Provision of Service

(A) Admission. 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 that a Qualified Healthcare Professional must see such a patient prior to initiating an FDA-approved medication for treatment of addiction. (B) In addition to the assessment required by 105 CMR 164.072, the Licensed or Approved Provider shall make as part of the patient record a medical evaluation by a Practitioner, psychiatrist, registered nurse, or licensed practical nurse, which confirms that the patient requires outpatient withdrawal management services based on: (1) an assessment of the current and potential withdrawal symptoms of the patient; (2) the patient's need for a structured program with frequent contact in order to engage in treatment; and (3) an assessment as to whether the community in which the patient resides poses a threat to the patient's abstinence. (C) Medical Examination. In addition to the assessment requirements of 105 CMR 164.072, the Licensed or Approved Provider shall ensure an initial medical examination, which conforms to principles established by the American Society of Addiction Medicine, is completed for all patients within 24 hours of admission. (1) The physical 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; possible infectious serologies if indicated; dermatological and neurological sequelae of addiction; possible concurrent surgical problems; and any other relevant laboratory studies as clinically indicated. When indicated, laboratory tests for these conditions shall be ordered. 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. The Licensed or Approved Provider shall ensure the patient's current prescription medications are assessed in relation to interactions with medication prescribed in the course of treatment. 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 nursing supervisor prior to implementation. All medical orders shall be signed by the medical director or their designated practitioner pursuant to their scope of practice. (6) When re-admitting 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 Practitioner discretion, provided that no more than three months elapses between physical examinations. (D) Treatment. (1) The Licensed or Approved Provider shall provide withdrawal management services after determining through physical examination such services are required. (2) Upon receiving medical clearance to participate in treatment services, the Licensed or Approved Provider shall provide each patient with at least nine hours of service programming each week. (3) Treatment shall include services specified in 105 CMR 164.074, and shall be provided either directly or through QSOAs. Services must also include: (a) a primary counselor to provide case management and motivational counseling that focus on engaging the patient to remain in withdrawal management services; and (b) supportive counseling during the relapse prevention phase to motivate the patient to utilize ongoing substance use disorder outpatient treatment and self-help groups. (E) Diversion Control. The Licensed or Approved Provider shall maintain a diversion control plan using measures to reduce the possibility of diversion of controlled substances that are FDA-approved for the treatment of opioid dependency, which shall include: (1) For patients who test positive for any FDA approved medications treatment of opioid use disorder at admission, procedures for determining whether patients are enrolled in an opioid treatment program or are prescribed any medications for treatment of opioid use disorder, and documentation of actions taken in patient records; Assignment of specific responsibility to the Medical Director and administrator for carrying out the diversion control measures and functions described in the plan; and (3) Initial review of the patient's prescription history through the MassPAT.