Presentation on theme: "Outpatient Substance Abuse Treatment Licensure Regulations July 2009"— Presentation transcript:
1 Outpatient Substance Abuse Treatment Licensure Regulations July 2009
2 DAS Mission StatementThe Division of Addiction Services (DAS) promotes the prevention and treatment of substance abuse and supports the recovery of individuals affected by the chronic disease of addiction. As the Single State Agency for substance abuse, DAS is responsible for regulating, licensing, monitoring, planning and funding substance abuse prevention, treatment and recovery support services in New Jersey.To achieve its mission, DAS provides leadership and collaborates with providers, consumers, and other stakeholders to develop and sustain a system of client-centered care that is accessible, culturally competent, accountable to the public, and grounded in best practices that yield measurable results.
3 Changes from N.J.A.C. 8:43A to N.J.A.C. 10:161B Staff QualificationsStaff SupervisionTreatment ServicesQuality AssuranceVolunteer ServicesDrug Screening
4 Staff Qualifications Administrator-N.J.A.C. 8:43A-1.4 A baccalaureate degree and two years of full-time or full-time equivalent, administrative or supervisory experience in a health care facility. Each additional year of full-time or full-time equivalent, administrative or supervisory experience and/or training in a health care facility may be substituted for each year of the four-year degree requirement. Four years of such experience and/or training may be used to satisfy the degree requirement.Administrator-N.J.A.C. 10:161B-1.7A master’s degree and two years full-time or full-time equivalent, administrative or supervisory experience in a substance abuse treatment facility.Individuals who do not meet the above qualifications shall have a Bachelor’s degree and five years of full-time or full-time equivalent, administrative or supervisory experience in a substance abuse treatment facility.
5 Staff Qualifications Director of Nursing-N.J.A.C. 8:43A-1:10 Shall be a registered professional nurse and shall have at least one year of full-time, or full-time equivalent, experience in nursing supervision and/or nursing administration in a licensed health care facilityDirector of Nursing-N.J.A.C. 10:161B-1.5Registered Professional Nurse licensed in New JerseyIn facilities not required but electing to appoint a Director of Nursing, at least six (6) months of full-time experience, or the full-time equivalent, in nursing supervision or nursing administration in the management of addictions in a licensed substance abuse treatment facilityIn an opioid treatment facility must have one (1) year of supervisory experience or three (3) years of experience working in a substance abuse treatment program or facility
6 Staff Qualifications Director of Substance Abuse Counseling Services No requirements specified in N.J.A.C. 8:43ADirector of Substance Abuse Counseling Services –N.J.A.C. 10:161B-1.8A New Jersey licensed psychologist with a Certification of Proficiency from APA in Alcohol and other Psychoactive Substance Use Disorders with a CCS or LCADCA New Jersey licensed clinical social worker with a CCS or LCADCA New Jersey licensed professional counselor with a CCS or LCADCA New Jersey licensed clinical alcohol and drug counselor with a Master’s degree recognized by the New Jersey Board of Marriage and Family Therapy ExaminersA New Jersey licensed, ASAM certified physician or board-certified psychiatristA New Jersey licensed advanced practice nurse with CCS or LCADC
7 Staff QualificationsQualifications of drug counselors-N.J.A.C. 8:43A-1.11Staffing ratio of 75/25 credentialed to non-credentialed staffCADC certifiedCertified by the American Academy of Health Care Providers in the Addictive DisordersSocial Worker in accordance with N.J.A.C. 8:43A-1.27Baccalaureate in Social Sciences and one (1) year experience in drug counselingCurrently enrolled in a program leading to one of the above
8 Staff Qualifications Substance Abuse Counselors-N.J.A.C. 10:161B-1.9 Staffing ratio of 50/50 credentialed to non-credentialed staffRecognizes licensed healthcare credentials, including LCADCs and CADCs, for which work of an alcohol and drug counseling nature is within the scope of practice.Non-credentialed staff are counselor interns actively working towards CADC, LCADC, or another healthcare professional license that includes work of an alcohol or drug counseling nature within its scope of practice.Counselor interns must be enrolled in a course of study leading to the CADC, LCADC or another healthcare professional license regulated by the New Jersey State Board of Marriage and Family Therapy Examiners Alcohol and Drug Counselor Committee, Professional Counselor Committee, State Board of Social Workers, or State Board of Psychological Examiners.Counselor interns must have supervision per the New Jersey State Board of Marriage and Family Therapy Examiners Alcohol and Drug Counselor Committee.
9 Treatment Services Nursing Services-N.J.A.C. 8:43A-Subchapter 8 Nursing services shall be provided directly by the facility or by written agreementShall have a “designee” in the absence of the Director of NursingThe Nursing care needs of the patient shall be assessed only by a registered professional nurseNursing Services-N.J.A.C. 10:161B-Subchapter 8Outpatient (OP), Intensive Outpatient (IOP) and Partial Care (PC) programs are not required to provide nursing services.Primary counselors (or designee) are responsible for obtaining health related information from the client and record such information in the clinical chart in the above programs.Provide a mechanism for referring clients for medical services as needed.Opioid Treatment and Detoxification programs shall appoint a Director of Nursing Services-10:161B-8.2.
10 Treatment ServicesResponsibilities of the Director of Substance Abuse Counseling ServicesNo requirements specified in N.J.A.C. 8:43A
11 Treatment ServicesResponsibilities of the Director of Substance Abuse Counseling Services-N.J.A.C. 10:161B-1.8Must provide clinical supervision as per N.J.A.C. 13:34C-6.0If not providing clinical supervision, shall ensure that direct clinical supervision is provided by a staff person who meets the requirements under N.J.A.C. 13:34C-6.3Is responsible for ensuring that direct clinical supervision is provided at least one hour per week to all clinical staff, individually or in a group setting, with group supervision not to exceed 50 percent of supervision timeEnsure documentation of direct clinical supervisionDevelop written objectives, policies and procedures, and quality assurance measures/activities for the provision of substance abuse counseling services to be reviewed by the administratorEnsure that assessment, and treatment for clients with co-occurring disorders is provided by appropriately trained and qualified clinical staff
12 Treatment ServicesResponsibilities of the Substance Abuse Counseling StaffNo requirements specified in N.J.A.C. 8:43AResponsibilities of the Substance Abuse Counseling Staff-N.J.A.C. 10:161B-1.9Must be supervised by appropriately credentialed staffAssess clients using ASI or other standardized clinical assessment toolDiagnose clients for a substance abuse disorder using the DSM-IV TR as permitted within scope of practiceRecommend appropriate level of care using ASAM PPC2-RDevelop treatment plans that are client-centered, with measurable objectives and recovery orientedConduct ongoing review of treatment plans and reviewing clients throughout treatment episodes according to ASAM PPC2-RProvide discharge planningParticipate as a member of the multi-disciplinary treatment team
13 Treatment Services Provision of Counseling Services-N.J.A.C. 8:43A The facility shall provide counseling services through written agreement or referralDevelop policies and proceduresCoordination and integration of counseling servicesDocumentation of clinical services
14 Treatment ServicesProvision of Substance Abuse Counseling-N.J.A.C. 10:161B-10.1Provide counseling services on site and assign every client to a primary substance abuse counselor at admissionIndividual Sessions: OP-Monthly, IOP-Weekly, PC-Weekly (based upon determination of multi-disciplinary treatment team)Family Sessions: OP-Monthly, IOP-Monthly, PC-Weekly (unless clinically contraindicated or the client and/or family members refuse to participate)Group counseling sessions shall not exceed an average of 12 clients and shall not exceed 14 clients in any one session. This does not apply to psychoeducational or family counseling services.
15 Treatment ServicesProvision of Substance Abuse Counseling-N.J.A.C. 10:161B-10.1Primary counselor to client ratioOutpatient :35Intensive Outpatient :24Partial Care :12Outpatient Detoxification :24Opioid Treatment Program :50(no single OTP counselor caseload of up to 50 clients shall include more than 35 clients in Phases I-III)
16 Treatment Services Co-Occurring Services No requirements specified in N.J.A.C. 8:43ACo-Occurring Services-N.J.A.C. 10:161B-10.4Must have clearly written policies governing the treatment of individuals with co-occurring disorders (COD) in a coordinated fashionEnsure clinical supervision is provided by appropriately credentialed supervisorsMust have appropriately qualified clinical and medical staff assessing/treating individuals with CODProvide case consultation and coordination and, where appropriate, referrals to mental health programs
17 Opioid Treatment Services Opioid Treatment Services-N.J.A.C. 8:43A-26.5Drug counselor’s caseload cannot exceed 50 patientsStage #1 One (1) counseling session per week (first 3 months of treatment)Stage #2 At least one (1) counseling session every two weeks (four to nine months of treatment)Stage #3 One (1) counseling session per month (10th month to end of two years of treatment)Stage #4 One (1) counseling session every three months (after two years of treatment)Availability of group, family, and/or vocational counseling
18 Opioid Treatment Services Opioid Treatment Services-N.J.A.C. 10:161B Subchapter 11Medical Director required, ASAM certified by June 1, 2012 per 10:161B11.2(a)Must employ a full-time Director of Substance Abuse Counseling Services as per N.J.A.C. 10:161B-11.2(b)Opioid Treatment Program Client to Staff Ratios :50no single OTP counselor caseload of up to 50 clients shall include more than 35 clients in Phases I-IIIComply with CSAT publication TIP-43 “Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs.”Opioid Treatment Programs shall participate in registry or other data management system implemented by DAS.
19 Opioid Treatment Services Opioid Treatment Services-N.J.A.C. 10:161B Subchapter 11Phase: I-A Clients in Phase I for a period of at least 12 months who have failed to progress in treatment.Phase I: One (1) counseling session per week (a total of four counseling sessions per month with one (1) session being an individual session). Phase I shall be three (3) months.Phase II: Two (2) counseling session per month (one (1) being an individual session). Phase II a minimum of six (6) months.Phase III: One (1) counseling session per month. Phase III shall be a minimum of nine (9) months.Phase IV: A minimum of one (1) individual session every three (3) months. Phase IV shall be a minimum of six (6) months.Phase V: Clients with 24 consecutive months of negative drug screen and meets other program criteria will receive counseling services as determine by the multi-disciplinary treatment team.Phase VI: Clients with 36 consecutive months of negative drug screens and meets other program criteria will receive counseling consistent with clinical needs as determined by the multi-disciplinary treatment team.
20 Detoxification Services No requirements specified in N.J.A.C. 8:43A
21 Detoxification Services Detoxification Services-N.J.A.C. 10:161B-Subchapter 12Must be licensed by DAS to provide outpatient detoxification servicesClients must meet ASAM PPC-2R Level I-D or II-D criteriaMedical Director required, ASAM certified by June 1, 2012Advanced Practice Nurses (APNs) and/or Physician Assistants (PAs) can provide servicesRegistered Nurse (RN) must be on duty all hours of operation when clients being detoxed are presentMust employ a full time Director of Substance Abuse Services as per N.J.A.C. 10:161B-1.8Twenty-Four (24) hour access to a nurse on call for clients and familyClients shall participate in IOP or PC programs as soon as medically possibleAA or NA 12-Step support group strongly encouragedDrug screenings done at least weekly during the detoxification processDAS does not condone ultra rapid opioid detoxification or rapid detoxification as a means for detoxification from opioids or other substancesPolicy and Procedures shall be consistent with ASAM PPC-2R criteria and CSAT Treatment Improvement Protocol, TIP 45 “Detoxification from Alcohol and Other Drugs” formerly known as TIP 19Treatment interventions shall be clearly documented in client’s clinical record
22 Licensure Implementation Plan Application processSurveys and renewals in the next six monthsWhat happens when current licenses expire?Citing deficiencies under N.J.A.C. 10:161BProvisional and conditional licensesTechnical assistance