Involuntary Termination from an Opioid Treatment Program

(A) Emergency Terminations. the Licensed or Approved Provider may terminate a patient immediately prior to a hearing and without provision for medically supervised withdrawal or Referral, under the conditions listed in 105 CMR 164.311(A)(1) through (8): when the program director reasonably determines the patient's continuance in the program presents an immediate and substantial threat of physical harm to other patients, program personnel or property; or (2) where the program's Medical Director reasonably determines continued treatment of a patient presents a serious documented medical risk; and the Licensed or Approved Provider shall document the reason for not providing a Referral in the patient record; (4) the Licensed or Approved Provider immediately notifies the patient of the decision and the reasons for the decision to immediately terminate the patient; (5) the Licensed or Approved Provider schedules a hearing, to be held on the next business day, on the decision to terminate and provides notice of the hearing to the patient as described in 105 CMR 164.311(B)(1)(a)1. and 3. and (C); the hearing is conducted in accordance with procedures specified in 105 CMR 164.311(D) providing that the decision required by 105 CMR 164.311(D)(7) shall be made within one business day; (7) the patient is notified of findings of the hearing within one business day of the hearing; and Licensed and Approved Providers are not required to provide medically supervised withdrawal services to patients who are discharged on an emergency, involuntary basis. (B) Nonemergency Termination. In a nonemergency situation, the Licensed or Approved Provider must afford the patient the following procedural rights: (1) Prior to initiating medically supervised withdrawal, the Licensed or Approved Provider shall: (a) Provide the patient with prompt written notice which shall contain: 1. a statement of the reasons for the proposed termination, e.g., violations of a specific rule or rules, noncompliance with treatment contract, etc., and the particulars of the infraction including the date, time, and place; 2. notification that the patient has the right, within two business days from the first business day following receipt of written notice, to submit a written request for a hearing as to the proposed termination; and 3. a copy of the Licensed or Approved Provider's hearing procedures. (b) Arrange with the patient or patient's advocate for a mutually convenient date and time for a hearing within ten business days of receipt of the notice. Additional time to secure appropriate representation may be granted to the patient under exceptional circumstances. (2) Afford the patient the opportunity of medically supervised withdrawal. If the patient chooses medically supervised withdrawal, the Licensed or Approved Provider shall provide medically supervised withdrawal, or make arrangements for appropriate medically supervised withdrawal in another opioid treatment program. The rate of dosage reduction shall be determined by the Licensed or Approved Provider's Medical Director in accordance with the patient's medical condition and the dosage level at which the patient was medicated before the decision was made to terminate or suspend. In determining an appropriate course of withdrawal, the Medical Director shall review the record, consider the patient's physical and mental health status, and, upon request of the patient, may take into account the opinions of the patient's other practitioners and medical providers. (3) If a patient is terminated for non-payment of fees, medically supervised withdrawal may begin immediately upon providing written notice of termination, and continue concurrent with patient's appeal, if any. (C) Documentation of Receipt of Notice. The Licensed or Approved Provider shall document provision of notice to the patient by obtaining the signature of the staff person providing notice and by obtaining a signed, dated receipt from the patient. If the patient refuses to sign a receipt, the Licensed or Approved Provider shall document that refusal on its record of notice. (D) Hearing Procedures. The Licensed or Approved Provider shall ensure that hearings are conducted in accordance with the following procedures: (1) The hearing shall be presided over by an impartial hearing officer, who may be any staff or other person(s) not directly involved in the facts of the incident giving rise to the disciplinary proceedings or in the decision to commence the proceedings; provided that the persons involved in either the facts of the incident or in the decision to commence the proceedings shall not have authority over the hearing officer(s); (2) The patient may be represented at the hearing by any responsible adult of the patient's choosing, including legal counsel; (3) The hearing shall be conducted in accordance with previously established written rules, which need not be the rules of evidence used in judicial proceedings, but which are designed to ensure a fair and impartial proceeding. The program shall prove by a preponderance of the evidence that the patient did commit the alleged violation; (4) The patient shall be entitled, upon request, to examine any documentary evidence in the possession of the Licensed or Approved Provider that pertains to the subject matter of the hearing; (5) The patient shall be entitled to call his or her own witnesses and to question any adverse witnesses; (6) The Licensed or Approved Provider shall make an audio recording of the hearing. The patient may also make an audio recording of the hearing at the patient's expense; (7) Hearings may be conducted by telephone, or using an audio-visual, real-time, two-way interactive communication system, provided that contemporaneous notes are taken of the hearing, and all other required documentation for the appeal hearing process is in place and documented; (8) The hearing officer shall make the decision within seven calendar days after the hearing and will base the decision solely upon the information presented at the hearing. The decision shall be based upon the Licensed or Approved Provider's policy and procedures in effect and posted at the time of the violation; and (9) The hearing officer shall issue the decision in writing, and shall provide the patient (and patient's representative, if requested) with a copy thereof. The decision shall include an explanation of the reasons for the decision, and instructions explaining how to file an appeal of an adverse decision to the Bureau. The instructions shall inform the patient that the patient's written request for an appeal constitutes the patient's consent to release information to the Bureau.