A. The Withdrawal Management rules in this section are based on the American Society of Addiction Medicine's established criteria for Level 2-WM: Ambulatory Withdrawal Management, 3.2-WM: Clinically Managed Residential Withdrawal Management (sometimes referred to as "social detox") and 3.7-WM: Medically Monitored Inpatient Withdrawal Management.B. These services must be provided in conjunction with DMH-Certified Level 1 Outpatient, Level 2 Intensive Outpatient Programs, Level 2.5 Partial Hospitalization Programs (PHP), Level 3.1 Clinically Managed Low-Intensity, Level 3.5 Clinically Managed Medium-Intensity, Level 3.5 Clinically Managed High-Intensity Residential Programs, and Level 3.7 Medically Monitored Intensive Inpatient Programs.C. All agency providers must utilize the results of a medical screening assessment(s) identifying the need for Withdrawal Management Services. The screening assessment(s) should be conducted as often as the individual case warrants.D. Agency providers providing Withdrawal Management Services must have written policies and procedures which specify the following:1. A person designated as responsible for coordinating Withdrawal Management Services;2. A description of the method by which Withdrawal Management Services are offered;3. A description of the method by which referrals are made to physicians and/or hospitals for appropriate medical intervention; and4. Criteria for admission, care, discharge, and transfer of a person to another level of care.E. All Residential Agency Providers must have a current contract on file with a Level 4 Medically Managed Intensive Inpatient Withdrawal Management Agency Provider. If applicable and funds are available, DMH will reimburse this contract for people experiencing physical withdrawals from benzodiazepines, opioids and/or alcohol, or people who have a history of a biomedical condition(s) that will complicate withdrawal. If the agency provider is serving pregnant women, the following must be included:1. The contract with the medical provider will state that women will not be detoxed during pregnancy without consideration by a physician or nurse practitioner of the impact it would have on the mother or her fetus.2. All Residential Services are responsible for ensuring that pregnant women are evaluated immediately by a physician, hospital, or medical clinic when symptoms of intoxication, impairment, or withdrawal are evident.3. All Residential Services must provide transportation for pregnant women who are referred to a physician, hospital, medical clinic or other appropriate residential facility.4. Withdrawal Management Services for pregnant/prenatal women will take into account up-to-date medical research.F. Agency providers should establish a protocol for immediate referral to an acute care facility such as: 1. The proper threshold score as established by the assessment instrument.2. When the person has any one of the following: (a) Seizures or history of seizures;(b) Current persistent vomiting or vomiting of blood;(c) Current ingestion of vomit in lungs;(d) Clouded sensorium such as gross disorientation or hallucination;(e) A temperature higher that 101 degrees Fahrenheit;(f) Abnormal respiration, such as shortness of breath, or a respiration rate greater than 26 breaths per minute;(g) Elevated pulse such as a heart rate greater than 100 beats per minute or arrhythmia;(h) Hypertension such as blood pressure greater than 160 over 120;(i) Sudden chest pain or other sign of coronary distress or severe abdominal pain;(j) Unconscious and not able to be awakened;(k) Other signs of significant illness such as jaundice, unstable diabetes, acute liver disease, severe allergic reaction, poisoning, progressively worsening tremors, chills, severe agitation, exposure, internal bleeding, or shock;(l) Uncontrollable violence; or(m) Suicidal or homicidal ideations.