La. Admin. Code tit. 48 § I-5727

Current through Register Vol. 50, No. 12, December 20, 2024

Section I-5727 - Additional Staffing Requirements

A. The providers opioid treatment program shall have the following staff in addition to the general staffing requirements.

1. Pharmacist or Dispensing Physician

a. An opioid treatment program that dispenses prescription medication on-site shall employ or contract with a pharmacist or dispensing physician to assure that any prescription medication dispensed on-site meets the requirements of applicable state statutes and regulations.

b. The pharmacist or dispensing physician shall have a current, valid unrestricted license to practice in the state of Louisiana.

c. The provider's pharmacist or dispensing physician shall:

i. provide on-site services;

ii. dispense all medications;

iii. consult with the provider as needed;

iv. evaluate medication policy and procedure of provider to dispense medications;

v. reconcile inventories of medications that were dispensed and/or administered at least every 30 days;

vi. maintain medication records for at least three years in accordance with state laws, rules and regulations;

vii. approve all transport devices for take-home medications in accordance with the program's diversion control policy;

viii. work collaboratively with the medical director to decrease the dose to accomplish gradual, but complete withdrawal, only when requested by the member;

ix. contribute to the development of the initial treatment plan;

x. contribute to the documentation for the treatment plan review every 90 days in the first two years of treatment; and

xi. document response to treatment in progress notes at least every 30 days.

2. Nursing

a. The provider shall maintain a nursing staff sufficient to meet the needs of the clients.

b. Each nurse shall have a current unrestricted license to practice nursing in the state of Louisiana.

c. The responsibilities of the nurse(s) include but are not limited to:

i. administering medications;

ii. monitoring the client's response to medications;

iii. evaluating the client's use of medications and treatment from the program and other sources;

iv. documenting responses to treatment in progress notes at least every 30 days;

v. contributing to documentation for the treatment plan review every 90 days in the first two years of treatment;

vi. conducting drug screens; and

vii. participating in discharge planning.

3. Licensed Mental Health Professionals

a. The provider shall maintain a sufficient number of LMHPs to meet the needs of its clients and there is at least one LMHP or UP on site when clinical services are being provided.

b. licensed mental health professionals shall have a current, valid and unrestricted license in the state of Louisiana, and must comply with current, applicable scope of practice and supervisory requirements identified by their respective licensing boards.

i. - ii. Repealed.

c. the LMHP providing substance use treatment services shall have documented credentials, experience and/or training in working with members who have substance use disorders, which shall be maintained in the individual's personnel record.

d. the provider shall ensure that:

i. the caseload of the LMHP shall not exceed 75 active clients; and

ii. there is an LMHP on site at least five hours/week.

e. licensed mental health professionals shall provide the following services:

i. conduct orientation;

ii. develop the initial plan for treatment;

iii. revise treatment to include input by all disciplines, members and significant others;

iv. provide individual counseling;

v. contribute to the development as well as document the initial treatment plan;

vi. document response to treatment in progress notes at least every 30 days;

vii. contribute to the development as well as document reviews of treatment plan every 90 days in the first two years of treatment by the treatment team; and

viii. conduct in discharge planning as appropriate.

4. Unlicensed Professionals

a. The provider shall have UPs sufficient to meet the needs of the clients.

b. The caseload of the UP shall not exceed 75 active clients.

c. unlicensed professionals of substance use services must be registered with the addictive disorders regulatory authority (ADRA) and meet regulations and requirements in accordance with RS 37:3387 et seq.

i. written verification of ADRA registration and documentation of supervision when applicable shall be maintained in the individual's personnel record.

ii. unlicensed staff who fall under a professional scope of behavioral health practice with formal board approved clinical supervision and whose scope includes the provision of substance use services will not need to register with ADRA.

d. unlicensed substance use providers must meet at least one of the following qualifications:

i. be a master's prepared behavioral health professional that has not obtained full licensure privileges and is participating in ongoing professional supervision. When working in substance use treatment settings, the master's-prepared UP must be supervised by an LMHP, who meets the requirements of this Section;

ii. be a registered addiction counselor;

iii. be a certified addiction counselor; or

iv. be a CIT that is registered with ADRA and is currently participating in a supervision required by the addictive disorders practice act.

e. unlicensed professionals perform the following services under the supervision of a physician or LMHP:

i. participate in conducting orientation;

ii. participate in discharge planning as appropriate; and

iii. provide support to the treatment team where applicable, while only providing assistance allowable under the auspices of and pursuant to the scope of the individual's license.

5. OTP Practitioner. There shall be an OTP practitioner who is on-site as needed or on-call as needed during hours of operation.

a. the OTP practitioner shall have a current, valid unrestricted license to practice in the state of Louisiana. The OTP practitioner shall be on-site or on-call as needed during the hours of operation to provide the following services:

i. examine member for admission;

ii. prescribe medications;

iii. monitor the member's response to medications;

iv. evaluate the member's use of medication and treatment from the program and other sources;

v. contribute to the development of the initial treatment plan;

vi. contribute to the documentation regarding the response to treatment for treatment plan reviews;

vii. contribute to the documentation for the treatment plan review every 90 days in the first two years of treatment;

viii. conduct drug screens; and

ix. participate in discharge planning.

6. Medical Director

a. the provider shall ensure that its medical director is a licensed physician with a current, valid unrestricted license to practice in the state of Louisiana with two years of qualifying experience in treating psychiatric disorders.

b. the medical director shall provide the following services:

i. decrease the dose to accomplish gradual, but complete withdrawal, only when requested by the member;

ii. provide medically approved and medically supervised assistance for withdrawal, only when requested by the member;

iii. participate in the documentation of reviews of treatment plan every 90 days in the first two years of treatment; and

iv. participate in discharge planning.

v. Repealed.

7. Clinical Supervisor (CS)

a. state regulations require supervision of unlicensed professionals by a CS, who:

i. is an LMHP that maintains a current and unrestricted license with its respective professional board or licensing authority in the state of Louisiana;

ii. shall be on duty and on call as needed; and

iii. has two years of qualifying clinical experience as an LMHP in the provision of services provided by the provider;

b. the CS shall have the following responsibilities:

i. provide supervision utilizing evidenced-based techniques related to the practice of behavioral health counseling;

ii. serve as resource person for other professionals counseling persons with behavioral health disorders;

iii. attend and participate in care conferences, treatment planning activities, and discharge planning;

iv. provide oversight and supervision of such activities as recreation, art/music, or vocational education;

v. function as member advocate in treatment decisions;

vi. ensure the provider adheres to rules and regulations regarding all behavioral health treatment, such ad group size, caseload, and referrals;

vii. provide only those services that are within the person's scope of practice; and

viii. assist the clinical director and/or medical director and governing body with the development and implementation of policies and procedures.

B. Training. All direct care employees shall receive orientation and training for and demonstrate knowledge of the following, including, but not limited to:

1. symptoms of opiate withdrawal;

2. drug screen testing and collections;

3. current standards of practice regarding opiate addiction treatment;

4. poly-drug addiction;

5. information necessary to ensure care is provided within accepted standards of practice; and

6. non-licensed direct care staff are required to complete a basic clinical competency training program approved by OBH prior to providing the service.

La. Admin. Code tit. 48, § I-5727

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 411721 (9/1/2015), Amended LR 481288 (5/1/2022), Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 411721 (9/1/2015), Amended LR 481288 (5/1/2022), Amended by the Department of Health, Health Standards Section, LR 51 (EMERGENCY).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161.