Md. Code Regs. 10.47.02.09

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.47.02.09 - Residential Services - Medically Monitored Intensive Inpatient Treatment Level III.7

A. Program Description. A medically monitored intensive inpatient treatment program shall:

(1) Offer a planned regimen of 24-hour professionally directed evaluation, care, and treatment in an inpatient setting;

(2) Act as an Intermediate Care Facility Type C/D; and

(3) Meet the certification requirements for detoxification services as described in COMAR 10.47.02.10E.

B. Patients who are appropriate for this level of treatment:

(1) Meet the current edition of the American Society of Addiction Medicine Patient Placement Criteria for Level III.7, or its equivalent as approved by the Administration; and

(2) Require 24-hour monitoring and care for subacute biomedical and emotional or behavioral conditions severe enough to warrant inpatient treatment.

C. Staffing. A program shall have:

(1) Appropriately credentialed staff as described in COMAR 10.47.01.06E;

(2) Staffing which allows for detoxification and can provide services necessary for treatment of coexisting medical, emotional, or behavioral problems that could interfere with recovery;

(3) A patient to alcohol and drug counselor ratio not exceeding eight patients for one full-time alcohol and drug counselor;

(4) On-site physician, physician assistant, or nurse practitioner coverage available to provide initial assessment and documented referral for care, and to monitor progress in treatment;

(5) A physician on call 24 hours a day;

(6) Nursing services, between 7 a.m. and 11 p.m., 7 days a week, including:

(a) 8 hours a day, 5 days a week coverage by a registered nurse; and

(b) The remainder of coverage by a licensed practical nurse; and

(7) At least two employees on duty between the hours of 11 p.m. and 7 a.m., 7 days a week, trained in crisis management and cardiopulmonary resuscitation.

D. Program Services. A program shall provide:

(1) An assessment as described in COMAR 10.47.01.04E within 2 days of admission;

(2) An individualized treatment plan as described in COMAR 10.47.01.04CC completed and signed by the alcohol and drug counselor and patient within 7 working days of the comprehensive assessment with a treatment plan update completed every 7 days;

(3) A minimum of 36 hours of therapeutic activities a week including, but not limited to:

(a) A minimum of one weekly individual counseling session;

(b) Group counseling;

(c) Alcohol and drug education;

(d) Nutrition education;

(e) Weekly family sessions; and

(f) Case management.

E. Medically Monitored Services.

(1) Nursing Services. Services shall include:

(a) An assessment at the time of the patient's admission, including a mental health focused assessment:

(i) Approved by the registered nurse and program physician;

(ii) Completed by qualified staff; and

(iii) Overseen by a registered nurse for patients admitted with any prescribed medication; and

(b) Medication monitoring conducted by:

(i) The registered nurse or overseen by the registered nurse in conjunction with the program's physician; and

(ii) Qualified nursing staff for patients who are admitted on or are prescribed any medications.

(2) Physician, Physician Assistant, or Nurse Practitioner Services.

(a) A physician, physician assistant, or nurse practitioner shall:

(i) Assess a patient within 24 hours of admission; and

(ii) Continue to assess the patient as is medically necessary after the first 24 hours of admission.

(b) A physician, physician assistant, or nurse practitioner shall conduct a physical examination of a patient within 96 hours of admission to the program.

(c) A physician or physician assistant shall assess a patient undergoing detoxification within 24 hours of admission or earlier if it is medically necessary to conduct the assessment in less than 24 hours.

(d) A physician or physician assistant shall provide on-site monitoring and further evaluation of patients undergoing detoxification on a daily basis, if medically necessary.

(e) A physician or physician assistant shall be available by telephone at all times to consult about patients undergoing detoxification.

F. Documentation. A designated clinical staff shall write a patient progress note at the end of each day services are provided and place the progress note in the patient's record.

G. Referral Services. The program shall offer the following services or maintain a listing of agency referral agreements for the following services:

(1) Services through the Division of Rehabilitation Services;

(2) Vocational assistance;

(3) Mental health services;

(4) Substance abuse treatment programs;

(5) Legal assistance; and

(6) Social services.

Md. Code Regs. 10.47.02.09

Regulations .09 Specific Program Requirements, adopted effective June 10, 2002 (29:11 Md. R. 882)
Regulation .09 amended as an emergency provision effective April 1, 2008 (35:9 Md. R. 894); amended permanently effective May 5, 2008 (35:9 Md. R. 898)