General Requirements for Substance Use Disorder Treatment Programs

PURPOSE: This rule describes general requirements applicable to all certified/deemed certified substance use disorder treatment programs as well as specific requirements that pertain to organizations that are funded by and/or have a contractual relationship with the department for the provision of services. PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. This material as incorporated by reference in this rule shall be maintained by the agency at its headquarters and shall be made available to the public for inspection and copying at no more than the actual cost of reproduction. This note applies only to the reference material. The entire text of the rule is printed here. (1) Screening and Assessment. All individuals shall be screened and assessed as specified in 9 CSR 10-7.030 Service Delivery Process and Documentation, and in accordance with programspecific requirements included in these regulations. (2) Diagnosis. Eligibility for services shall include a diagnosis of a substance use disorder by a licensed diagnostician in accordance with the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), 2013, incorporated by reference and made a part of this rule as published by the American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-3901. This rule does not incorporate any subsequent amendments or additions to this publication. (A) The following mental health professionals are approved to render diagnoses in accordance with the DSM-5: 1. Physicians/Psychiatrists; 2. Psychologists (licensed or provisionally licensed); 3. Advanced Practice Registered Nurses; 4. Professional Counselors (licensed or provisionally licensed); 5. Marital and Family Therapists (licensed or provisionally licensed); 6. Licensed Clinical Social Workers; 7. Licensed Master Social Workers who are under registered supervision with the Missouri Division of Professional Registration for licensure as a Clinical Social Worker. LMSWs not under registered supervision for their LCSW credential cannot render a diagnosis. (B) Signatures can be obtained by a face-to-face meeting with a licensed diagnostician or a face-to-face meeting with a master’s level Qualified Addiction Professional (QAP) or a Qualified Mental Health Professional (QMHP) followed by sign off by a licensed diagnostician. Signature stamps shall not be used. (C) The diagnosis is not considered complete until the diagnostician’s signature is obtained. The licensed diagnostician is accountable for the stated diagnoses. (D) A licensed supervisor must sign off on assessments and diagnoses completed by provisionally licensed providers. (3) Treatment Plan. All individuals shall participate in the development of an individual treatment plan and regular plan reviews and updates as specified in 9 CSR 10-7.030 Service Delivery Process and Documentation, and in accordance with program-specific requirements included in these regulations. (4) Services to Family Members. Family therapy and family conference shall be available to family members of persons participating in substance use disorder treatment. (A) Family members shall be routinely informed of available services and the program shall demonstrate the ability to effectively engage family members in the recovery process. (B) A separate record for a family member is not required if group rehabilitative support is the only service provided by a program that is funded by/contracted with the department. Documentation of group rehabilitative support sessions and the participating family member(s) shall be maintained. (5) Peer Support and Social Networks. Services shall be designed and organized to engage individuals and their family members/natural supports in peer support services, social networks, and resources in the community. (6) Services to Women. An organization that lacks certification to provide women and children’s CSTAR services must meet the following requirements in order to provide services to women: (A) Offer gender-specific groups which address therapeutic issues relevant to women; (B) Have staff with experience and training in the delivery of services for women with substance use disorders, including cooccurring disorders and trauma-related services and supports; (C) Women who are pregnant shall be referred to a women and children’s CSTAR program unless it is documented in the clinical record the program can meet the individual’s treatment needs, or the program cannot immediately make arrangements for admission to a women and children’s CSTAR program. 1. If temporary admission to the program is necessary, arrangements for transfer to a women and children’s CSTAR program shall be completed as soon as possible, with efforts documented in the clinical record; and (D) If the program is unable to refer a woman who is pregnant to a women and children’s CSTAR program or immediately assess and admit her to provide interim services, staff shall contact designated department staff to make arrangements for immediate admission to treatment with another provider. (7) Services to Adolescents. An organization that lacks certification to provide adolescent CSTAR services must meet the following requirements in order to provide services to adolescents: (A) Offer groups specifically for adolescents; and (B) Have staff with experience and training in the provision of services for adolescents with substance use disorders. (8) Program Schedule. A current schedule of groups and other structured program activities shall be maintained. (A) Each person shall actively participate in program activities, with individualized scheduling and services based on his/her treatment goals and needs and physical and behavioral health status. (9) Priority Populations. Individuals who will be receiving department-funded/contracted services shall be appropriately screened at the point of first contact to determine if a crisis situation exists and whether they meet eligibility criteria as a priority population. (A) The following populations shall receive priority assessment and admission to appropriate services: 1. Women who are pregnant and inject drugs; 2. Women who are pregnant; 3. Individuals who have injected drugs in the past thirty (30) days; 4. Civil involuntary commitments—ninety-six (96) hour commitments must be admitted to withdrawal management services, and thirty (30) day commitments must be admitted to withdrawal management services or residential treatment; 5. Individuals determined to be high risk who are referred by the Department of Corrections’ institutions and Division of Probation and Parole via the designated referral form and protocol; 6. Applicants for and recipients of Temporary Assistance for Needy Families (TANF) referred by the Department of Social Services, Family Support Division, via electronic referral and protocol; 7. Children/youth and families served through the Children’s System of Care; and 8. Other populations specified by the department. A. Women who are pregnant and individuals who are involuntarily committed must receive immediate admission. B. High-risk referrals from correctional institutions and probation and parole shall be assessed and admitted to appropriate services within five (5) business days of initial contact or scheduled release date. C. Other priority populations shall be assessed and admitted to appropriate services within seventy-two (72) hours of initial contact. (10) Referrals and Interim Services. If an individual who will be receiving department-funded/contracted services has been determined to have injected drugs within the past thirty (30) days, and he/she cannot be assessed and admitted to the program within forty-eight (48) hours of receiving such a request, staff shall— (A) Refer the individual to an alternative substance use disorder treatment program that has sufficient capacity to admit him/her within forty-eight (48) hours; or (B) Provide interim substance use services within forty-eight (48) hours of the initial request and admit him/her to treatment within one hundred twenty (120) days of the initial request. (C) Interim services shall be provided until the individual is enrolled in an episode of care. Interim services are intended to maintain engagement and help the individual recognize the harmful consequences of substance use, reduce the adverse health effects of substance use, and reduce the likelihood of detrimental or unlawful behavior. 1. An assessment is not required for individuals receiving interim services. 2. Interim services may be delivered on an individual or group basis. 3. Documentation must be included in the individual record for those who miss a scheduled session or refuse interim services, including efforts to reengage. 4. Interim services must include, but are not limited to: A. Counseling and education about HIV, tuberculosis (TB), and hepatitis; B. Counseling and education about the risks of sharing needles; C. Counseling and education about the risks of transmission of infectious diseases to sexual partners and infants and measures to ensure such transmission does not occur; D. Referral for HIV, TB, or hepatitis treatment services, if necessary; E. Group rehabilitative support focusing on reducing the adverse health effects of substance use or other aspects of treatment and recovery; and F. Referral to recovery support programs or self-help (mutual support) groups that offer social, emotional, and informational support for individuals seeking treatment and educational materials that will increase understanding about addiction and recovery, including other local resources available. 5. Interim services may include services such as motivational interviewing to establish a therapeutic partnership and support engagement in treatment when the program has the capacity to admit the individual into an appropriate episode of care. (11) Waiting Lists. The department may require organizations that receive federal block grant funds to maintain a waiting list for specific populations to meet block grant reporting requirements. When a waiting list is required, the organization shall— (A) Document the individual’s date of placement on the list, including identified needs; (B) Implement a process for maintaining contact with individuals who meet criteria as a priority population and are awaiting admission to treatment; (C) Maintain the list through ongoing review and updates; (D) Identify procedures for referring individuals who are in crisis or are a priority population to necessary care or interim services; (E) Document all contacts with individuals on the waiting list; and (F) Respond to long-term waiting lists through strategic or community-based planning, involvement of support services, and referral to available services/supports. (12) Discharge. Each individual’s length of engagement in services shall be based on his/her needs and progress in achieving treatment goals. (A) Criteria to consider in determining successful completion and discharge from treatment includes, but is not limited to, the individual’s ability to— 1. Recognize and understand his/her substance use disorder and its resulting impact on family members/natural supports, impairments on health and social functioning, and other societal consequences; 2. Demonstrate absence of an immediate or a recurring crisis that poses a substantial risk for a return to use of substances; 3. Stabilize emotional problems, when applicable, such as not experiencing serious psychiatric symptoms and taking medication as prescribed; 4. Demonstrate independent living skills; 5. Implement a plan to prevent return to use of substances; and 6. Develop family and/or social networks which support recovery/resiliency and a continuing recovery plan. (B) Discharges prior to an individual accomplishing his/her treatment goals shall be documented in the individual record, including the rationale for discharge. AUTHORITY: sections 630.050, 630.655, and 631.010, RSMo 2016.* Original rule filed Feb. 28, 2001, effective Oct. 30, 2001. ** Rescinded and readopted: Filed May 28, 2021, effective Dec. 30, 2021. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008; 630.655, RSMo 1980; and 631.010, RSMo 1980. **Pursuant to Executive Order 21-07, 9 CSR 30-3.100, paragraph (6)(A)2. was suspended from April 23, 2020 through August 31, 2021.