Tenn. Comp. R. & Regs. 0940-05-42-.06

Current through September 10, 2024

Section 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.

Tenn. Comp. R. & Regs. 0940-05-42-.06

Original rule filed June 8, 1999; effective August 22, 1999. Amendment filed February 18, 2003; effective May 4, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012.

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.