Provision of Services

(A) At the time of admission, the Licensed or Approved Provider shall determine that the patient requires this service type because: (1) the patient's current and potential withdrawal symptoms are not severe; and (2) the patient's incapacity results from a substance use disorder or dual diagnosis. (B) Assessment. Pursuant to 105 CMR 164.072(B), the Licensed or Approved Provider may initiate patient treatment prior to completion of the assessment required by 105 CMR 164.072 upon obtaining sufficient information to initiate treatment for the acute problem at the time of presentation and that the assessment is subsequently completed in a reasonable timeframe, provided a Qualified Healthcare Professional must see such a patient prior to initiating an FDA-approved medication for treatment of addiction. (C) Initial Medical Examination. In addition to the assessment required by 105 CMR 164.072, the Licensed or Approved Provider shall ensure each patient has an initial medical examination, which conforms to principles established by the American Society of Addiction Medicine and is completed for all patients within 24 hours of admission. The Medical Director can defer as clinically indicated any of the requirements below if a patient is directly referred from a practitioner who has completed an examination, or components of an examination, which fulfill the requirements of 105 CMR 164.152(C)(1)(a) through (c). (1) The examination shall include: (a) tests for the presence of opioids including, but not be limited to, buprenorphine, methadone, and fentanyl; alcohol; benzodiazepines; cocaine; and any other drugs the Licensed or Approved Provider determines are clinically indicated or as approved by the Commissioner and listed in Department guidance; (b) a brief mental status exam; and (c) an assessment of pulmonary, liver, and cardiac abnormalities; dermatological and neurological sequelae of addiction; possible infectious serologies if indicated; and possible concurrent surgical problems. These laboratory tests are not required to be completed prior to the initiation of medication for addiction treatment. Any relevant laboratory findings shall be documented and reviewed with the patient and medical director. Evidence of direct referrals to address findings shall be properly documented. The Licensed or Approved Provider shall ensure laboratory tests are completed by licensed facilities that comply with all applicable federal and state licensure and certification requirements. (2) The Licensed or Approved Provider shall also ensure the patient's current prescription medications are assessed in relation to interactions with medication prescribed in the course of treatment including, but not limited to, a review of MassPat. When appropriate, prior to prescribing, dispensing or administering an approved opioid agonist medication the Licensed or Approved Provider shall ensure the approved medication is not contraindicated by the patient's current prescribed medications or health status. For women of child-bearing age, the Licensed or Approved Provider shall include a pregnancy test in the physical examination. If the examination is conducted by a qualified health care professional who is not a physician, the results of the examination and any recommendations arising from the examination shall be reviewed by the medical director or their delegated qualified healthcare professional prior to implementation. (5) All medical orders shall be signed by the medical director or their delegated qualified healthcare professional. (6) When readmitting a patient who had been admitted within the previous three months, the timing, frequency and interval of a complete physical examination shall be subject to physician discretion, providing that no more than three months elapse between physical examinations. (D) Treatment Services. Once the patient receives medical clearance to participate, the Licensed or Approved Provider shall provide the patient with at least four hours of service programming each day. The programming shall include services specified in 105 CMR 164.074, and may be provided directly or through QSOAs. The Licensed or Approved Provider shall provide at least one multidisciplinary team review for each patient stay. (E) Termination and Discharge. In addition to the termination and discharge requirements delineated in 105 CMR 164.075, the Licensed or Approved Provider's written procedures shall include the following provisions and shall incorporate these provisions into the policies as described in 105 CMR 164.040 and 105 CMR 164.081: (1) Criteria for medical discharge; Procedures for emergency and involuntary terminations in accordance with the following: (a) In an emergency situation, where the patient's continuation in the program presents an immediate and substantial threat of physical harm to other patients, program personnel or property or where the continued treatment of a patient presents a serious medical risk to the patient as determined by the medical director or the nurse-in-charge, the Licensed or Approved Provider may suspend a patient immediately and without provision for further withdrawal management or Referral. The patient shall be afforded the right to an appeal as described in the program policies and as required by 105 CMR 164.080. (b) In a nonemergency situation, wherein the patient's continuation does not present the immediate and substantial threat or serious medical risk described in 105 CMR 164.133(E)(2)(a), the Licensed or Approved Provider may not terminate the patient without first affording the patient the procedural rights defined in 105 CMR 164.079 and 164.080.