| (i) the program has made good faith efforts to secure a qualified medical director, but has failed; (ii) the program can secure the services of a licensed physician who is willing to serve as medical director and participate in an in-service training plan; (iii) the program has developed an in-service training plan which is acceptable to the SMA; (iv) the program has obtained the services of a medical consultant who meets the requirements of subparagraph (A) of this paragraph above and will be available to oversee the in-service training of the medical director and the delivery of medical services at the program requesting the variance. (5) Physicians. (A) The program physician(s) other than the medical director shall be licensed to practice medicine in Texas and in accordance with 22 TAC, Chapter 163, and shall have worked in the field of addiction medicine a minimum of one year. (B) Programs that are unable to secure the services of a physician who meets the requirements of subparagraph (A) of this paragraph regarding the 1 year experience in the field of addiction medicine may apply to the SMA for a variance. The SMA has the discretion to grant such a variance when there is a showing that: (i) the program has made good faith efforts to secure a qualified physician, but has failed; (ii) the program can secure the services of a licensed physician who is willing to serve as program physician and participate in an in-service training plan; (iii) the program has developed an in-service training plan which is acceptable to the SMA; and (iv) the program employs a qualified medical director who has the experience and credentials specified in paragraph (3)(A) of this subsection or has completed the in-service training program specified in paragraph (3)(B) of this subsection. (6) Counseling staff shall meet the requirements of a qualified credentialed counselor or counselor intern in Texas as defined in 40 TAC, Chapter 150, unless exempted. (7) Nursing staff shall be licensed to practice in Texas and in accordance with 22 TAC, Chapter 217 or 22 TAC, Chapter 235. (8) Pharmacists shall be licensed to practice in Texas and in accordance with 22 TAC, Chapter 283. (9) Other health care professionals must be licensed in Texas and in accordance with applicable Texas state regulations. (e) Patient admission and assessment. (1) Voluntary participation. The person responsible for the program shall ensure that: (A) a patient voluntarily chooses to participate in a program; (B) all relevant facts concerning the use of the narcotic drug used by the program are clearly and adequately explained to the patient; (C) all patients, with full knowledge and understanding of its contents, sign an informed written consent to treatment; and (D) a parent, legal guardian, or responsible adult designated by the state authority (e.g., "Emancipated minor laws") consents in writing for the treatment of patients under the age of 18. (2) Screening. All applicants for admission must be initially screened by a health care professional certified or licensed in accordance with applicable Texas state regulations to determine eligibility for admission. No applicant may be processed for admission until it has been verified that he or she meets all applicable criteria, and that the sources and methods of verification have been recorded in the applicant's file. The screening process must include: (A) verification, to the extent possible, of an applicant's identity including name, address, date of birth, and other identifying data; (B) history of narcotic dependence, evidence of current physiologic dependence, and a physical examination; (C) medical history, including HIV status, pregnancy, current medications (prescription and non-prescription), and active medical conditions; (D) patient history including, but not limited to, psychological and sociological background, educational and vocational achievements, and current mental status exam; and (E) determination if the applicant needs special services and determination that the program is capable of addressing these needs either directly or through referral. (3) Exceptions. (A) Pregnant patients, regardless of age, who have had a documented opiate dependency in the past and who may return to opiate dependency may be admitted to treatment and placed on a maintenance regimen. For such patients, evidence of current dependence on opiates is not needed if a program physician certifies in writing the pregnancy and finds treatment to be medically justified. Pregnant patients are required to be given the opportunity for, and should be encouraged to access prenatal care either by the program or by referral to appropriate health-care providers. (B) A person who has resided in a penal or chronic care institution for one month or longer may be admitted to maintenance treatment within six months after release from such an institution without documented evidence of opiate dependency, provided the person would have been eligible for admission prior to incarceration or institutionalization, and the admission is medically justified. The medical justification must be documented in the patient's record. (C) Applicants under 18 years of age are required to have had two documented attempts at short-term detoxification or drug-free treatment to be eligible for maintenance treatment. No person under 18 years of age may be admitted to a maintenance treatment program unless a parent, legal guardian, or responsible adult designated by the state authority completes and signs an informed written consent form. A person under 18 years of age shall not be given an initial dose of narcotic drug until the results of the admission drug test for drugs of abuse are reviewed by the physician. All documents must be kept in the patient's record. (D) Under certain circumstances, a patient who has been treated and later voluntarily detoxified from comprehensive maintenance treatment may be readmitted to maintenance treatment without evidence to support findings of current physiologic dependence, up to two years after discharge, if the program attended is able to document prior narcotic drug comprehensive maintenance treatment of six months or more, and the admitting program physician, in his or her reasonable clinical judgment, finds readmission to comprehensive treatment to be medically justified. For patients meeting these criteria, the quantity of take-home medication, if take-home medication is permitted for the narcotic drug, will be determined in the reasonable clinical judgment of the program physician, but in no case may the quantity of take-home medication be greater than would have been allowed at the time the patient voluntarily terminated previous treatment. The admitting program physician or a program employee under supervision of the admitting program physician must enter in the patient's record documented evidence of the patient's prior treatment and evidence of all decisions and criteria used relating to the admission of the patient and the quantity of take-home medication permitted. The admitting program physician shall date and sign these entries in the patient's record or review the health-care professional's entries therein before the program administers any medication to the patient. In the latter case, the admitting program physician shall date and sign the entries in the patient's record made by the health-care professional within 72 hours of administration of the initial dose to the patient. (4) Assessment. Each patient admitted to the program must be evaluated by the medical director or program physician and clinical staff who have been determined to be qualified by education, training, and experience to perform such assessments. The purpose of such assessments shall be to determine whether maintenance treatment, detoxification, or drug free treatment will be the most appropriate treatment modality for the patient. The evaluation must include an assessment of the patient's needs for other services including, but not limited to, medical, psychosocial, educational, and vocational. A signed and dated statement by the program physician, that he or she has reviewed all documented evidence to support a one year history of opiate dependence and current opiate dependence, and that in his or her reasonable clinical judgment, the applicant fulfills the requirements for admission to the program is required to be recorded in the patient's file prior to the administration of an any narcotic drug to the patient. (5) Transfer of patients. (A) The admitting program shall obtain from the patient an authorization for disclosure of confidential information, pursuant to 42 CFR, §§2.31-2.34, for the purpose of obtaining accurate and current information concerning the patient's treatment at the former program. Cont'd... |
