Substance Use Disorder Treatment Facility

(1) Scope. The provisions of 104 CMR 27.18 apply to all Facilities, or units within a facility, that are operated by the Department of Mental Health to provide substance use disorder treatment for adults who are subject to an order of involuntary commitment under M.G.L. c. 123, § 35. Except as expressly provided in 104 CMR 27.18, no other provisions of 104 CMR 27.00 shall apply to Facilities subject to 104 CMR 27.18. (2) Commitment Status under M.G.L. c. 123, § 35. A substance use disorder, as defined in 105 CMR 164.006: Definitions shall qualify as a category of mental illness for the purpose of involuntary commitment under M.G.L. c. 123, § 35. A substance use disorder shall not qualify as a category of mental illness for the purpose of involuntary commitment under any other section of M.G.L. c. 123. (3) Substance Use Disorder Treatment Facility (facility). Substance use disorder treatment facility provides a range of services, including medically monitored detoxification, medically assisted treatment and clinical stabilization services for adults 18 years of age or older who are subject to an order of involuntary commitment under M.G.L. c. 123, § 35. (4) Approval to Operate. The facility shall not operate without approval of the Department of Public Health. The Department of Public Health shall have the right to inspect the facility prior to granting such approval, and at any other time, to determine compliance with applicable requirements of 105 CMR 164.000: Licensure of Substance Abuse Treatment Programs. (5) Applicable Standards for Substance Use Disorder Treatment. In addition to the operational standards of 104 CMR 27.00, the facility shall also meet the requirements for substance use disorder treatment as set forth in 105 CMR 164.012(D)(3). The facility may request a waiver of one or more of these requirements in accordance with the provisions of 105 CMR 164.023: Waivers. (6) Admission Criteria. A facility or unit within a facility may be designated for a specific population, such as male or female, and may restrict admission to members of that population. In addition, only patients who meet the following criteria may be admitted to and retained in the facility: (a) The individual must be 18 years of age. (b) The individual must be subject to an order of involuntary commitment under the provisions of M.G.L. c. 123, § 35. Individuals who meet the admission criteria may be admitted to and retained in the facility only in accordance with the provisions of M.G.L c. 123, § 35. (7) Facility Medical Director. The facility shall designate a psychiatrist as the facility medical director who shall be responsible for administering all medical or behavioral health services performed at the facility. The facility medical director shall be fully licensed to practice medicine under Massachusetts law, and shall have completed a minimum of six months clinical experience with alcohol or other substance use disorders. (8) Staffing Pattern. The facility shall establish a staffing pattern that includes staff in sufficient numbers, qualifications and shift coverage to ensure the provision of services, safety of patients and staff and operation of the program in accordance with the requirements of 104 CMR 27.18. (9) General Physical Requirements. The facility shall provide space that is safe, comfortable, well-lit, well-ventilated, adequate in size and of sufficient quality to be utilized in a manner consistent with the overall philosophy and treatment goals of the program. The facility shall also provide sufficient security features to enable the staff to prevent physical harm to patients and to staff and to prevent elopement from the facility, including the capacity to lock the facility to prevent unauthorized access to the community. (10) Policies and Procedures. The facility shall have written policies and procedures consistent with the requirements of this title and accepted standards of care for substance use disorder treatment services and applicable law. (11) Treatment. Each patient shall be informed upon admission of the right to receive treatment upon giving informed consent. The patient shall, upon giving informed consent, receive substance use disorder treatment and services, as needed. If a patient is deemed incapable of giving informed consent, medication treatment may not be administered or performed without authorization by a court of competent jurisdiction or the consent of the patient’s legally authorized representative. Prior to an adjudication of incapacity and appointment of a guardian, or activation of a health care proxy, a patient retains the right to accept or refuse medications as prescribed. (12) Periodic Review. In addition to the clinical reviews required pursuant to 104 CMR 27.18(21)(a), the facility shall conduct a periodic review of each patient upon admission and once during the first three months of admission in accordance with M.G.L. c. 123, § 4. Each patient shall be provided advance written notice of the scheduled review and shall have the opportunity to participate to the fullest extent possible. Notice to family members shall be provided upon the express written consent of the patient or the patient’s legally authorized representative. (13) Patient Rights. The legal and civil rights of patients are set forth in 104 CMR 27.13. In addition, a patient receiving substance use disorder treatment shall have the right to have drug screens conducted in a manner that preserves the patient’s dignity. The facility shall safeguard and ensure these rights and shall appoint a human rights officer and establish a human rights committee in accordance with the requirements of 104 CMR 27.14. (14) Restraint and Seclusion. The facility shall comply with all standards and requirements for the use of restraint and seclusion as provided in 104 CMR 27.12. (15) Patient Records. Records of the identity, diagnosis, prognosis or treatment of any patient shall be privileged and confidential and shall only be disclosed in conformity with applicable state and federal laws and regulations regarding the confidentiality of patient records including, but not limited to, 42 CFR Part 2 (Confidentiality of Alcohol and Drug Abuse Patient Records), and 45 CFR Parts 160 and 164 (HIPAA Privacy and Security Rules) and, to the extent not preempted by federal law, M.G.L. c. 123, § 36 and 104 CMR 27.16. (a) Each patient record shall be maintained and stored in accordance with the requirements of 42 CFR Part 2, and 104 CMR 27.16(3) and (4). (b) Each patient receiving substance use disorder treatment shall be provided a notice of privacy practices which meets the requirements of 42 CFR Part 2 and 45 CFR Parts 160 and 164. (c) Inspection of the record by the patient or others shall be governed by 42 CFR Part 2, and all applicable federal and state laws and regulations. (16) Complaints and Investigations. Any patient in a facility shall have the right to make a complaint regarding any incident or condition which he or she believes to be dangerous, illegal or inhumane as those terms are defined in 104 CMR 32.00: Investigation and Reporting Responsibilities. Complaints shall be reported, reviewed, investigated and resolved in accordance with the requirements of 104 CMR 32.00. (17) Interpreter Services. The facility shall provide competent interpreter services for non- English speaking patients in accordance with the requirements of 104 CMR 27.17. The facility may contract interpreter services pursuant to a Qualified Service Organization Agreement subject to the requirements of 42 CFR Part 2. (18) Transfer. A patient who is subject to an order of involuntary commitment under M.G.L. c. 123, § 35 may be transferred to another facility in accordance with the requirements of M.G.L. c. 123, § 3. The receiving facility must be approved by the Department of Public Health to provide substance use disorder treatment to patients involuntarily committed under M.G.L. c. 123, § 35. (19) Transport. A patient who is subject to an order of involuntary commitment under M.G.L. c. 123, § 35 may be transported for evaluation or treatment to a medical facility, court, or to other destination approved by the facility director, facility medical director, or their designee(s). The provisions of 104 CMR 27.08(10) shall permit and govern the use of restraint during transport. (20) Absence without Authorization. A facility shall have a written plan for an emergency response when a patient leaves the facility grounds or an off-grounds activity without permission. The facility’s plan shall specify action to be taken by facility staff, and notice to interested parties, including law enforcement, as permitted by law. (21) Discharge. A patient who is subject to an order of involuntary commitment under M.G.L. c. 123, § 35 may be released prior to the expiration of the commitment period under the order upon proper judicial order or upon written determination by the facility director that release of that individual will not result in a likelihood of serious harm to the patient or others as a result of the patient’s substance use disorder. (a) A clinical review of the necessity of the commitment shall be conducted on days 30, 45, 60 and 75, as long as the commitment continues. The results of clinical reviews must be documented in the patient’s medical record. (b) Upon discharge, the individual shall be encouraged to consent to, and shall be provided with, a recommended post-discharge treatment plan with identified resources for further treatment. Upon receipt of authorization consistent with 104 CMR 27.18(11), the facility shall refer the individual to an appropriate program or service provider for further treatment.