be documentation which verifies that  approved
service program staff and supporting  personnel  who  work  directly  with
clients are appropriately trained.
  (2) There shall be a written plan for providing training.
  (3) There shall be documentation that the written plan is  developed  in
consultation with a physician.

  History:  1981 AACS.


R  325.14924   Control register and client records.
  Rule 924. (1)  A  program  shall  establish  a  control  register  which
includes all of the following information:
  (a) The name of the client.
  (b) The date and time of client's arrival.
  (c) The client's means of arrival and by whom transported.
  (2) A program shall keep client records which shall include all  of  the
following information:
  (a) The medical exam and evaluation.
  (b) The treatment plan.
  (c) An evaluation of social and psychological needs.
  (d) The discharge summary.

  History:  1981 AACS.


R  325.14925   Physician  and   physician's   designated   representative;
  staffing requirements.
  Rule 925. (1) An approved service program shall have a written agreement
with a licensed physician.
  (2) There shall be a licensed physician on call 24 hours a day, 7 days a
week.
  (3) An approved service program shall be staffed 24  hours  per  day,  7
days per week by a licensed physician or by a designated representative of
a licensed physician. The designation of a representative shall be written
and signed by the licensed physician.
  (4) The physician shall review and countersign all medical  evaluations,
diagnoses, and treatment records at least once every 72 hours.

  History:  1981 AACS.


R  325.14926   Triage process.
  Rule 926. An approved service program shall have a  written  description
of its triage process. There shall be documentation that this  process  is
developed in conjunction with a licensed physician. The description  shall
include all of the following:
  (a) The method used in determining the level of urgency of need of  each
individual client.
  (b)  Identification  of  the  services  to   be   performed,   including
transportation if necessary.
  (c) The method of assigning the priority of required services.

  History:  1981 AACS.


R  325.14927   Medical  examination;  substance  abuse  history;   medical
history; treatment of unconscious person and persons with severe medical
complications prohibited; agreements with emergency medical departments;
incapacitated   persons;   treatment   plan   for   persons   undergoing
detoxification required; protective custody.
  Rule 927. (1) A medical examination shall  be  performed  every  time  a
person who is apparently incapacitated is brought to an  approved  service
program, unless the individual has  been  transferred  from  an  emergency
medical service where an examination was performed  and  documentation  of
the examination is  available  to  the  program.  If  the  examination  is
performed at the approved service program, it  shall  be  performed  by  a
physician or his or her designee.
  (2) The medical examination  that  is  performed  upon  arrival  at  the
approved service program shall include  an  examination  for  illness  and
injury.
  (3) Substance abuse history information shall be obtained as soon  after
admission as is  practicable.  This  history  shall  include  all  of  the
following:
  (a) Substances used in the past, including prescribed drugs.
  (b) Substances used recently, especially those used within the  last  48
hours.
  (c) Substances of preference.
  (d) Frequency with which each substance is used.
  (e) Prevous occurrences of overdose,  withdrawal,  or  adverse  drug  or
alcohol reactions.
  (f) History of previous substance abuse treatment received.
  (g) Year of first use of each substance.
  (4) A complete medical history shall  be  obtained.  The  history  shall
contain all of the following information:
  (a) Head injuries.
  (b) Nervous diseases.
  (c) Convulsive diseases.
  (d) Major and minor operations.
  (e) Major accidents.
  (f) Fractures.
  (g) Venereal infections.
  (h) Cardiovascular diseases.
  (i) Respiratory diseases.
  (j) Endocrine diseases.
  (k) Rheumatic diseases.
  (l) Gastrointestinal diseases.
  (m) Allergic diseases.
  (n) Gynecological-obstetrical history, as appropriate.
  (5) An approved service program shall not treat unconscious  persons  or
persons  with  severe  medical  complications.  These  persons  shall   be
transported to the nearest hospital which  is  capable  of  providing  the
necessary services. This transportation plan  shall  be  included  in  the
written triage process.
  (6)  Approved  service  programs  shall  have  written  agreements  with
emergency medical departments  to  provide  services  beyond  the  medical
capacity of approved service programs.
  (7) An approved service program shall have a written description of  its
procedures for a medical evaluation. This description shall be approved by
the program physician.
  (8) If an individual in an incapacitated condition is to be admitted  to
an approved service program, there shall be documentation in  his  or  her
medical  exam  records  which  explicitly  attests  to  the   individual's
incapacitated condition.  The  basis  of  the  decision,  including  blood
alcohol level, if taken, shall be specified.
  (9) If an individual is found not  to  be  incapacitated,  the  approved
service program medical records shall so state. An individual found not to
be incapacitated  cannot  be  held  in  protective  custody,  but  may  be
voluntarily admitted for residential care services.
  (10) Approved service programs shall have a written description  of  the
protocol for treatment of incapacitated individuals. This  protocol  shall
be approved by the program physician.
  (11) There shall be a treatment  plan  for  each  client  who  undergoes
detoxification  at  an  approved  service  program.  A  standard  of  care
procedure specifying an appropriate treatment regimen may be utilized. The
treatment plan shall include all of the following:
  (a) Those services necessary to meet the client's medical needs.
  (b) Referrals to be made for medical and nursing services which are  not
provided by the program.
  (c)  Documentation  that  the  treatment  plan  has  been   periodically
evaluated and updated.
  (12) The approved service  program  shall  not  keep  an  individual  in
protective  custody  more  than  72  hours.  If  the  physician  deems  it
appropriate, an individual may voluntarily remain in the approved  service
program for more than 72 hours. The physician shall document the need  for
additional approved service  program  services  beyond  72  hours  in  the
client's medical records. The physician shall also enter documentation  of
the need for additional services in the medical records for  each  24-hour
period beyond 72 hours.

  History:  1981 AACS.


R  325.14928   Discharge.
  Rule 928. (1) Unless a client  leaves  voluntarily  before  his  or  her
course of treatment is completed, a client shall not be discharged from an
approved service program while physically dependent upon a drug prescribed
for him or her by the program physician, unless  the  client  is  provided
with an opportunity to withdraw from the drug or the client is referred to
an outside resource which is willing to continue administering  the  drug.
  (2) The offer to provide withdrawal  or  referral  to  another  resource
shall be made both orally and in writing. If  a  client  refuses  such  an
offer, the program shall attempt to secure a  signed  statement  from  the
client which verifies that the offer was made to,  and  rejected  by,  the
client. Failing that, a record shall be entered documenting  the  attempt.
  (3) There shall be documentation that an evaluation of  the  social  and
psychological needs of the client has been completed before discharge from
the approved service program. A referral to treatment  shall  be  made  if
appropriate and if desired by the client.
  (4) After discharge from  the  approved  service  program,  a  discharge
summary that describes the rationale for discharge, the  client's  medical
condition at discharge, referrals made,  and  instructions  given  to  the
client shall be entered into the client's case record.

  History:  1981 AACS.