Rule 111-8-53-.10 - Staffing(1) Staff Ratios and Responsibilities. The program shall have sufficient and appropriate types and numbers of staff to provide the treatment and services as required by applicable state law and regulation and as outlined in its program description. When the program is open to provide treatment, there shall be a minimum of one clinical staff member and at least one additional staff member on site at all times. Patient-staff ratios shall be adjusted to ensure reasonable and prompt access to medical staff and counselors by patients and to provide the frequency and intensity of medical and counseling services required by the patients. (a) Administrator. The governing body of each program shall designate in writing an administrator. The administrator shall be responsible for the on-going and day-to-day operations of the program, for overall compliance with federal, state, and local laws and regulations regarding the operation of narcotic treatment programs, and for all program employees including practitioners, agents, or other persons providing services at the program. The administrator must be at least 21 years of age, must have at least one year of supervisory and administrative experience in the field of substance abuse treatment, and must have at least one year of experience working in a narcotic treatment program. Programs must notify the Department in writing within 10 calendar days whenever there is a change in administrator. (i) Criminal History Background Check - Administrators. The program must obtain a satisfactory criminal history background check for the person being considered for employment as an administrator and must obtain a new background check for the employed administrator every three (3) years thereafter. The records check must be performed as prescribed in these rules. Programs licensed prior to May 4, 2017 shall only be subject to the requirements of Rule 111-8-53-.10(a)(i) - (iv) if there is a change in the administrator.(ii) At the time of initial employment, in lieu of a records check application, the program may submit evidence, satisfactory to the Department, that within the immediately preceding 12 months the administrator has received a satisfactory narcotic treatment program criminal records check determination.(iii) A person with an unsatisfactory criminal history background check determination must not serve as an administrator of a licensed narcotic treatment program. Failure to satisfy this requirement may result in enforcement action against the facility as prescribed in Chapter 111-8-25.(iv) The administrator must immediately submit to an additional criminal history background check when the Department provides the administrator with written notice of any one of the following:1. There is reason to believe that the administrator has acquired a criminal record as defined by these rules; or2. The criminal history background check is required in connection with a complaint investigation being conducted by the Department. (b) Clinical Director. The governing body of each program shall designate in writing a clinical director. The clinical director shall be responsible for the day-to-day and on-going clinical aspects of the program and of the treatment for those patients admitted to the program. Programs must notify the Department in writing within 10 calendar days whenever there is a change in clinical director.(c) Medical Director. The governing body of each program shall designate in writing a medical director to be responsible for the administration of all medical services, including compliance with all federal, state, and local laws and regulations regarding the medical treatment of narcotic addiction. A physician may serve as medical director of no more than two narcotic treatment programs provided that all such programs are in substantial compliance with these rules and are within 50 miles of the physician's primary residence or primary office location. Programs must notify the Department in writing within 10 calendar days whenever there is a change in medical director.(d) Program Physician. Programs are required to provide sufficient physician coverage to provide the medical treatment and oversight necessary to serve patient needs. A program physician's responsibilities for each patient include, but are not limited to, performing medical history and physical exams, determination of diagnosis under current DSM criteria, determination of narcotic dependence, reviewing treatment plans determining dosage and all changes in doses, ordering take-home privileges, discussing cases with the treatment team, and issuing any emergency or verbal orders relating to patient care. At all times a program is open and a physician is not present on site, a program physician must be available on call for consultation and emergency orders. Programs must be able to document a referral agreement with a local hospital or health care facility. Any program physician who is not a medical director must work under the supervision of the program's medical director.(e) Physician's Assistants and Nurse Practitioners. Licensed physician's assistants and certified nurse practitioners may be employed by programs and perform any functions permitted under Georgia law.(f) Nurses. Programs shall ensure that appropriate nursing care is provided at all times the program is in operation and that an appropriately licensed and qualified health care professional is present at all times medication is administered at the program.(g) Counselors. There must be at least one full-time counselor for every 50 patients. To be considered "full-time," a counselor must work a minimum of 35 hours per week. The program shall assign no more than 40 patients to counselors in training who are not yet certified.(2) Staff Qualifications. (a) Medical Director. All medical directors shall be licensed to practice medicine in Georgia, shall maintain their licenses in good standing and shall have had, at a minimum, 12 hours of training in narcotic-addiction treatment within the 12 months preceding the date of hire when hired after the effective date of these rules.(b) Program Physician. All program physicians must be licensed to practice medicine in the State of Georgia, must maintain their licenses in good standing, and must have had, at a minimum, 12 hours of training in narcotic-addiction treatment within the 12 months preceding the date of hire when hired after the effective date of these rules. If the program physician has not had such training, he or she must be working under the direction of a qualified medical director with an acceptable training plan, completed within 12 months of the date of hire, that consists of a combination of continuing education in addiction medicine and in-service training by the program's medical director.(c) Medical staff. All medical staff must be licensed and in good standing to practice their respective professions in the State of Georgia, have 12 hours of training in narcotic-addiction treatment within the 12 months preceding the date of hire when hired after the effective date of these rules, and practicing within the scope authorized by law. If any member of the medical staff has not had such training, he or she must be working under the direction of a qualified medical director with an acceptable training plan, completed within 12 months of the date of hire, that consists of a combination of continuing education in addiction medicine and in-service training by the program's medical director.(d) Nurses. All registered nurses and licensed practical nurses must be licensed to practice in Georgia in compliance with Chapter 26 of Title 43 of the Official Code of Georgia Annotated, the "Georgia Registered Professional Nurse Practice Act," and must maintain their licenses in good standing.(e) Counselors. All counselors must be certified in addiction counseling pursuant to Section 7(b)(15) of Chapter 10A of Title 43 of the Official Code of Georgia Annotated within three (3) years of employment by the program. Programs licensed prior to May 4, 2017 shall have three (3) years to comply with this requirement.(f) Clinical Directors. All clinical directors must be licensed to practice medicine in the State of Georgia, licensed as a practitioner to provide treatment, therapeutic advice, or counseling for the rehabilitation of drug-dependent persons in compliance with state practice acts, or certified as an addiction counselor, must be at least 21 years of age, and must have at least one year of supervisory and administrative experience in the field of substance abuse treatment.(g) Professional Practice. All professional staff members, including, but not limited to, physicians, pharmacists, physicians' assistants, nurse practitioners, registered nurses, licensed practical nurses, and counselors, may perform only those duties that are within the scope of their applicable professional practice acts and Georgia licenses.(3) Medical Staff Supervision. Programs that do not employ a registered nurse to supervise the nursing staff must ensure that licensed practical nurses adhere to written protocols and are supervised by the Medical Director to ensure that nursing services are being appropriately delivered. (a) Supervision by Medical Director must occur at least one time per month, be documented in writing, reviewed with the Administrator and Clinical Director, and include the following areas: 1. the written policies and procedures required in Rule 111-8-53-.15;2. changes made to policies and procedures required in Rule 111-8-53-.15; and3. areas identified by Administrator, Clinical Director, Director of Pharmacy Services, Medical Director or Program Physician as requiring training for all licensed practical nurses;(4) Staff Training and Orientation. Prior to working with patients, all staff members who provide treatment and services must be oriented in accordance with these rules and must thereafter receive additional training in accordance with these rules. (a) Orientation must include instruction in: 1. The program's written policies and procedures that are relevant to the employee's range of duties and responsibilities;2. The employee's assigned duties and responsibilities;3. Reporting patient progress and problems to supervisory personnel and procedures for handling medical emergencies or other incidents that affect the delivery of treatment or services; and(b) Additional training consisting of a minimum of 16 hours of training or instruction must be provided annually for each staff member who provides treatment services to patients. Such training must be in subjects that relate to the employee's assigned duties and responsibilities and in subjects about current clinical practice guidelines for narcotic treatment, such as dosage based on a physician's clinical decision making and an individual patient's needs; drug screens; take-home medication practices; phases of treatment; treating abusers of multiple substances; narcotic treatment during pregnancy; HIV and other infectious diseases; co-morbid psychiatric conditions; and referring patients for primary care or other specialized services. Programs shall maintain records documenting that each staff member has received the required annual training.(5) Employee Drug Testing. Programs shall establish and implement written policies and procedures for pre-employment and ongoing random drug testing of all program employees. Each sample must be collected and handled in accordance with accepted standards of clinical laboratory practice and tested for opiates, methadone and related drugs, amphetamines, cocaine, benzodiazephines, THC, and other drugs with satisfactory documentation of the results retained by the program.Ga. Comp. R. & Regs. R. 111-8-53-.10
O.C.G.A. §§ 26-5-2et seq., 31-2-5, 31-2-7.
Original Rule entitled "Staffing" adopted. F. Sep. 9, 2013; eff. Sept. 29, 2013.Amended: F. Feb. 15, 2018; eff. Mar. 7, 2018.