La. Admin. Code tit. 48 § I-5725

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-5725 - Treatment

A. Client Admission Criteria. The program shall only admit clients that:

1. are at least 18 years old, unless the client has consent from a parent, or legal guardian, if applicable;

2. meet the federal requirements regarding the determination that the client is currently addicted to opiates;

3. are verified by an OTP practitioner that treatment is medically necessary;

4. have had a complete physical evaluation by the client's or program's OTP practitioner before admission to the opioid treatment program; and

5. have had a full medical exam, including results of serology and other tests, completed within 14 days of admission.

6. Repealed.

B. Treatment Phases

1. Initial Treatment. During the initial treatment phase that lasts from three to seven days in duration, the provider shall:

a. conduct client orientation;

b. provide individual counseling; and

c. develop the initial treatment plan including initial dose of medication and plan for treatment of critical health or social issues.

2. Early Stabilization. In the early stabilization period that begins on the third to seventh day following initial treatment through 90 days duration, the provider shall:

a. conduct weekly monitoring by a nurse of the clients response to medication;

b. provide at least four individual counseling sessions;

c. revise the treatment plan within 30 days to include input by all disciplines, the client and significant others; and

d. conduct random monthly drug screen tests.

3. Maintenance Treatment. In the maintenance treatment phase that follows the end of early stabilization and lasts for an indefinite period of time, the provider shall provide:

a. random monthly drug screen tests until the client has negative drug screen tests for 90 consecutive days as well as random testing for alcohol when indicated;

b. thereafter, monthly testing to clients who are allowed six days of take-home doses, as well as random testing for alcohol when indicated;

c. continuous evaluation by the nurse of the client's use of medication and treatment from the program and from other sources;

d. documented reviews of the treatment plan every 90 days in the first 2 years of treatment by the treatment team; and

e. documentation of response to treatment in a progress note at least every 30 days.

4. Medically Supervised Withdrawal from Synthetic Narcotic with Continuing Care. Medically supervised withdrawal is provided if and when appropriate. If provided, the provider shall:

a. decrease the dose of the synthetic narcotic to accomplish gradual, but complete withdrawal, as medically tolerated by the client;

b. provide counseling of the type and quantity determined by the indicators and the reason for the medically supervised withdrawal from the synthetic narcotic; and

c. conduct discharge planning with continuity of care to assist client to function without support of the medication and treatment activities.

5. Required Withdrawal. The provider shall provide medically-approved and medically-supervised assistance to withdrawal from the synthetic narcotic when:

a. the client requests withdrawal;

b. quality indicators predict successful withdrawal; or

c. client or payer source suspends payment of fees.

C. Counseling. The provider shall ensure that:

1. counseling is provided when requested by the client or clients family;

2. written criteria are used to determine when a client will receive additional counseling;

3. the type and quantity of counseling is based on the assessment and recommendations of the treatment team;

4. written documentation supports the decisions of the treatment team, including indicators such as positive drug screens, maladjustment to new situations, inappropriate behavior, criminal activity, and detoxification procedure; and

5. all counseling is provided individually or in homogenous groups, including but not limited to family member(s), spouse, child(ren) or significant other as identified by the client, not to exceed 12 clients.

D. Physical Evaluations/Examinations. The provider shall ensure that each client has a documented physical evaluation and examination by an OTP practitioner as follows:

1. upon admission;

2. every other week until the client becomes physically stable;

3. as warranted by clients response to medication during the initial stabilization period or any other subsequent stabilization period;

4. after the first year and annually thereafter; and

5. any time that the client is medically unstable.

La. Admin. Code tit. 48, § I-5725

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 411721 (9/1/2015), Amended LR 481288 (5/1/2022), Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 411721 (9/1/2015), Amended LR 481288 (5/1/2022), Amended by the Department of Health, Health Standards Section, LR 51 (EMERGENCY).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161.