Chapter 5122-29 Requirements and Procedures for Mental Health Services Provided by Agencies

5122-29-01 Purpose.

The purpose of this chapter is to state the requirements and procedures for mental health services provided by agencies.

R.C. 119.032 review dates: 04/14/2009 and 04/14/2014

Promulgated Under: 119.03

Statutory Authority: 5119.01(H), 5119.61(A), 5119.611(C)

Rule Amplifies: 5119.01(H), 5119.61(A), 5119.611(C)

Prior Effective Dates: 1-1-1991

5122-29-02 Applicability.

(A) The provisions of the rules contained in this chapter are applicable to each agency providing mental health services that are funded by, or funding is being sought by, a community mental health board; is subject to department licensure according to section 5119.22 of the Revised Code:- or that voluntarily requests certification. Any service contact(s) provided by an agency that is paid for in whole or in part by any community mental health board shall be subject to the provisions of this chapter.

R.C. 119.032 review dates: 04/14/2009 and 04/14/2014

Promulgated Under: 119.03

Statutory Authority: 5119.01(H), 5119.61(A), 5119.611(C)

Rule Amplifies: 5119.01(H), 5119.61(A), 5119.611(C)

Prior Effective Dates: 1-1-1991, 7-15-2001, 10-1-2003

5122-29-03 Behavioral health counseling and therapy service.

(A) Behavioral health counseling and therapy service means interaction with a person served in which the focus is on treatment of the person's mental illness or emotional disturbance. When the person served is a child or adolescent, the interaction may also be with the family members and/or parent, guardian and significant others when the intended outcome is improved functioning of the child or adolescent and when such interventions are part of the ISP.

(B) Behavioral health counseling and therapy service shall consist of a series of time-limited, structured sessions that work toward the attainment of mutually defined goals as identified in the ISP.

(C) Behavioral health counseling and therapy service shall be provided by staff qualified according to paragraph (G) of this rule.

(D) Behavioral health counseling and therapy service may be provided in the agency or in the natural environment of the person served, and regardless of the location shall be provided in such a way as to ensure privacy.

(E) For behavioral health counseling and therapy services for children and adolescents, the agency shall ensure timely collateral contacts with family members, parents or guardian and/or with other agencies or providers providing services to the child/adolescent.

(F) The following shall apply with regard to the use of interactive videoconferencing. Interactive videoconferencing is defined in Chapter 5122-24 of the Administrative Code:

(1) "Client site" means the location of a client at the time at which the service is furnished via interactive videoconferencing technology. .

(2) "Provider site" means the site where the eligible practitioner furnishing the service is located at the time the service is rendered via interactive video conferencing technology.

(3) The agency shall obtain from the client/parent/legal guardian, signed, written consent for the use of videoconferencing technology.

(4) It is the responsibility of the agency to assure contractually that any entity or individuals involved in the transmission of the information guarantee that the confidentiality of the information is protected. When the client chooses to utilize videoconferencing equipment at a client site that is not arranged for by the agency, e.g., at his/her home or that of a family or friend, the agency is not responsible for any breach of confidentiality caused by individuals present at the client site.

(5) The agency shall provide the client written information on how to access assistance in a crisis, including one caused by equipment malfunction or failure.

(6) It is the responsibility of the agency to assure that equipment meets standards sufficient to:

(a) Assure confidentiality of communication;

(b) Provide for interactive videoconferencing communication between the practitioner and the client; and

(c) Assure videoconferencing picture and audio are sufficient to assure real-time interaction between the client and the provider and to assure the quality of the service provided.

(d) The client site must also have a person available who is familiar with the operation of the videoconferencing equipment in the event of a problem with the operation.

(e) If the client chooses to utilize videoconferencing equipment at a client site that is not arranged for by the agency, e.g., at his/her home or that of a family or friend, the agency is only responsible for assuring the equipment standards at the provider site.

(7) The decision of whether or not to provide initial or occasional in-person sessions shall be based upon client choice, appropriate clinical decision-making, and professional responsibility, including the requirements of professional licensing, registration or credentialing boards.

(G) Behavioral health counseling and therapy service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-1991, 7-15-2001, 3-25-2004, 12-15-2005, 8-23-2007, 12-13-2007

5122-29-04 Mental health assessment service.

(A) Mental health assessment is a clinical evaluation provided by an eligible individual either at specified times or in response to treatment, or when significant changes occur. It is a process of gathering information to assess client needs and functioning in order to determine appropriate service/treatment based on identification of the presenting problem, evaluation of mental status, and formulation of a diagnostic impression. The outcome of mental health assessment is to determine the need for care, and recommend appropriate services/treatment and/or the need for further assessment. Results of the mental health assessment shall be shared with the client.

(B) An initial mental health assessment must be completed prior to the initiation of any mental health services. The only exceptions to this would be the delivery of crisis intervention mental health services or pharmacologic management services as the least restrictive alternative in an emergency situation.

(1) The initial mental health assessment must, and subsequent mental health assessments may, include at minimum:

(a) An age appropriate psychosocial history and assessment, to include consideration of multi-cultural/ethnic influences;

(b) The presenting problem;

(c) A diagnostic impression and treatment recommendations;

(d) For any service provided in a type 1 residential facility licensed by ODMH pursuant to rules 5122-30-01 to 5122-30-30 of the Administrative Code, a physical health screening to determine the need for a physical health assessment. Such screening shall be completed within one week of admission to the facility; and

(e) As determined by the provider, any other clinically indicated areas. Such areas may include, but are not limited to:

(i) Age appropriate areas of assessment such as for children, e.g., growth and development, family effect on child and child effect on family, and play and daily activities;

(ii) Use of alcohol/drugs;

(iii) Behavioral/cognitive/emotional functioning;

(iv) Mental status exam;

(v) Environment and home;

(vi) Leisure and recreation;

(vii) Childhood history;

(viii) Military service history;

(ix) Financial status;

(x) Usual social, peer-group and environmental setting, (to include involvement in consumer-operated or peer services);

(xi) Sexual orientation/history/issues;

(xii) Family circumstances/custody status;

(xiii) Vocational assessment;

(xiv) Educational assessment;

(xv) Legal assessment;

(xvi) Early detection of mental illness that is life-threatening to self or others;

(xvii) Nutritional status;

(xviii) Maladaptive or problem behaviors;

(xix) Psychiatric evaluation;

(xx) Psychological assessment including intellectual, projective, neuropsychological, and personality testing;

(xxi) Evaluations of language, self-care, visual-motor, and cognitive functioning;

(xxii) Current level of functioning/functional status;

(xxiii) Strengths;

(xxiv) Relationships with family/significant others;

(xxv) Spirituality;

(xxvi) Health/medical history, including current health and dental status as well as the presence of any physical disabilities; and

(xxvii) Indications of abuse and/or neglect.

(2) Mental health service providers may accept mental health assessments from prior evaluations. The clinical record shall reflect that such assessments have been reviewed and updated when appropriate prior to the initiation of any mental health services.

(C) The following shall apply with regard to the use of interactive videoconferencing. Interactive videoconferencing is defined in Chapter 5122-24 of the Administrative Code:

(1) "Client site" means the location of a client at the time at which the service is furnished via interactive videoconferencing technology.

(2) "Provider site" means the site where the eligible practitioner furnishing the service is located at the time the service is rendered via interactive videoconferencing technology.

(3) The agency shall obtain from the client/parent/legal guardian, signed, written consent for the use of videoconferencing technology.

(4) It is the responsibility of the agency to assure contractually that any entity or individuals involved in the transmission of the information guarantee that the confidentiality of the information is protected. When the client chooses to utilize videoconferencing equipment at a client site that is not arranged for by the agency, e.g., at his/her home or that of a family or friend, the agency is not responsible for any breach of confidentiality caused by individuals present at the client site.

(5) The agency shall provide the client written information on how to access assistance in a crisis, including one caused by equipment malfunction or failure.

(6) It is the responsibility of the agency to assure that equipment meets standards sufficient to:

(a) Assure confidentiality of communication;

(b) Provide for interactive videoconferencing communication between the practitioner and the client; and

(c) Assure videoconferencing picture and audio are sufficient to assure real-time interaction between the client and the provider and to assure the quality of the service provided.

(d) The client site must also have a person available who is familiar with the operation of the videoconferencing equipment in the event of a problem with the operation.

(e) If the client chooses to utilize videoconferencing equipment at a client site that is not arranged for by the agency, e.g., at his/her home or that of a family or friend, the agency is only responsible for assuring the equipment standards at the provider site.

(7) The decision of whether or not to provide initial or occasional in-person sessions shall be based upon client choice, appropriate clinical decision-making, and professional responsibility, including the requirements of professional licensing, registration or credentialing boards.

(D) Mental health assessment service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-22-1979, 4-18-1991, 7-15-2001, 3-25-2004, 8-23-2007, 7-1-2008

5122-29-05 Pharmacologic management service.

(A) Pharmacologic management service is a psychiatric/mental health/medical intervention used to reduce/stabilize and/or eliminate psychiatric symptoms with the goal of improved functioning, including management and reduction of symptoms. Pharmacologic management services should result in well-informed/educated individuals and family members and in decreased/minimized symptoms and improved/maintained functioning for individuals receiving the service. The purpose/intent is to:

(1) Address psychiatric/mental health needs as identified in the mental health assessment and documented in the client's ISP;

(2) Evaluate medication prescription, administration, monitoring, and supervision;

(3) Inform individuals and family regarding medication and its actions, effects and side effects so that they can effectively participate in decisions concerning medication that is administered/dispensed to them;

(4) Assist individuals in obtaining prescribed medications, when needed; and

(5) Provide follow-up, as needed.

(B) Pharmacologic management service shall consist of one or more of the following elements as they relate to the individual's psychiatric needs, and as clinically indicated:

(1) Performance of a psychiatric/mental health examination;

(2) Prescription of medications and related processes which include:

(a) Consideration of allergies, substance use, current medications, medical history, and physical status;

(b) Behavioral health education to individuals and/or families, (e.g., purpose, risks, side effects, and benefits of the medication prescribed); and

(c) Collaboration with the individual and/or family, including their response to the education, as clinically indicated. The method of delivery of education can be to an individual or group of individuals.

(3) Administration and supervision of medication and follow-up, as clinically indicated. Prescription, administration and supervision of medication is governed by professional licensure standards, Ohio Revised Code, Administrative Code, and scope of practice.

(a) Clinicians who order medications and persons who receive medication orders shall be appropriately licensed and acting within the scope of their practice.

(4) Medication monitoring consisting of monitoring the effects of medication, symptoms, behavioral health education and collaboration with the individual and/or family as clinically indicated. The method of delivery of medication monitoring can be to an individual or group of individuals.

(C) The following shall apply with regard to the use of interactive videoconferencing. Interactive videoconferencing is defined in Chapter 5122-24 of the Administrative Code.

(1) "Client site" means the location of a client at the time at which the service is furnished via interactive videoconferencing technology.

(2) "Provider site" means the site where the eligible practitioner furnishing the service is located at the time the service is rendered via interactive videoconferencing technology.

(3) The agency shall obtain from the client/parent/legal guardian, signed, written consent for the use of videoconferencing technology.

(4) It is the responsibility of the agency to assure contractually that any entity or individuals involved in the transmission of the information guarantee that the confidentiality of the information is protected. When the client chooses to utilize videoconferencing equipment at a client site that is not arranged for by the agency, e.g., at his/her home or that of a family or friend, the agency is not responsible for any breach of confidentiality caused by individuals present at the client site.

(5) The agency shall provide the client written information on how to access assistance in a crisis, including one caused by equipment malfunction or failure.

(6) It is the responsibility of the agency to assure that equipment meets standards sufficient to:

(a) Assure confidentiality of communication;

(b) Provide for interactive videoconferencing communication between the practitioner and the client; and

(c) Assure videoconferencing picture and audio are sufficient to assure real-time interaction between the client and the provider and to assure the quality of the service provided.

(d) The client site must also have a person available who is familiar with the operation of the videoconferencing equipment, in the event of a problem with the operation.

(e) If the client chooses to utilize videoconferencing equipment at a client site that is not arranged for by the agency, e.g., at his/her home or that of a family or friend, the agency is only responsible for assuring the equipment standards at the provider site.

(7) The decision of whether or not to provide initial or occasional in-person sessions shall be based upon client choice, appropriate clinical decision-making, and professional responsibility, including the requirements of professional licensing, registration or credentialing boards.

(D) Pharmacologic management service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-1991, 10-1-1993, 7- 15.2001, 3-25-2004, 12-15-2005, 12-13-2007

5122-29-06 Partial hospitalization service.

(A) Partial hospitalization is an intensive, structured, goal-oriented, distinct and identifiable treatment service that utilizes multiple mental health interventions that address the individualized mental health needs of the client. Partial hospitalization services are clinically indicated by assessment with clear admission and discharge criteria. The environment at this level of treatment is highly structured, and there should be an appropriate staff-to-client ratio in order to guarantee sufficient therapeutic services and professional monitoring, control, and protection. The purpose and intent of partial hospitalization is to stabilize, increase or sustain the highest level of functioning and promote movement to the least restrictive level of care. The outcome is for the individual to develop the capacity to continue to work towards an improved quality of life with the support of an appropriate level of care.

(B) In addition to the definitions found in rule 5122-24-01 of the Administrative Code, the following definition applies to this rule:

(1) "Partial hospitalization program day" means the total amount of hours an individual receives partial hospitalization service during a twenty-four hour calendar day.

(C) Partial hospitalization must be an intense treatment service that consists of high levels of face-to-face mental health interventions that address the individualized mental health needs of the individual as identified in his/her ISP.

(D) The minimum program length of this service shall be in accordance with the appropriate behavioral health standards of the agency's national accrediting body(ies). Such accrediting bodies are identified in rule 5122-25-02 of the Administrative Code.

(E) For purposes of this rule, a partial hospitalization program day shall consist of a minimum of two hours and up to a maximum of seven hours of scheduled intensive activities that may include, but are not limited to, the following:

(1) Determination of needed mental health interventions;

(2) Skills development

(a) Interpersonal and social competency as age, developmentally, and clinically appropriate, such as:

(i) Functional relationships with adults;

(ii) Functional relationship with peers;

(iii) Functional relationship with the community/schools;

(iv) Functional relations with employer/family; and

(v) Functional relations with authority figures.

(b) Problem solving, conflict resolution, and emotions/behavior management.

(c) Developing positive coping mechanisms;

(3) Managing mental health and behavioral symptoms to enhance vocational/school opportunities and/or independent living; and

(4) Psycho-educational interventions including individualized instruction and training of persons served in order to increase their knowledge and understanding of their psychiatric diagnosis(es), prognosis(es), treatment, and rehabilitation in order to enhance their acceptance of these psychiatric disabilities, increase their cooperation and collaboration with treatment and rehabilitation, improve their coping skills, and favorably affect their outcomes. Such education shall be consistent with the individual's ISP and be provided with the knowledge and support of the interdisciplinary/intersystem team providing treatment in coordination with the ISP.

(F) When an agency provides more than one partial hospitalization service to an individual within the partial hospitalization program day, and the length of one or more of those partial hospitalization services consists of the daily minimum of two hours, the agency must ensure that each service provided is separate and distinct from the others.

(G) Providers of partial hospitalization services shall have a staff development plan based upon identified individual needs of partial hospitalization program staff. Evidence that the plan is being followed shall be maintained.

(H) Partial hospitalization service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-1991, 7-15-2001, 7-1-2006, 8-23-2007

5122-29-07 Forensic evaluation service.

(A) "Forensic evaluation service" means an evaluation resulting in a written expert opinion regarding a legal issue for an individual referred by a criminal court, domestic relations court, juvenile court, adult parole authority, or other agency of the criminal justice system or an ODMH operated. regional psychiatric hospital. Forensic evaluation service includes all related case consultation and expert testimony. Forensic evaluation service also assists courts and the adult parole authority to address mental health legal issues such as those referenced in paragraph (B) of this rule.

(B) Forensic evaluation service addresses mental health legal issues, including the following:

(1) Competency to stand trial, as defined in division (G)(3) of section 2945.371 of the Revised Code;

(2) Criminal responsibility (insanity), as defined in division (G)(4) of section 2945.371 of the Revised Code;

(3) Post-"NGRI" (not guilty by reason of insanity) examination, as defined in division (A) of section 2945.40 of the Revised Code:

(4) Presentence, as defined in section 2951.03 of the Revised Code;

(5) Mitigation of penalty, as defined in section 2947.06 of the Revised Code;

(6) Mitigation of death penalty, as defined in section 2929.03 of the Revised Code;

(7) Domestic violence evaluation, as defined in section 2919.271 of the Revised Code;

(8) Competence to be a witness, as defined in section 2317.01 of the Revised Code;

(9) Adult parole authority, for parole revocation and other legal questions;

(10) Psychological effects of an act upon the victim, as defined in section 2930.13 of the Revised Code;

(11) Domestic relations, for custody and visitation;

(12) Juvenile dependency, neglect, delinquency, competency; or responsibility (Ohio rules of juvenile procedure, rule 32); or waiver to adult court (Ohio rules of juvenile procedure, rule 30);

(13) Battered woman syndrome, as defined in section 2945.392 of the Revised Code;

(14) Violation of anti-stalking protection order, as defined in section 2903.212 of the Revised Code;

(15) Drug intervention in lieu of conviction, as defined in section 2951.041 of the Revised Code;

(16) Non-secured status, as defined in section 2945.401 of the Revised Code;

(17) Post sentence evaluation-probation or parole, as defined in section 2967.22 of the Revised Code;

(18) Modification of sentence, as defined in section 2929.51 of the Revised Code; or

(19) Juvenile competency evaluation for serious youthful offenders, as defined in Chapter 2152. of the Revised Code.

(C) No examiner should undertake a forensic evaluation without an appropriate order from the court ordering the evaluation, or an official written request if the agency requesting the forensic evaluation is a parole or probation department, or ODMH operated regional psychiatric hospital.

(D) Forensic evaluation service shall provide the following standards of confidentiality:

(1) The relationship between the person being evaluated and the examiner is not confidential in the usual understanding of that term. A written report shall be made to the court or adult parole authority, whether or not the person being evaluated cooperates with the examiner. The relationship between the court or adult parole authority shall be explained orally and in writing to the person being evaluated. It shall be clearly noted that information gathered and expert opinions reached by the examiners shall be summarized in a written report and/or testimony to the court or adult parole authority or other referring agency.

(2) Reports to the criminal courts shall be forwarded only to the court that referred the person or to other court officials, prosecution and defense attorneys, as designated by the referring court. The court may, at its discretion, distribute the report, and bears the responsibility for that distribution. Reports to the adult parole authority shall be forwarded only to that agency, which may, at its discretion, distribute the report, and bears the responsibility for that distribution. Reports may be distributed to other parties only with the written authorization of the court or adult parole authority, or other referring agency.

(3) Reports of forensic evaluations shall be stored separately from other types of client records, and shall be considered the property of the court that ordered them or the agency that referred the person.

(E) Each forensic evaluation report shall include at least the following:

(1) The name and qualifications of the examiner(s);

(2) The name of the court or agency that referred the person;

(3) The legal or referral question being assessed;

(4) Identifying information about the person being evaluated, including relevant clinical, social, and criminal history;

(5) The duration and location of the interview(s) with the person being evaluated;

(6) A description of collateral information used to develop the report;

(7) Psychological and/or psychiatric data that address the legal or referral issue, if applicable; and

(8) Opinions and recommendations.

(F) The forensic evaluation shall be presented in non-technical terms and in reasonable detail. The data and recommendations shall be pertinent to the legal or other referral question. Collateral information shall be used in a forensic evaluation to the fullest extent possible. Opinions in a forensic evaluation report shall not be based entirely on self-report of the person being evaluated if collateral information is available.

(G) Reports shall contain sufficient information to substantiate the conclusions and recommendations made. Special caution shall be exercised with self-incriminating statements by the person being evaluated, information about others not being evaluated, or other material of a particularly sensitive, personal nature not related to the issue and for which the forensic evaluation was requested.

(H) For some types of forensic evaluations (e.g., competence to stand trial and sanity), the qualifications of the examiner(s) are regulated by statute. Examinations for which qualifications are not specified by law shall be conducted by staff who are qualified according to paragraph (K) of this rule.

(I) Forensic evaluations shall be completed within the time limits specified by law. Examinations for which no statutory time limit exists shall be completed within a reasonable time, as determined in consultation with the court or agency requesting the service.

(J) The agency shall ensure that:

(1) All staff who perform forensic evaluation services shall have training and continuing education relating to the legal and mental health issues involved in the services they provide; and

(2) All persons who perform forensic evaluation services listed in paragraphs (B)(1)

to (B)(19) of this rule shall provide written documentation of at least twenty-four hours of training every three calendar years that is specific to the forensic mental health area.

(K) Forensic evaluation service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Replaces: 5122-29-07

Effective: 01/09/2011
R.C. 119.032 review dates: 10/25/2010 and 01/09/2016
Promulgated Under: 119.03
Statutory Authority: 5119.01(H), 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.01(H), 5119.61(A), 5119.611(C)
Prior Effective Dates: 1/1/1991, 7/15/2001, 10/1/2003, 7/01/2009

5122-29-08 Behavioral health hotline service.

(A) Behavioral health hotline service means an agency's twenty-four hour per day, seven days per week capability to respond to telephone calls, often anonymous, made to an agency for crisis assistance. The person may or may not become a client of the agency.

(B) Behavioral health hotline service shall:

(1) Be available twenty-four hours per day, seven days per week;

(2) Make crisis intervention mental health service available by referral to another service or agency;

(3) Include, but not be limited to, the following:

(a) Short-term intervention and crisis management provided by telephone;

(b) Suicide prevention intervention;

(c) Appropriate linkages to all needed services and other community resources;

(d) Information and referral services; and

(e) A clearly identified linkage to make available immediate psychiatric and medical services when necessary.

(4) Ensure that all staff and volunteers receive training in crisis intervention;

(5) Be provided by staff qualified according to paragraph (D) of this rule; and

(6) Document the call in the "ICR" if it is known that the person calling is a person served by the agency.

(C) The agency service plan for behavioral health hotline services shall include, but not be limited to the requirements that the service:

(1) Function as part of an integrated, comprehensive system of health, mental health, and other human service providers;

(2) Ensure the ability to use and work with case management systems and pre-hospitalization screening services on a priority basis;

(3) Coordinate with the community's emergency service systems, such as hospital, fire, police, ambulance services, etc.;

(4) Maintain a current listing of available residential or housing placements that can be accessed quickly when emergency housing is needed in conjunction with a crisis intervention mental health service; and

(5) Is provided as part of the community mental health board's emergency crisis plan for the service district.

(D) Behavioral health hotline service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-1991, 7-15-2001, 3-25-2004, 8-23-2007

5122-29-10 Crisis intervention mental health service.

(A) Crisis intervention is that process of responding to emergent situations and may include: assessment, immediate stabilization, and the determination of level of care in the least restrictive environment in a manner that is timely, responsive, and therapeutic.

Crisis intervention mental health services need to be accessible, responsive and timely in order to be able to safely de-escalate an individual or situation, provide hospital pre-screening and mental status evaluation, determine appropriate treatment services, and coordinate the follow through of those services and referral linkages.

Outcomes may include: de-escalating and/or stabilizing the individual and/or environment, linking the individual to the appropriate level of care and services including peer support, assuring safety, developing a crisis plan, providing information as appropriate to family/significant others, and resolving the emergent situation.

(B) Crisis intervention mental health service shall consist of the following required elements:

(1) Immediate phone contact capability with individuals, parents, and significant others and timely face-to-face intervention shall be accessible twenty-four hours a day/seven days a week with availability of mobile services and/or a central location site with transportation options. Consultation with a psychiatrist shall also be available twenty-four hours a day/seven days a week. The aforementioned elements shall be provided either directly by the agency or through a written affiliation agreement with an agency certified by ODMH for the crisis intervention mental health service;

(2) Provision for de-escalation, stabilization and/or resolution of the crisis;

(3) Prior training of personnel providing crisis intervention mental health services that shall include but not be limited to: risk assessments, de-escalation techniques/suicide prevention, mental status evaluation, available community resources, and procedures for voluntary/involuntary hospitalization. Providers of crisis intervention mental health services shall also have current training and/or certification in first aid and cardio-pulmonary resuscitation (CPR) unless other similarly trained individuals are always present; and

(4) Policies and procedures that address coordination with and use of other community and emergency systems.

(C) Crisis intervention mental health service shall consist of the following elements when clinically indicated:

(1) A face-to-face crisis assessment shall be conducted by an eligible clinician and shall include:

(a) Understanding the presenting crisis;

(b) Risk assessment of lethality, propensity of violence, medical/physical conditions including alcohol/drug screen/assessment, and support systems;

(c) Mental status;

(d) Consumer strengths; and

(e) Identification of treatment needs and level of care determination; and

(2) A crisis plan will be established that includes referral and linkages to appropriate services and coordination with other systems. The crisis plan should also address safety issues, follow-up instructions, alternative actions/steps to implement should the crisis recur, voluntary/involuntary procedures and the wishes/preferences of the individual and parent/guardian, as appropriate.

(D) Documentation shall include the elements of the overall assessment of the crisis and intervention.

(E) Crisis intervention mental health service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-1991, 10-1-1993, 7-15-2001, 3-25-2004, 1-9-2006, 8-23-2007

5122-29-11 Employment service.

(A) The purpose and intent of an employment service is to promote recovery through the implementation of evidence based and best practices which allow individuals to obtain and maintain integrated competitive meaningful employment by providing training, ongoing individualized support, and skill development that honor client choice. The outcome of an employment service is that individuals will obtain and maintain a job of their choosing through rapid job placement which will increase their self-sufficiency and further their recovery. Employment services should be coordinated with mental health services and substance use treatment and services.

(B) Consistent with the purpose and intent of paragraph (A) of this rule, employment services shall include at least one of the following evidence based and best practice employment activities, unless prior approval has been given for a non-listed activity as provided by paragraph (D) of this rule:

(1) Vocational planning (assessment);

(2) Training (work and personal);

(3) Job seeking skills training (JSST);

(4) Job development and placement;

(5) Job coaching;

(6) Individualized job supports, which may include regular contact with the employers, family members, guardians, advocates, treatment providers, and other community supports;

(7) Benefits planning;

(8) General consultation, advocacy, building and maintaining relationships with employers;

(9) Individualized placement and support supported employment (IPS SE), in accordance with the requirements for qualified providers set forth in rule 5122-29-30 of the Administrative Code;

(10) Rehabilitation guidance and counseling; or,

(11) Time unlimited vocational support.

(C) Any of the following employment supports may be provided in conjuction with at least one employment activitiy either that is listed in paragraph (B) of this rule or which has received prior approval from OhioMHAS:

(1) Facilitation of natural supports;

(2) Transportation; or,

(3) Peer services.

(D) Individualized placement and support supported employment (IPS SE).

Providers who chose to offer IPS SE employment service shall meet the following requirements to be OhioMHAS qualified providers:

(1) IPS SE is an evidence based practice which is integrated and coordinated with mental health treatment and rehabilitation designed to provide individualized placement and support to assist individuals with a severe and persistent mental illness or co-occurring mental illness and substance use disorder obtain, maintain, and advance within competitive community integrated employment positions.

(2) In order to be an IPS SE qualified provider, the provider must:

(a) Provide the evidence-based practice of IPS SE;

(b) Have periodic fidelity reviews completed by an Ohio department of mental health and addiction services (OhioMHAS) approved fidelity reviewer as required by the developer of the practice, and,

(c) Achieve the minimum fidelity score necessary to maintain fidelity, as defined by the developer of the practice.

(3) In the event a provider fails to achieve the required minimum fidelity score, the provider will receive technical assistance to address areas recommended for improvement as identified in the fidelity review by an OhioMHAS approved fidelity reviewer. If the subsequent fidelity review results in a score of less than the required minimum, the provider will no longer by designated as a qualified IPS provider until their fidelity score again reaches the minimum.

(4) Providers implementing IPS SE may become a provisionally qualified IPS SE provider by participating in a baseline fidelity review. Providers may be provisionally qualified one time only and only between the baseline fidelity review and the next subsequent fidelity review. A provider must meet other requirements of this rule in order to receive provisional qualification.

(E) Employment services shall be provided and supervised by staff who:

(1) Are qualified according to rule 5122-29-30 of the Administrative Code; or,

(2) Have experience working with individuals that have a mental illness or substance use disorder.

Replaces: 5122-29-11

Effective: 12/18/2014
Five Year Review (FYR) Dates: 12/18/2019
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/1991, 7/15/2001, 8/23/2007, 7/1/2009

5122-29-12 Driver intervention program.

(A) A driver intervention program is a program of screening, education, and referral for individuals who are arrested or convicted of operation of a vehicle or water craft under the influence of alcohol or a drug of abuse under section 4511.19 or 1547.11 of the Revised Code or a substantially similar municipal ordinance or other alcohol-related traffic statute or ordinance.

(B) No entity may operate, or purport to operate, a driver intervention program in Ohio unless it has received driver intervention program certification from the Ohio department of alcohol and drug addiction services.

(C) Except as otherwise provided in this rule, the provisions of this rule are applicable to all driver intervention programs in Ohio, public or private.

The provisions do not negate the necessity of driver intervention programs to be certified programs in accordance with the provisions of Chapter 5122-25 of the Administrative Code.

(D) Each driver intervention program shall have either representatives from law enforcement officers, judges, prosecuting and defense attorneys, and treatment center representatives on its governing authority or establish an advisory board with such representatives.

If an advisory board is established, it shall:

(1) Meet annually; and,

(2) Minutes shall be maintained for advisory board meetings.

(E) Program administration:

(1) Each driver intervention program shall have a program director that is responsible for the overall day-to-day operation of the driver intervention program. The driver intervention program director shall be responsible to the governing authority of the organization. If the driver intervention program is a component of a larger organization, the driver intervention program director may report to the executive director/chief executive officer of the organization, who would report to the governing authority. A program director hired on or after April 20, 2004 shall meet the following qualifications:

(a) The program director shall have a bachelor's degree and two years' experience in alcohol and other drug addiction services or an allied profession to include one year as a supervisor;

(b) Three years' experience in alcohol and other drug addiction services or an allied profession to include a minimum of one year as a supervisor; or,

(c) Three years' experience in business administration to include a minimum of one year as a supervisor.

(2) The position description of the driver intervention program director shall include, at a minimum, the following responsibilities:

(a) Overseeing the day-to-day operations of the driver intervention program.

(b) Developing and implementing the policies and procedures of the driver intervention program.

(c) Developing and revising as necessary, the driver intervention program's education curriculum.

(d) Preparing an annual plan for the operation of the driver intervention program.

(e) Implementing the driver intervention program's quality assurance and improvement activities and findings.

(f) Hiring and terminating driver intervention program staff.

(g) Ensuring that the driver intervention program is operating in accordance with the Ohio department of alcohol and drug addiction services' driver intervention program certification standards.

(F) Services supervisor:

(1) Each driver intervention program shall have a services supervisor. The driver intervention program director can also be the services supervisor of the driver intervention program if he/she meets the qualifications of a services supervisor as stated in this rule.

(2) An individual hired as the services supervisor of a driver intervention program on or after April 20, 2004 shall have one or more of the following current licenses and/or certifications issued by a professional regulatory board in Ohio:

(a) Licensed physician who is licensed by the state of Ohio medical board.

(b) Licensed psychologist who is licensed by the state of Ohio psychology board.

(c) Professional clinical counselor who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(d) Licensed independent social worker who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(e) Licensed chemical dependency counselor III who is licensed by the state of Ohio chemical dependency professionals board.

(f) Licensed independent chemical dependency counselor licensed by the state of Ohio chemical dependency professionals board.

(g) A nurse registered with the Ohio board of nursing.

(h) Licensed social worker who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(i) Professional counselor who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(j) Certified prevention specialist I who is certified by the Ohio chemical dependency professionals board.

(k) Certified prevention specialist II who is certified by the Ohio chemical dependency professionals board.

(l) Licensed marriage and family therapist who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(m) Licensed independent marriage and family therapist who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(3) The services supervisor's personnel file shall contain copies or verification of, current licenses, certifications, and registrations issued to the individual from professional regulatory boards in Ohio.

(G) Each driver intervention program shall maintain the following:

(1) Outline of the current education curriculum of the driver intervention program.

(2) Copy of the revenue and expenditure budget for the driver intervention program.

(H) Each driver intervention program shall meet, at a minimum, the following handicapped accessibility requirements:

(1) Entrances, hallways and spaces where services are provided and office space for employees shall be handicapped accessible.

(2) Facility shall have at least one handicapped accessible bathroom.

(3) Facility shall have designated handicapped parking space(s) based on the Americans with disabilities act accessibility guidelines.

(4) Facility shall have at least one drinking fountain that is handicapped accessible.

(5) Facility shall have at least one telephone that is handicapped accessible.

(6) Each residential driver intervention programs shall have at least one handicapped accessible shower facility.

(I) Emergency medical plan and first aid supplies:

(1) Each driver intervention program shall have a written emergency medical plan that includes, at a minimum, the following:

(a) Current emergency telephone numbers for fire, emergency squad, police and poison control.

(b) Location of first aid supplies at the program site during operation of the driver intervention program.

(c) General instructions for medical emergencies including supervision of clients during the emergency.

(d) General instructions in case of illness of a client.

(e) Procedure for documenting unusual incidents and notifying families.

(2) A copy of the emergency medical plan shall be conspicuously posted at the program site during the operation of each driver intervention program.

(J) Client records:

(1) Each driver intervention program shall have written policies and/or procedures for maintaining a uniform client records system that include, at a minimum, the following:

(a) Statement that program staff, contract employees, volunteers and student interns shall not convey to a person outside of the program that an individual attends or receives services from the driver intervention program, or disclose any information identifying a client as an alcohol or other drug services client unless the client consents in writing for the release of information; the disclosure is allowed by a court order; the disclosure is to entities with which the provider has entered into a qualified service organization agreement (QSOA) pursuant to 42 CFR part 2;or the disclosure is made to qualified personnel for a medical emergency, research, audit or program evaluation purposes. The driver intervention program has the authority to deny services if a client refuses consent to the release of information.

(b) Statement that the federal laws and regulations do not protect any threat to commit, any information about a crime committed by a client, either at the program or against any person who works for the driver intervention program.

(c) Statement that the federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities.

(d) Each disclosure made with the client's written consent must be consistent with 42 C.F.R., part 2, by including the following written statement: "This information has been disclosed to you from records protected by federal confidentiality rules. The federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 C.F.R., part 2. A general authorization for the release of medical or other information is not sufficient for this purpose. The federal rules restrict any use of information to criminally investigate or prosecute any alcohol or drug abuse client."

(e) Policy on the access of client records by clients, staff, and others.

(f) Components of client records and time lines, when applicable, for completing each component.

(g) Policy on the storage of client records that requires records be maintained in accordance with 42 C.F.R., part 2, confidentiality of alcohol and drug abuse client records.

(h) Policy on the destruction of client records to include the requirement that records be maintained for at least six years after clients have been discharged from the program. Client records shall be destroyed to maintain client confidentiality as required by state and federal law.

(2) A record shall be maintained for each client of a driver intervention program. Each record shall include, at a minimum, the following components:

(a) Identification of client (name of client and/or client identification number).

(b) Client fee agreement.

(c) Consent for services.

(d) Documentation reflecting receipt of the schedule for the driver intervention program being attended by the client.

(e) Documentation reflecting receipt of the driver intervention program rules and/or expectations of clients.

(f) Documentation reflecting receipt of the program's policy on client rights that lists the client rights required by this rule.

(g) Documentation reflecting receipt of the program's client grievance procedure.

(h) Documentation reflecting receipt of a written summary of the federal laws and regulations that indicate the confidentiality of client records are protected as required by 42 CFR, part 2.

(i) Intake report.

(j) Identification of at least two screening instruments that were administered to the client and documentation of the results of both tests.

(k) Results and recommendations of the screening.

(l) Recommendations for alcohol and/or drug assessment.

(m) Assessment, if completed by the driver intervention program.

(n) Any recommendations made to a court or other organization.

(o) Date of each group session provided.

(p) Length of each group session provided.

(q) Topic/content of each group session provided.

(r) Client's response/feedback during each group session.

(s) Disclosure of client information forms, when applicable.

(3) Disclosure of client information forms shall include the following information as required by 42 C.F.R., part 2:

(a) Name of program making the disclosure.

(b) Name or title of the individual or the name of the organization to which the disclosure is to be made.

(c) Name of the client.

(d) Purpose of the disclosure.

(e) Type and amount of information to be disclosed.

(f) Original signature of the client or person authorized to give consent.

(g) Date client or other authorized person signed the form.

(h) Statement that the consent is subject to revocation at any time except to the extent the program or person who is to make the disclosure has already acted in reliance on it.

(i) The date, event, or condition upon which the consent will expire, unless revoked before that specified time.

(4) Each client record shall include a program completion report which shall include, at a minimum, the following documentation. A copy of the report shall be sent to the court or organization that referred the client to the driver intervention program.

(a) Results and recommendations of the screening.

(b) Any recommendations for alcohol and/or drug assessment.

(c) Any recommendations made to a court or other organization.

(d) Number of hours of driver intervention programming the client attended.

(e) Any referrals made to alcohol and drug addiction treatment programs and any referrals made to other organizations.

(f) Date, signature, and credentials of the program director, services supervisor or program staff of the driver intervention program who makes the recommendation.

(g) Summary of client's participation.

(h) Disclosure of client information form that is prepared in accordance with 42 CFR, part 2, confidentiality of alcohol and drug abuse patient records, for information released to courts, organizations and/or individuals and for management information reports to the Ohio department of alcohol and drug addiction services.

(5) A policy and procedure, in accordance with 42 CFR, part 2, confidentiality of alcohol and drug abuse patient records, for tracking clients for a reasonable time following program completion.

(6) If a program maintains electronic client records, the program must be able to produce hard copies of client records upon legally valid requests and have a written policy and procedure indicating how client original signatures and staff original signatures are obtained and verified for documentation.

(7) If a program discontinues operations or is taken over or acquired by another entity, it shall comply with 42 C.F.R., part 2, subsection 2.19 which governs the disposition of records by discontinued programs.

(K) Intake report:

(1) An intake report shall be completed for each client at the beginning of the first day of the driver intervention program. Documentation shall include, at a minimum, the following:

(a) Client identification number and name.

(b) Prescription and over-the-counter drugs being taken by the client.

(c) Type and amount of any medications brought to the program.

(d) Special dietary requirements.

(e) Known allergies, including but not limited to food and drug reactions.

(f) Pregnancy status of women.

(g) Special needs of clients.

(h) Name, address, and telephone number of a person who is to be contacted in the event of an emergency.

(2) Baggage and materials brought to the driver intervention program shall be inspected to ascertain that they do not contain contraband, which includes, at a minimum, illegal drugs, alcohol, or firearms. Documentation shall appear in the intake report.

(3) The intake report shall be dated and signed by the staff member completing the intake report.

(L) Screening:

(1) Screening means a preliminary gathering and sorting of information used to determine whether a comprehensive assessment is appropriate.

(2) Each client of a driver intervention program shall be administered at least two screening instruments. The results shall be recorded in the client's record.

(3) Screening interviews shall include, at a minimum, the following:

(a) Client identification.

(b) Presenting problem and/or precipitating factors leading to the need for screening.

(c) Past and present use of alcohol and other drugs.

(d) History of treatment for alcohol and other drug abuse.

(e) Medical problems.

(f) Legal history.

(g) Recommendations for referral, if applicable, for a comprehensive assessment to determine the extent and severity of alcohol and other drug abuse problems and need for treatment.

(h) Date, signature, and credentials of program staff who completed the screening.

(M) Referral for assessment:

(1) Each driver intervention program shall have a written procedure for making referrals for assessment which requires that a completed release of information shall be obtained prior to contacting a program.

(2) Each driver intervention program shall have a written policy stating that the basis for making a recommendation to a court or other organization for alcohol and drug addiction comprehensive assessment shall include, at a minimum, the following:

(a) Results of the two screening instruments and screening interview.

(b) Observations of the client during screening, client education on alcohol and drug abuse and addiction and group sessions.

(3) Each driver intervention program shall have a written policy for submitting a copy of the report to the court or organization that referred the client to the driver intervention program, as requested by the referral source.

(N) A driver intervention program may conduct client assessments. Assessments shall be conducted in accordance with rules set forth by the Ohio department of mental health and addiction services.

(O) Dietary services:

Each driver intervention program that prepares and/or serves meals as part of its daily scheduled activities shall operate its dietary services in accordance with laws, regulations, or ordinances of the Ohio board of dietetics, Ohio department of health and/or local health department.

(P) Pharmaceutical services:

(1) Driver intervention programs are prohibited from dispensing and/or administering medications.

(2) Clients who take prescription medications and/or over-the-counter medications may "self-medicate" at driver intervention programs. Each driver intervention program that permits clients to self-medicate shall have written policies and/or procedures for client self-medication that include, at a minimum, the following:

(a) Policy prohibiting clients from having prescription medication in their possession at the program site or while involved in program activities off site, unless required by a physician for medical necessity.

(b) Procedures for obtaining and accounting for controlled substances from clients at the time of admission to or upon entering the program and return of same, as appropriate, at the time of discharge/departure.

(c) Procedures for storing medications in a locked cabinet.

(d) Procedures for reporting theft or loss of over the-counter medications or prescription medication.

(e) Procedures for self-medication.

(3) Clients shall not be denied driver intervention services due solely to their use of prescribed psychotropic medication(s).

(Q) Non-residential driver intervention programs:

(1) Each non-residential driver intervention program shall consist of at least thirteen hours of alcohol and drug addiction programming that includes, at a minimum, the following:

(a) One hour of screening and individual contact.

(b) Eight hours of client education on alcohol and drug abuse and addiction including traffic safety education.

(c) Four hours of small group discussion sessions.

(2) Each non-residential driver intervention program is prohibited from delivering more than eight hours of alcohol and drug addiction programming to clients each day.

(3) Each client shall be administered at least two screening instruments.

(4) An individual screening interview shall be done with each client to discuss the screening findings, recommendations and referrals made to a referring court or other organization.

(5) A program completion report shall be prepared for each client.

(6) Small group discussion sessions:

(a) Small group discussion sessions shall not exceed a staff to client ratio of one to fifteen.

(b) The total number of clients in a group session shall not exceed fifteen, regardless of the number of staff.

(7) If a non-residential driver intervention program is operated within a residential driver intervention program, its programmatic content must be the same as that of the residential driver intervention program, and shall include the mid-day and evening meals.

(8) If a non-residential driver intervention program operates its program for five hours or more on any day, the program shall have provisions for a mid-day meal of at least thirty minutes. This mid-day meal shall be included in the program's schedule that is available to clients upon request. Time for meals may not supplant any of the minimum thirteen-hour alcohol and drug programming.

(9) The program shall have at least one staff member who is on-site and actively supervising and/or monitoring clients at all times during the program.

(R) Forty-eight hour residential driver intervention programs:

(1) Each forty-eight hour residential driver intervention program shall consist of at least sixteen hours of alcohol and drug addiction programming that includes, at a minimum, the following:

(a) One hour of screening and individual contact.

(b) Ten hours of client education on alcohol and drug abuse and addiction including traffic safety education.

(c) Five hours of small group discussion sessions.

(2) Each client shall be administered at least two screening instruments.

(3) An individual screening interview session shall be done with each client to discuss the screening findings, recommendations and referrals to a referring court or other organization.

(4) A program completion report shall be prepared for each client.

(5) Small group discussion:

(a) Small group discussion sessions shall not exceed a staff to client ratio of one to fifteen.

(b) The total number of clients in a small group discussion session shall not exceed fifteen, regardless of the number of staff.

(6) The program shall have at least one staff member who is on-site and actively supervising and/or monitoring clients at all times during the program.

(S) Seventy-two hour residential driver intervention programs:

(1) Each seventy-two hour residential driver intervention program shall consist of at least twenty-one hours of alcohol and drug addiction programming that includes, at a minimum, the following:

(a) One hour of screening and individual contact.

(b) Fifteen hours of client education on alcohol and drug abuse and addiction including traffic safety education.

(c) Five hours of small group discussion sessions.

(2) Each client shall be administered at least two screening instruments.

(3) An individual screening interview shall be conducted with each client to discuss the screening findings, recommendations, referrals, and recommendations made.

(4) Small group discussion:

(a) Small group discussion sessions staff to client ratio shall not exceed one to fifteen.

(b) The total number of clients in a group session shall not exceed fifteen, regardless of the number of staff.

(5) A program completion report shall be prepared for each client.

(6) The program shall provide morning, mid-day, and evening meals of at least thirty minutes duration.

(7) The program shall have at least one staff member who is on-site and actively supervising and/or monitoring clients at all times during the program.

(T) Each driver intervention program shall have a written educational curriculum that includes, at a minimum, the following:

(1) Traffic safety education as it relates to alcohol and drug use.

(2) Client education on alcohol and drug abuse and addiction.

(3) Small group discussion topics.

(U) Each program shall prepare an educational curriculum for its driver intervention program that shall be approved by the program's governing authority that includes, but is not limited to, the following:

(1) Time table for conducting the program.

(2) Instructional outline for each topic/module.

(3) Method of instruction, including audio/visual aids.

(V) Each program shall have a program schedule that can be given to clients upon request.

(W) Traffic safety education:

(1) Traffic safety education shall include, at a minimum, the following information on the criminal justice system and relevant law.

(a) Blood alcohol content (BAC), drugs and impairment.

(b) Levels of license suspension and revocation.

(c) Fines and levels of incarceration.

(2) The driving task and the specific psychomotor skills required.

(3) The physiological and psychological effects of alcohol and other drugs on driving performance.

(4) Traffic safety education sessions shall not exceed an instructor to client ratio of one to forty eight.

(X) Client education on alcohol and drug abuse and addiction:

(1) Client education on alcohol and drug abuse and addiction shall include, at a minimum, the following:

(a) Physical and psychological aspects of the use of alcohol and other drugs.

(b) Combining the use of alcohol with other drugs.

(c) Social consequences of the use of alcohol and other drugs.

(d) Signs and symptoms of abuse and dependence of alcohol and other drugs.

(e) Dysfunctional behavior resulting from the use of alcohol and other drugs.

(f) Progressive nature of alcohol and drug abuse and dependence.

(g) Abstinence as a life-style and self-help programs such as alcoholics anonymous and narcotics anonymous.

(h) Treatment alternatives and local resources.

(2) Programming does not include the following:

(a) Individual and/or group counseling.

(b) Self-help study sessions.

(c) Anger management and stress reduction therapies.

(3) Staffing for client education group sessions on alcohol and drug abuse and addiction shall not exceed an instructor to client ratio of one to forty eight.

(Y) Indigent clients:

(1) A driver intervention program that receives funds that originate and/or pass through the Ohio department of mental health and addiction services shall have a policy and procedure which states that admission to the driver intervention program shall not be denied because an individual is indigent as long as public funds are available to cover the cost of the program.

(2) Indigent individuals are persons who have in their possession at the beginning of a driver intervention program a document which indicates the client is a recipient of public assistance, including, but not limited to, supplemental security income, social security disability income, medicaid, temporary assistance for needy families or other category of assistance as defined by the Ohio department of mental health and addiction services.

(3) The client record of indigent individuals shall include a photocopy of the documentation that was used to verify indigent status.

Effective: 4/1/2016
Five Year Review (FYR) Dates: 04/01/2021
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36

5122-29-13 Adult educational service.

(A) "Adult educational service" means time-limited and structured educational interventions for adults, such as educational advising, literacy instruction, basic educational instruction or instruction in community and independent living skills.

(B) Adult educational service shall:

(1) Include, but not be limited to, educational counseling, literacy, basic educational instruction and community and independent living skills such as budgeting and money management;

(2) Be provided by staff qualified according to paragraph (D) of this rule;

(3) Promote coordination among similar providers within the community mental health board service district, and with agencies and boards of adjacent community mental health board service districts to maximize the rehabilitation opportunities for persons served by the agency; and

(4) Ensure that the service plan is consistent with the principles of a community support system and promotes peer support and other approaches identified by persons served to achieve their stated educational goals.

(C) The agency shall:

(1) Assess the needs and desires of persons served including, but not limited to reading, writing, arithmetic, and post-secondary education and independent living skills;

(2) Provide access to and coordinate with community educational programs, including adult basic education, vocational schools, technical schools, community colleges, four-year colleges, universities, and peer literacy programs; and

(3) Make every effort to utilize existing community educational programs before directly providing adult educational service.

(D) Adult education service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-1991, 7-15-2001, 8-23-2007

5122-29-14 Social and recreational service.

(A) "Social and recreational service" means a service that includes structured and non-structured activities and support to enhance the quality of life of the person served.

(B) Social and recreational service shall:

(1) Be designed to meet the needs of persons with severe mental disabilities;

(2) Be provided by staff qualified according to paragraph (D) of this rule;

(3) Occur, whenever possible, in facilities used for social and recreational purposes by other members of the community;

(4) Promote coordination among similar providers within the community mental health board service district, and with agencies and boards of adjacent community mental health board service districts to maximize the rehabilitation opportunities for persons served by the agency; and

(5) Ensure that the service plan is consistent with the principles of a community support system and promotes peer support and other approaches identified by persons served to maximize supports outside the mental health service system.

(C) The agency plan for social and recreational service shall be developed with the participation of persons served and shall include hours, location, and days of operation.

(D) Social and recreational service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-1991, 10-1-1993, 7-15-2001, 8-23-2007

5122-29-15 [Effective until 7/1/2016] Self-help/peer support service.

(A) Self-help/peer support service means individual or group interactions conducted by persons receiving services, persons who have received services, or their families or significant others, for the purpose of providing emotional support and understanding, sharing experiences in coping with problems, and developing a network of people that provides on-going support outside the formal mental health service system.

(B) Self-help/peer support service service shall:

(1) Ensure consultation with persons providing self-help/peer support service to identify an agency staff person to serve as an advisor, help gain access to educational information, or participate in planning as requested by the self-help/peer support service;

(2) Promote coordination among similar providers within the community mental health board service district, and with agencies and boards of adjacent community mental health board service districts to maximize the opportunities for self-help/peer support; and

(3) Ensure that the service plan is consistent with the principles of a community support system and other approaches identified by persons served to maximize supports outside the mental health service system.

(C) Self-help/peer support services may be provided in the home of a person served as part of an effort to enhance a person's support network and to enhance their ability to live in the least restrictive setting.

(D) The agency shall facilitate the establishment of self-help/peer support when such supports are unavailable or inaccessible in the community. Services shall be available to groups such as persons with mental illness and their families and significant others, women, children and adolescents and ethnic and racial minorities.

R.C. 119.032 review dates: 04/14/2009 and 04/14/2014

Promulgated Under: 119.03

Statutory Authority: RC 5119.22, 5119.61(A), 5119.611(C)

Rule Amplifies: RC 5119.22, 5119.61(A), 5119.611(C)

Prior Effective Dates: 1-1-91; 7-15-01; 3-25-04

5122-29-15 [Effective 7/1/2016] Peer recovery services.

(A) Peer recovery services are community-based services for individuals with a mental illness or substance use disorder; and consist of activities that promote recovery, self-determination, self-advocacy, well-being, and independence. Peer recovery services are individualized, recovery-focused, and based on a relationship that supports a person's ability to promote their own recovery.

(B) Peer recovery services promote self-directed recovery by assisting an individual.

They promote trauma informed care and diversity competence, encourage self-direction, and advocate for informed choice.

(C) "Recovery" means the personal process of change in which Ohio residents strive to improve their health and wellness, resiliency, and reach their full potential through self-directed actions.

(D) Peer recovery services may include, but are not limited to:

(1) Ongoing exploration of recovery needs;

(2) Supporting individuals in achieving personal independence as identified by the individual;

(3) Encouraging hope;

(4) Supporting the development of life skills such as budgeting and connecting to community resources;

(5) Developing and working toward achievement of personal recovery goals;

(6) Modeling personal responsibility for recovery;

(7) Teaching skills to effectively navigate to the health care delivery system to effectively and efficiently utilize services;

(8) Providing group facilitation that addresses symptoms or behaviors, though processes that assist an individual in eliminating barriers to seeking or maintaining recovery, employment, education, or housing;

(9) Assisting with accessing and developing natural support systems in the community;

(10) Promoting coordination and linkage among similar providers;

(11) Coordinating or assistance in crisis interventions and stabilization as needed;

(12) Conducting outreach;

(13) Attending and participating in treatment team; or,

(14) Assisting individuals in the development of empowerment skills through self-advocacy and activities that mitigate discrimination and inspire hope.

(E) Peer recovery services are not site specific but shall be provided in locations that meet the needs of the individual.

(F) Peer recovery services may be facilitated to individuals or groups.

(G) Peer recovery services shall be provided by certified peer recovery supporters as defined in rule 5122-29-15.1 of the Administrative Code; and supervised by staff who either:

(1) Have been delivering peer services for five years, have completed the sixteen hour on-line e-based academy courses offered through the Ohio department of mental health and addiction services, and have completed the 4 hour in-person supervising peers training by Ohio department of mental health and addiction services recovery support staff; or,

(2) Clinicians that have that have completed the sixteen hour on-line e-based academy courses offered through the Ohio department of mental health and addiction services, and have completed the four hour in-person supervising peers training administered by the Ohio department of mental health and addiction services recovery support staff or their designee.

Replaces: 5119-29-15

Effective: 7/1/2016
Five Year Review (FYR) Dates: 07/01/2021
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1-1-91; 7-15-01; 3-25-04

5122-29-15.1 [Effective 7/1/2016] Certified peer recovery supporter.

(A) A "certified peer recovery supporter" is an individual who has self-identified as being in recovery from a mental illness or substance use disorder, and has been certified through the department.

Peer recovery supporter certification requires the completion of the following requirements:

(1) A sixteen hour on-line e-based academy administered by the department;

(2) Submission of proof of a minimum of forty hours of peer service delivery training or three equivalent years formal experience in peer service delivery;

(3) Passing the department peer recovery supporter exam;

(4) Submission of a signed certified peer recovery supporter code of ethics established by the department;

(5) The submission of a completed application; and,

(6) The submission with the completed application, the results of a bureau of criminal identification and investigation criminal records check conducted within thirty days prior to submission.

Certified peer recovery supporters may have an identified specialty of mental health or addiction based upon their personal recovery experience.

(B) Certified peer recovery supporters shall be certified for a period of two years from the date of issuance of certification by the department.

(C) Peer recovery supporter certification may be renewed by submission to the department of:

(1) A renewal application;

(2) Proof of thirty hours of continuing education credits; and,

(3) The results of a bureau of criminal identification and investigation criminal records check conducted within thirty days prior to submission.

Renewal of certified peer recovery supporter status is dependent on all materials being completed and submitted to the department. Renewal of certification is for two years from the date of the expiration of previous certification or the completion of the review of renewal materials, whichever is later.

(D) Peer recovery supporter certification may be denied, not renewed, or revoked for any of the following:

(1) A failure to provide peer recovery supporter services in accordance with the standards set forth in this rule.

(2) A failure to submit a complete certification or renewal application.

(3) A failure to complete any of the requirements for certification or renewal.

(4) The department determines that the certified peer recovery supporter pledge has been violated.

(5) The individual is included in one of the following databases:

(a) The sex offender and child-victim offender database established pursuant to division (A)(11) of section 2950.13 of the Revised Code (available at http://www.icrimewatch.net/index.php?AgencyID=55149&disc=);

(b) The database of incarcerated and supervised offenders established pursuant to section 5120.66 of the Revised Code (available at http://www.drc.ohio.gov/OffenderSearch/Search.aspx).

(6) The individual shall have a criminal records check that is free from any convictions, excluding minor traffic violations, and has been released from all sanctions, for three years prior to application.

Except that individuals with an offense listed in paragraph (I) of this rule shall be permanetly excluded from certification and shall not be eligible for a waiver.

(7) The individual has a negative finding from the department conflict of interest review committee.

(E) The denial of an application for certification or renewal, or the revocation of certification is subject to appeal under Chapter 119. of the Revised Code.

(F) Continuing education shall be based on individual needs, skill level, and interest of the individual; and shall address, at a minimum, the following:

(1) An understanding of systems care, such as natural support systems, entitlements and benefits, inter and intra-agency systems of care, crisis response systems, medications, culture, trauma informed care, diversity competence, human traffickin, and intent of peer recovery services (2) Characteristics of populations to be served such as symptoms, medications, culture, age, gender, sexual orientation, and human development.

(G) Any individual disqualified from certification due to a criminal offense in paragraph (D) of this rule may request a waiver of that disqualification by submission of a waiver request form. The waiver form shall set forth factors related to conviction, time lapsed since the conviction, related circumstances, and changes in the applicant's life since the charge or conviction. If a waiver a is granted for an individual, the waiver is only for those offenses listed on the waiver and is not subject to review by the department upon the individual's certification renewal.

(H) Applications for certification and renewal, and all accompanying materials, are subject to public records requests pursuant to chapter 149. of the Revised Code; however the department shall not use the applications for any purpose other than determining certification status and shall be kept confidential unless disclosure is required by state or federal law.

(I) Disqualifying offenses.

(1) 2903.01 (aggravated murder);

(2) 2903.15 (permitting child abuse);

(3) 2903.16 (failing to provide for a functionally impaired person);

(4) 2903.21 (aggravated menacing);

(5) 2905.32 (human trafficking);

(6) 2905.33 (unlawful conduct with respect to documents);

(7) 2903.34 (patient abuse and neglect);

(8) 2903.341 (patient endangerment);

(9) 2905.04 (child stealing) as it existed prior to July 1, 1996;

(10) 2905.05 (criminal child enticement);

(11) 2907.02(rape) ;

(12) 2907.03 (sexual battery);

(13) 2907.04 (unlawful sexual conduct with a minor, formerly corruption of a minor);

(14) 2907.05 (gross sexual imposition);

(15) 2907.06 (sexual imposition);

(16) 2907.07(importuning) ;

(17) 2907.08 (voyeurism) ;

(18) 2907.12 (felonious sexual penetration);

(19) 2907.21 (compelling prostitution);

(20) 2907.22 (promoting prostitution);

(21) 2907.31 (disseminating matter harmful to juveniles);

(22) 2907.32 (pandering obscenity);

(23) 2907.321 (pandering obscenity involving a minor);

(24) 2907.322 (pandering sexually-oriented matter involving a minor);

(25) 2907.323 (illegal use of minor in nudity-oriented material or performance);

(26) 2907.33 (deception to obtain matter harmful to juveniles);

(27) 2909.22 (soliciting/providing support for act of terrorism);

(28) 2909.23 (making terrorist threat);

(29) 2909.24(terrorism) ;

(30) 2913.40 (Medicaid fraud);

(31) 2919.22 (endangering children);

(32) 2925.02 (corrupting another with drugs);

(33) 2925.23 (illegal processing of drug documents);

(34) 2925.24 (tampering with drugs);

(35) 2925.36 (illegal processing of drug samples);

(36) 3716.11 (placing harmful objects in food or confection);

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Effective: 7/1/2016
Five Year Review (FYR) Dates: 07/01/2021
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36

5122-29-16 Consumer-operated service.

(A) "Consumer-operated service" means any service or activity that is planned, developed, administered, delivered, and evaluated by persons, a majority of whom are receiving or have received inpatient mental health services or other mental health services of significant intensity and duration.

(B) Consumer-operated service shall:

(1) Be planned, developed, administered, delivered, and evaluated by persons, a majority of whom are receiving or have received inpatient mental health services or other mental health services of significant intensity and duration;

(2) Be responsive to the needs of persons served and be based on local needs as identified by the individuals providing the service;

(3) Adhere to all applicable local, state, and federal laws, particularly those designed to assure safety of facilities;

(4) Promote coordination among similar providers within the community mental health board service district, and with agencies and boards of adjacent community mental health board service districts to maximize the rehabilitation opportunities for persons served by the agency; and

(5) Ensure that the service plan is consistent with the principles of a community support system and promotes peer support outside the mental health service system.

(C) The department shall waive all or any portion of the certification standards that would prevent or significantly impede the development and operation of a consumer-operated service.

R.C. 119.032 review dates: 04/14/2009 and 04/14/2014

Promulgated Under: 119.03

Statutory Authority: 5119.01(G), 5119.22, 5119.61(M)

Rule Amplifies: 5119.01(G), 5119.22, 5119.61(M)

Prior Effective Dates: 1-1-1991, 7-15-2001

5122-29-17 Community psychiatric supportive treatment (CPST) service.

(A) Community psychiatric supportive treatment (CPST) service provides an array of services delivered by community based, mobile individuals or multidisciplinary teams of professionals and trained others. Services address the individualized mental health needs of the client. They are directed towards adults, children, adolescents and families and will vary with respect to hours, type and intensity of services, depending on the changing needs of each individual. The purpose/intent of CPST services is to provide specific, measurable, and individualized services to each person served. CPST services should be focused on the individual's ability to succeed in the community; to identify and access needed services; and to show improvement in school, work and family and integration and contributions within the community.

(B) Activities of the CPST service shall consist of one or more of the following:

(1) Ongoing assessment of needs;

(2) Assistance in achieving personal independence in managing basic needs as identified by the individual and/or parent or guardian;

(3) Facilitation of further development of daily living skills, if identified by the individual and/or parent or guardian;

(4) Coordination of the ISP, including:

(a) Services identified in the ISP;

(b) Assistance with accessing natural support systems in the community; and

(c) Linkages to formal community service/systems;

(5) Symptom monitoring;

(6) Coordination and/or assistance in crisis management and stabilization as needed;

(7) Advocacy and outreach;

(8) As appropriate to the care provided to individuals, and when appropriate, to the family, education and training specific to the individual's assessed needs, abilities and readiness to learn;

(9) Mental health interventions that address symptoms, behaviors, thought processes, etc., that assist an individual in eliminating barriers to seeking or maintaining education and employment; and

(10) Activities that increase the individual's capacity to positively impact his/her own environment.

(C) The methods of CPST service delivery shall consist of:

(1) Service delivery to the person served and/or any other individual who will assist in the person's mental health treatment.

(a) Service delivery may be face-to-face, by telephone, and/or by video conferencing; and

(b) Service delivery may be to individuals or groups.

(2) CPST services are not site specific. However, they must be provided in locations that meet the needs of the persons served. When a person served is enrolled in a residential treatment or residential support facility setting, CPST services must be provided by staff that are organized and distinct and separate from the residential service as evidenced by staff job descriptions, time allocation or schedules, and development of service rates.

(D) There must be one CPST staff who is clearly responsible for case coordination. This staff person must be an employee of an agency that is certified by ODMH to provide CPST services. This person may delegate CPST services to eligible providers internal and/or external to the certified agency as long as the following requirements and/or conditions are met:

(1) All delegated CPST activities are consistent with this rule in its entirety;

(2) The delegated CPST services may be provided by an entity not certified by ODMH to provide CPST services as long as there is written agreement between the certified agency and the non-certified entity that defines the service expectations, qualifications of staff, program and financial accountability, health and safety requirements, and required documentation; and

(3) An entity that is not certified by ODMH for CPST service may only seek reimbursement for CPST services through a certified agency and with a written agreement as required in this paragraph.

(E) Providers of CPST service shall have a staff development plan based upon identified individual needs of CPST staff. Evidence that the plan is being followed shall be maintained. The plan shall address, at a minimum, the following:

(1) An understanding of systems of care, such as natural support systems, entitlements and benefits, inter- and intra-agency systems of care, crisis response systems and their purpose, and the intent and activities of CPST;

(2) Characteristics of the population to be served, such as psychiatric symptoms, medications, culture, and age/gender development; and

(3) Knowledge of CPST purpose, intent and activities.

(F) Community psychiatric supportive treatment (CPST) service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 08/01/2013
R.C. 119.032 review dates: 04/16/2013 and 08/01/2018
Promulgated Under: 119.03
Statutory Authority: 5119.61(A), 5119.611(E)
Rule Amplifies: 5119.61(A), 5119.611(E)
Prior Effective Dates: 1/1/1991, 1/1/1994 (Emer.), 6/30/1995, 9/24/1995, 7/15/2001, 3/25/2004, 8/23/2007, 7/1/2008, 12/15/2011

5122-29-18 Inpatient psychiatric service.

(A) "Inpatient psychiatric service" means the most intensive level of psychiatric treatment for persons posing a significant danger to self or others and/or displaying severe psychosocial dysfunction or mental instability. Treatment encompasses multi-disciplinary assessments and multimodal interventions. At minimum, twenty-four hour intensive care by physicians and registered nurses, a 1:4 nursing staff-to-patient ratio, and a structured treatment milieu are required. Special treatment and safety measures may include involuntary treatment and a locked unit.

(B) Inpatient psychiatric service refers to residence and treatment provided in a psychiatric hospital or unit licensed or operated by the state of Ohio in accordance with section 5119.20 of the Revised Code.

(C) Inpatient psychiatric services shall be licensed by the department in accordance with section 5119.20 of the Revised Code and rules 5122-14-01 to 5122-14-13 of the Administrative Code. Evidence of a current full, probationary, or interim license issued by the department pursuant to section 5119.20 of the Revised Code shall constitute compliance with certification standards, and the inpatient psychiatric service shall be certified pursuant to division (M) of section 5119.61 of the Revised Code for a time period that is the same as the specified time period of the current full, probationary, or interim license.

R.C. 119.032 review dates: 04/14/2009 and 04/14/2014

Promulgated Under: 119.03

Statutory Authority: 5119.01(G), 5119.20, 5119.61(M)

Rule Amplifies: 5119.01(G), 5119.20, 5119.61(M)

Prior Effective Dates: 1-1-1991, 7-15-2001

5122-29-19 Consultation service.

(A) "Consultation service" means a formal and systematic information exchange between an agency and a person other than a client, which is directed towards the development and improvement of individualized service plans and/or techniques involved in the delivery of mental health services. Consultation service can also be delivered to a system (e.g., school or workplace) in order to ameliorate conditions that adversely affect mental health.

(B) Consultation services shall be provided according to priorities established to produce the greatest benefit in meeting the mental health needs of the community. Priority systems include schools, law enforcement agencies, jails, courts, human services, hospitals, emergency service providers, and other systems involved concurrently with persons served in the mental health system.

(C) Consultation may be focused on the clinical condition of a person served by another system or focused on the functioning and dynamics of another system. Consultation related to the clinical condition of a person served shall be provided by staff qualified according to paragraph (D) of this rule.

(1) The agency shall survey periodically other community systems to determine mental health consultation needs that may be desired by the systems, persons or families being served by those other systems.

(2) The agency shall maintain a record of all consultation services provided, including the name of the person or system to whom the service was provided, the nature of the consultation, and the outcome of the consultation.

(D) Consultation service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-1991, 7-15-2001, 8-23-2007

5122-29-20 Prevention service.

(A) Prevention services are a planned sequence of culturally relevant, evidenced-based strategies; which are designed to reduce the likelihood of or delay the onset of mental, emotional, and behavioral disorders. Prevention services shall:

(1) Be intentionally designed to reduce risk or promote health before the onset of a disorder; and,

(2) Be population-focused and targeted to specific levels of risk.

Prevention services are reserved for interventions designed to reduce the occurrence of new cases of MEB disorders, and shall not be used for clinical assessment, treatment, recovery support services, relapse prevention or medications of any type.

(B) "Coalition" means a collaboration of groups or individuals which have agreed to work together towards a common goal of reducing local incidence, prevalence, and consequences of MEB disorders.

(C) "Culturally relevant" means the service delivery systems respond to the needs of the community demonstrated through readiness, resource and need assessment activities; capacity development efforts; engaging stakeholders in planning; sound implementation science; evaluation and quality improvement and sustainability activities.

(D) "Evidenced-Based" means an intervention that has been identified as effective by a nationally recognized organization, a federal, or state agency, and has produced a consistent positive pattern of results on the majority of the intended recipients or target population. The intervention must also be implemented to fidelity as defined by the developer; and provided or supervised by licensed, certified, or registered professionals in accordance with paragraph (B) of rule 5122-29-30 of the Administrative Code.

(E) "Mental, emotional, or behavioral" (MEB) disorder means a diagnosable mental illness or substance use disorder.

(F) Levels of risk are:

(1) Universal: targeted to the general public or a whole population group that has not been identified on the basis of individual risk. The intervention is desirable for everyone in that group.

(2) Selective: targeted to individuals or to a subgroup of the population whose risk of developing MEB disorders are significantly higher than average. The risk may be imminent or it may be a lifetime risk. Risk groups may be identified on the basis of biological, psychological, or social risk factors that are known to be associated with the onset of a MEB disorder. Those risk factors may be at the individual level for non-behavioral characteristics (e.g., biological characteristics such as low birth weight), at the family level (e.g., children with a family history of substance abuse but who do not have any history of use), or at the community/population level (e.g., schools or neighborhoods in high-poverty areas).

(3) Indicated: targeted to high-risk individuals who are identified as having minimal but detectable signs or symptoms that foreshadow MEB, as well as biological markers which indicate a predisposition in a person for such a disorder but who does not meet diagnostic criteria at the time of the intervention.

(G) Mandatory strategies: In order to be certified prevention providers must provide at least one of these strategies:

(1) Education: This strategy focuses on the delivery of services to target audiences with the intent of influencing attitude or behavior. It involves two-way communication and is distinguished from information dissemination by the fact that interaction between educator or facilitator and participants is the basis of the activities. Activities influence critical life skills and social or emotional learning including, but not limited to, attachment, emotional regulation, empathy, family and social connectedness, decision-making, refusal skills, critical analysis, and systematic judgment abilities.

(2) Environmental: This strategy seeks to establish or change standards or policies to influence the incidence and prevalence of behavioral health problems in a population. Activities address family, social, neighborhood, school or community norms and seek to reduce identified risk factors and increase protective factors; this is accomplished through media, messaging, policy and enforcement activities conducted at multiple levels.

(H) Supporting strategies: In addition to the strategies in paragraph (G) of this rule, prevention providers must provide at least one of the following strategies in order to be certified:

(1) Community-based process: This strategy focuses on enhancing the ability of the community to provide prevention services through organizing, training, planning, interagency collaboration, coalition building or networking.

(2) Alternatives: This strategy focuses on providing opportunities for positive behavior support as a means of reducing risk taking behavior, and reinforcing protective factors. Alternative programs include a wide range of social, cultural and community service or volunteer activities.

(3) Information dissemination: This strategy focuses on building awareness and knowledge of behavioral health and the impact on individuals, families and communities, as well as the dissemination of information about prevention services. It is characterized by one-way communication from source to audience.

(4) Problem identification and referral: This strategy focuses on referring individuals who are currently involved in primary prevention services and who exhibit behavior that may indicate the need for behavioral health or other assessment. This strategy does not include clinical assessment or treatment for behavioral health. It also does not include SBIRT.

(I) Prevention providers must demonstrate that prevention interventions are:

(1) Culturally relevant;

(2) Age appropriate;

(3) Gender appropriate; and,

(4) Targeted toward multiple settings within the community.

(J) Prevention providers must document procedures for referring consumers to the following:

(1) Alcohol addiction, drug addiction, mental health, gambling addiction and primary care health services;

(2) Social services; and,

(3) Community resources.

(K) Prevention providers must document an evaluation process for the following:

(1) Prevention interventions (2) Prevention workforce development activities

(L) Volunteers

(1) Volunteers assisting with universal prevention interventions must be monitored by an eligible provider other than an Ohio registered applicant.

(2) Volunteers assisting with selective or indicated prevention interventions must be monitored by personnel that are eligible to supervise prevention personnel as set forth in rule 5122-29-30 of the Administrative Code.

(M) Prevention service providers are not required to keep records of individuals who receive prevention services. Any records which are kept shall be kept in manner compliant with the confidentiality requirements of 42 C.F.R. and HIPAA.

(N) Educational entities under the jurisdiction of the Ohio department of education or the Ohio board of regents are exempt from the prevention certification rule.

(O) Coalitions providing services as defined in both paragraph (G)(2) of this rule and either paragraph (H)(1) or (H)(3) of this rule are exempt from the prevention certification rule.

Effective: 4/1/2016
Five Year Review (FYR) Dates: 04/01/2021
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36

5122-29-21 Mental health education service.

(A) "Mental health education service" means formal educational presentations made to individuals or groups that are designed to increase community knowledge of and to change attitudes and behaviors associated with mental health problems, needs and services.

(B) Mental health education service shall:

(1) Focus on educating the community about the nature and composition of a community support program;

(2) Be designed to reduce stigma toward persons with severe mental disability or serious emotional disturbances, and may include the use of the media such as newspapers, television, or radio. Community opinion leaders shall be high priority recipients of this service;

(3) Focus mental health education service for the community on issues that affect the population served or populations identified as unserved or underserved by the agency;

(4) Evaluate the effectiveness of services through evaluation mechanisms such as pre-tests and post-tests, when applicable;

(5) Be provided by staff qualified according to paragraph (C) of this rule; and

(6) Include the participation of persons served, and their families or significant others in planning, implementing and evaluating services provided.

(C) Mental health education service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-1991, 7-15-2001, 8-23-2007

5122-29-22 Referral and information service.

(A) "Referral and information service" means responses, usually by telephone, to inquiries from people about services in the community. Referral may include contacting any agency or a provider in order to secure services for the person requesting assistance.

(B) Referral and information service shall be planned and coordinated with other health and human service providers, and shall:

(1) Have a mechanism to compile information about services available in the service system and the community; and

(2) Have mechanisms to determine whether persons referred were able to access services, were satisfied with the services, or experienced any problems with the referral source. This information shall be used to determine if particular providers shall continue to be used as referrals for persons seeking services. All state and federal confidentiality laws shall be adhered to in this process.

(C) The agency shall ensure access and availability of referral and information service including:

(1) A referral and information service shall have a published telephone number, including a published telephone number for special telephone services for the hearing impaired; and

(2) The agency shall ensure access and availability for persons whose primary means of communication is a language other than english, and for persons with communication impairments such as speech, language or hearing disorders, access to telecommunication devices for the deaf (TDD), and for persons with visual impairments.

(D) Each call and contact shall be logged and shall include the date, time and person answering the call or contact.

R.C. 119.032 review dates: 04/14/2009 and 04/14/2014

Promulgated Under: 119.03

Statutory Authority: 5119.01(G), 5119.22, 5119.61(M)

Rule Amplifies: 5119.01(G), 5119.22, 5119.61(M)

Prior Effective Dates: 1-1-1991, 7-15-2001

5122-29-23 Adjunctive therapy service.

(A) "Adjunctive therapy service" means interventions using a variety of media and activities to develop or maintain social or physical skills.

(B) Adjunctive therapy service includes interventions using a variety of media such as art, dance, music and recreation to develop or maintain social or physical skills. Such interventions shall be developed and reviewed as part of the ISP.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-1991, 7-15-2001, 8-23-2007

5122-29-24 Occupational therapy service.

(A) "Occupational therapy service" means the evaluation of learning and performance skills and analysis, selection and adaptation of activities for individuals whose abilities to cope with daily living are threatened or impaired by developmental deficiencies, the aging process, environmental deprivation, physical, psychological, or social injury or illness.

(B) Occupational therapy service shall:

(1) Include assessment and treatment services regarding social, emotional, physical and cognitive functioning as appropriate to the functional level of the person served; and

(2) Ensure linkages with other community services, as appropriate, to provide opportunities for performance of purposeful activities and/or normalizing occupations and other needed services.

(C) Occupational therapy service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.01(G), 5119.22, 5119.61(M)
Rule Amplifies: 5119.01(G), 5119.22, 5119.61(M)
Prior Effective Dates: 1-1-1991, 7-15-2001

5122-29-25 School psychology service.

(A) School psychology services shall:

(1) Include mental health services related to school behavior and learning problems;

(2) Be coordinated with school personnel, as appropriate, in the school setting attended by the person served; and

(3) Be included in the "ISP" with evidence of coordination between and approval of mental health and educational personnel, and in consultation with the person served, and parent or guardian, as appropriate.

(B) School psychology service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.01(G), 5119.22, 5119.61(M)
Rule Amplifies: 5119.01(G), 5119.22, 5119.61(M)
Prior Effective Dates: 1-1-1991, 7-15-2001

5122-29-27 Other mental health services.

(A) "Other mental health services" means services other than those listed under divisions (A) to (Q) of section 340.09 of the Revised Code. Other mental health services may include representative payeeship, transportation and other supportive mental health services and may be offered by a variety of entities, including YMCAs, churches, children's cluster or family and children first.

(B) Other mental health services approved by the community mental health board and the department shall:

(1) Ensure that the agency or organization providing the service meets the appropriate standards or regulations under which they operate;

(2) Ensure that staff providing the service have participated in orientation or training regarding basic information about mental illness and/or emotional disturbance and know how to obtain assistance from the mental health system if needed; and

(3) Develop mechanisms to solicit and receive feedback about the quality of the service from persons served.

(C) Agencies providing other mental health services shall receive certification to provide the service(s) according to either paragraph (A)(1)(f) or paragraph (A)(2)(g) of rule 5122-25-04 of the Administrative Code.

Effective: 07/01/2009
R.C. 119.032 review dates: 04/14/2009 and 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5119.22, 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.22, 5119.61(A), 5119.611(C)
Prior Effective Dates: 1-1-91, 7-15-01

5122-29-28 Intensive home based treatment (IHBT) service.

(A) Intensive home based treatment (IHBT) service is a comprehensive mental health service provided to a child/adolescent and his or her family that integrates community psychiatric supportive treatment (CPST) service or health home service for persons with serious and persistent mental illness for a person enrolled in the service, mental health assessment service, mental health crisis response, behavioral health counseling and therapy service, and social services with the goal of either preventing the out-of-home placement or facilitating a successful transition back to home. IHBT service may also be provided to transitional age youth between the ages of eighteen and twenty-one who have an onset of serious emotional and mental disorders in childhood or adolescence. These intensive, time-limited mental health services are provided in the the child/adolescent's natural environment with the purpose of stabilizing and improving his/her mental health functioning .

The purpose of IHBT is to enable a child/adolescent with serious emotional disturbance (SED) to function successfully in the least restrictive, most normative environment. IHBT services are culturally, ethnically, racially, developmentally and linguistically appropriate, and respect and build on the strengths of the child/adolescent and family's race, culture, and ethnicity.

(B) In addition to the definitions in rule 5122-24-01 of the Administrative Code, the following definitions apply to this rule:

(1) "Caseload" means the individual cases open or assigned to each full-time equivalent IHBT staff.

(2) "Continued stay review" means a review of a child/adolescent's functioning to determine the need for further services to achieve or maintain service goals and objectives.

(3) "Crisis response" means the immediate access and availability , by phone and face-to-face, as clinically indicated, to the child/adolescent and family, which may include crisis stabilization, safety planning, and the alleviation of the presenting crisis.

(4) "Face-to-face contacts" means in-person IHBT provided in the home, school, and community working directly with the person served and his or her family, or on the child/adolescent 's behalf.

(5) "Home" means any long-term family living arrangement including biological, kinship, adoptive, and non-custodial families who have made a long-term commitment to the child/adolescent.

(6) "Out-of-home placement" means any removal of the child/adolescent from his or her home. Planned respite, where the child's main residence remains his or her home, is not considered out-of-home placement.

(C) IHBT certified agencies must be certified to provide behavioral health counseling and therapy service, mental health assessment service, and community psychiatric supportive treatment (CPST) service in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code. Persons receiving IHBT service shall receive the services specified in this paragraph from IHBT staff with the exception of a physician providing mental health assessment service. Staff providing CPST service as part of IHBT shall meet the provider qualifications specified under the IHBT portion of rule 5122-29-30 of the Administrative Code.

(D) The agency shall determine who is eligible to receive the service and must document how the child/adolescent meets the following criteria necessary to receive IHBT services:

(1) Is clinically determined to meet the "person with serious emotional disturbance" (SED) criteria in paragraph (B) (48) of rule 5122-24-01 of the Administrative Code . IHBT may also be provided to an individual age eighteen through twenty-one who meets all of the other diagnostic criteria for SED, and is still living at home and/or in the custody of a public child serving agency and/or under the jurisdiction of juvenile court and/or in the custody of the Ohio department of youth services; and

(2) Meets one or more of the following criteria as documented in the ICR:

(a) Is at risk for out-of-home placement due to his/her behavioral health/mental health condition;

(b) Has returned within the previous thirty days from an out-of-home placement or is transitioning back to their home within thirty days; or

(c) Requires a high intensity of mental health interventions to safely remain in or return home; and

(E) The following describes the activities and components of IHBT:

(1) IHBT is an intensive service that consists of multiple face-to-face contacts per week with the child/adolescent and family, which includes collateral contacts related to the mental health needs of the child/adolescent as documented in the ICR. The frequency of contacts may fluctuate based on the assessed needs and unique circumstances of the child, adolescent, and family.

(2) IHBT is strength-based and family-driven, with both the child/adolescent and family regarded as equal partners with the IHBT staff in all aspects of developing the service plan and service delivery;

(3) IHBT is provided in the home, school, and community where the child/adolescent lives and functions;

(4) Provided by staff with a caseload that averages over any six month period and per full time equivalent staff:

(a) Twelve or less when provided by a team of two, or

(b) Eight or less when provided by an individual staff;

(5) Crisis response is available twenty-four hours a day, seven days a week. Crisis response may be provided through written agreement with another agency, as long as at least one agency IHBT staff is accessible to the provider agency, and is available to the client and family as needed;

(6) Each child/adolescent and family receiving IHBT is assessed for risk and safety issues. When clinically indicated, a jointly written safety plan shall be developed that is provided to the child/adolescent and family;

(7) Collaboration occurs with other child-serving agencies or systems, e.g., school, court, developmental disabilities, job and family services, and health care providers that are providing services to the child/adolescent and family, as well as family and community supports identified by the child/adolescent and family;

(8) The service is flexible and individually tailored to meet the needs of the child/adolescent and family. Appointments are made at a time that is convenient to the child/adolescent and family, including evenings and weekends if necessary;

(9) The service is time-limited, with length of stay matched to the presenting mental health needs of the child/adolescent. IHBT should not exceed six months length of stay. IHBT certified agencies must have clearly written guidelines for granting extensions and procedures for continued stay of each individual. A continued stay review must be documented for each child/adolescent receiving IHBT beyond six months, and every forty-five days thereafter. The continued stay review must include the criteria in paragraph (C) of this rule; and

(10) The child/adolescent and family's IHBT aftercare service needs are addressed. Continuing care planning shall be collaborative between the child/adolescent, family and IHBT staff.

(F) The agency must demonstrate that the following staff requirements and qualifications are met:

(1) A minimum of two full-time equivalent staff provide the service. Services may be provided by a single person, or team of staff clearly sharing various responsibilities for the same child/adolescent and family. Each child/adolescent shall have a staff assigned with lead responsibility. IHBT direct care staff must be fully dedicated to the IHBT program and cannot have mixed service caseloads (including behavioral health counseling and therapy, diagnostic assessment and CPST services).

(2) The agency must have a documented plan for clinical supervision, which includes:

(a) The IHBT supervisor shall have a designated responsibility to IHBT;

(b) Each staff person shall receive clinical supervision that is appropriate for the staff person's expertise and caseload complexity; and

(c) Consideration of the staff person's assessed training needs.

(3) The IHBT supervisor shall have primary responsibility for providing supervision to the IHBT staff twenty-four hours a day, seven days a week. If the IHBT supervisor is unavailable, then supervision must be provided by staff qualified according to rule 5122-29-30 of the Administrative Code.

(G) The agency must demonstrate that each IHBT staff has an individualized training plan based on an assessment of his/her specific training needs. The following professional training and development criteria must be met:

(1) Each staff receives an assessment of initial training needs based on the skills and competencies necessary to provide IHBT service prior to providing IHBT service; and

(2) The agency shall have a written description of the skills and competencies required to provide IHBT service, which may include the following:

(a) Family systems;

(b) Risk assessment and crisis stabilization;

(c) Parenting skills and supports for children/adolescents with SED;

(d) Cultural competency;

(e) Intersystem collaboration with a focus on schools, courts, and child welfare:

(i) Knowledge of other systems;

(ii) System advocacy; and

(iii) Roles, responsibilities, and mandates of other child/adolescent-serving entities;

(f) Trauma-informed care;

(g) Educational and vocational functioning:

(i) Assessment and intervention strategies for resolving barriers to successful educational and vocational functioning;

(ii) Knowledge of special education laws; and

(iii) Strategies for developing positive home-school partnerships and connections;

(h) IHBT philosophy, including strength-based assessment and treatment planning; and

(i) Differential diagnosis with special needs children/adolescents, including co-occurring substance use disorders and developmental disabilities, for staff credentialed to diagnose.

(H) The agency's training plan must include provisions for ongoing training specific to the identified training needs of the staff as it relates to the population served, including attention to cultural competency, changing demographics, new knowledge or research, and other areas identified by the agency.

(I) The agency must demonstrate that each IHBT supervisor receives training specific to the clinical and administrative supervision of the service.

(J) The agency shall obtain at least one fidelity review of the agency's entire IHBT service every twelve months by an individual or organization external to the agency, utilizing the Ohio department of mental health IHBT fidelity rating tool or other rating tool approved by the department. The agency shall incorporate the results of the fidelity review into the agency's performance improvement program, if indicated.

(K) Intensive home based treatment service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 07/01/2013
R.C. 119.032 review dates: 04/16/2013 and 07/01/2018
Promulgated Under: 119.03
Statutory Authority: 5119.61(A), 5119.611(E)
Rule Amplifies: 5119.61(A), 5119.611(E)
Prior Effective Dates: 7/1/2005, 1/9/2006, 8/23/2007, 12/13/2007, 7/1/2009, 2/17/2012

5122-29-29 Assertive community treatment (ACT) service.

(A) Assertive community treatment (ACT) is a collaborative, multidisciplinary team approach that shall include, at a minimum, behavioral health counseling and therapy service, mental health assessment service, pharmacologic management service, community psychiatric supportive treatment (CPST) service, self-help/peer support service, mental health crisis response service, substance abuse services, and supported employment services.

ACT services are provided to an individual with a major functional impairment(s) and/or behavior which present a high risk to the individual due to severe and persistent mental illness and which necessitate high service intensity. ACT services are also provided to the individual's family and other support systems. A client receiving ACT services may also have coexisting substance abuse, mental retardation/developmental disabilities, and/or physical health diagnoses. The service is available twenty-four hours a day, seven days a week.

The purpose/intent of ACT team services is to provide the necessary services and supports which maximize recovery, and promote success in employment, housing, and the community.

(B) In addition to the definitions in rule 5122-24-01 of the Administrative Code, the following definitions apply to this rule:

(1) "Competitive employment" means activity conducted as part of a community job for which anyone can apply and for which the individual is paid at least minimum wage.

(2) "Crisis response" means the immediate access and availability of the ACT team, by phone and face-to-face, as clinically indicated, to the client or essential others, and which may include crisis stabilization, safety planning, and the alleviation of the presenting crisis.

(3) "Essential other" means an individual who has regular contact and emotional or functional significance to the person served including family, friends, guardians, landlords, neighbors, etc.

(4) "Peer specialist" means an employee who has experienced serious and persistent mental illness, and who provides direct services, including social and emotional support, coupled with instrumental support, to persons receiving mental health services. A peer specialist promotes recovery through training, role modeling and sharing experiences, and facilitates recovery by providing hope, encouragement, self-determination, validation, and connection to the community.

(5) "Supported employment" means a group of services which assists and supports a person choosing, obtaining, and maintaining competitive employment according to his/her preferences and without requiring prevocational activities.

(C) ACT certified agencies shall be certified to provide behavioral health counseling and therapy service, mental health assessment service, pharmacologic management service, and community psychiatric supportive treatment (CPST) service in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code.

(D) Agencies shall develop clearly identified admission criteria which shall be reflective of the intensive nature of the service. Admission criteria shall include attention to:

(1) Diagnosis, including co-occurring disorders;

(2) Psychiatric service utilization history;

(3) Symptoms; and

(4) Functioning.

(E) The agency must demonstrate that each ACT team meets, at a minimum, the following staff requirements and qualifications:

(1) Designated team leader, who is qualified to supervise the service;

(2) Psychiatrist, including a minimum ratio of .40 full-time equivalent psychiatrist per one hundred clients receiving ACT services. Each ACT team shall have no more than three psychiatrists. The ACT team psychiatrist(s) may collaborate with a nurse practitioner(s) and/or clinical nurse specialist(s) to fulfill part of the psychiatrist(s)'s roles and responsibilities, provided that the nurse practitioner(s) and/or clinical nurse specialist(s) has a nursing specialty in mental health or psychiatric mental health;

(3) A substance abuse team member, including a minimum ratio of one full-time equivalent substance abuse team member per one hundred clients receiving ACT services:

(a) Prior to providing the service, each substance abuse team member receives an assessment of initial training needs based on the skills and competencies necessary to provide ACT service. A training and supervision plan shall be developed based on this assessment ensuring the substance abuse team member has or will obtain within six months the necessary skills and competencies, which may include:

(i) Engagement strategies;

(ii) Motivational strategies; and

(iii) Relapse prevention.

(b) An agency with more than one ACT team may be exempt from this requirement on one or more, but not all, of their ACT teams, providing all of the following conditions are met:

(i) The agency has at least one ACT team for dually-diagnosed individuals with alcohol and other drug service needs. This specialized team shall include a substance abuse team member; and

(ii) The agency's ACT service description, and ACT policies and procedures shall describe the client population needs served by each agency ACT team. In addition, the policies and procedures shall:

(a) Include the requirement that each client receiving ACT services and in need of alcohol and other drug services is served on an ACT team that includes a substance abuse team member; and

(b) Specify the procedures to ensure a client on a team without a substance abuse team member, but who is later assessed to be in need of substance abuse services, receives all ACT services from an ACT team with a substance abuse team member;

(c) All actions by the substance abuse team member and ACT team shall be in compliance with division (B) of section 3793.06 and section 4758.02 of the Ohio Revised Code.

(4) Registered nurse, including a minimum ratio of 1.0 full-time equivalent registered nurse per one hundred clients receiving ACT services. Each registered nurse shall have a specialty or documented competency in psychiatry;

(5) Vocational specialist, including a minimum ratio of 1.0 full time equivalent vocational specialist per one hundred clients receiving ACT services. Prior to providing the service, each vocational specialist receives an assessment of initial training needs based on the skills and competencies necessary to provide ACT service. A training and supervision plan shall be developed based on this assessment ensuring the vocational specialist has or will obtain within six months the necessary skills and competencies, which may include:

(a) Supported employment;

(b) Job placement;

(c) Individualized job development; and

(d) Benefits planning; and

(6) Prior to providing the service, each peer specialist receives an assessment of initial training needs based on the skills and competencies necessary to provide ACT service. A training and supervision plan shall be developed based on this assessment ensuring the peer specialist has or will obtain within six months the necessary skills and competencies, which may include:

(a) Recovery;

(b) Peer support;

(c) Consumer advocacy organizations; and

(d) Psychiatric advance directives:

(i) education and advocacy; and

(ii) information and referral.

(F) The agency must demonstrate that each ACT team member's roles and responsibilities include, at a minimum, the following:

(1) The team leader:

(a) Provides direct supervision of team members; and

(b) Provides direct services.

(2) The psychiatrist:

(a) Provides clinical leadership to the ACT team in assessment, treatment planning, general healthcare, medical and psychosocial approaches; and

(b) Collaborates with each nurse practitioner and/or clinical nurse specialist, when these staff are utilized to fulfill part of the requirement in paragraph (F)(2) of this rule, in assessment, treatment planning, general healthcare, medical and psychosocial approaches, and a review of each ACT client's progress and treatment.

(3) The psychiatrist, along with the nurse practitioner and clinical nurse specialist when these staff are utilized to fulfill part of the requirement in paragraph (F)(2) of this rule, provides consultation and training to other ACT team members regarding the client's medical psychiatric care, including pharmacologic management needs.

(4) The substance abuse team member:

(a) Provides training to other ACT team members on the signs, symptoms and early identification of alcohol and other drug use and abuse, and the disease of alcoholism and drug dependency;

(b) Assists in coordinating individual treatment planning including aftercare and recovery support services for each client actively involved in alcohol and other drug treatment;

(c) Assists each client receiving drug and alcohol treatment in becoming involved with self-help support groups;

(d) Assists each client receiving drug and alcohol treatment in developing and maintaining social support networks; and

(e) Ensures that each client referred by the ACT team for alcohol and other drug treatment is referred to an individual or program licensed or certified to provide alcohol and other drug treatment.

(5) The registered nurse:

(a) Conducts health assessments;

(b) Coordinates with other health providers; and

(c) Provides training to other ACT team members to help them monitor psychiatric symptoms and medication side effects.

(6) The vocational specialist:

(a) Provides training to other ACT team members to help them integrate interventions to support vocational goals;

(b) Liaisons with other providers of vocational rehabilitation services, if applicable;

(c) Provides or makes appropriate referral for benefits planning; and

(d) Provides a full range of supported employment services. Eligibility is based upon client choice, and efforts are made to engage the client in supported employment regardless of diagnosis, symptoms, work history, substance use, or treatment compliance. Supported employment activities must include:

(i) Interventions to achieve competitive employment. Volunteer jobs, sheltered employment, and enclaves shall not be suggested to a client as preparatory to employment, or as long-term vocational goals;

(ii) Interventions individualized to the client's job preferences, life-style, and mental health coping skills;

(iii) Commencing the employment search within four weeks after the client expresses a desire to work;

(iv) Time unlimited follow-along services. Contact with the client and employer, as appropriate, shall continue for the duration of the job; and

(v) Utilizing a job termination, if any, as a learning opportunity, and beginning a new employment search within four weeks.

(7) The peer specialist:

(a) Engages the client, and provides outreach and support; and

(b) Provides training and education to other ACT team members and clients on:

(i) Recovery;

(ii) Peer support;

(iii) Consumer advocacy organizations; and

(iv) Psychiatric advance directives:

(a) Education and advocacy; and

(b) Information and referral.

(G) The agency must demonstrate that each ACT team:

(1) Consists of a minimum of 4.0 full-time equivalent direct care staff members;

(2) Serves no more than one-hundred twenty clients; and

(3) Provides a minimum of a one-to-fifteen direct service staff-to-client ratio, excluding psychiatrists, and nurse practitioners and/or clinical nurse specialists when these staff are utilized to fulfill part of the requirement in paragraph (F)(2) of this rule.

(H) Each month the agency must demonstrate that ACT staff provide each client a minimum of the following service contacts for the ACT services specified in paragraph (C) of this rule:

(1) Three face-to-face service contacts. At least sixty-five percent of all face-to-face service contacts shall occur in the community; and

(2) Six total service contacts.

(3) Clinically appropriate reasons for the inability to implement any portion of this paragraph shall be documented in the ICR.

(I) The agency must demonstrate that the ACT team has a minimum of one contact per month with family/essential others, with the consent of and choice by the person served.

(J) The agency must demonstrate that each month sixty-five percent or more of the ACT team clients shall receive contact by more than one ACT team member.

(K) Each ACT team shall meet a minimum of four times each week to plan and review ACT client progress. Telephone conferences are acceptable. Each psychiatrist, as well as each nurse practitioner and clinical nurse specialist when these staff are utilized to fulfill part of the requirement in paragraph (F)(2) of this rule, shall attend a minimum of one team meeting each week. The team shall document attendance and participation at this meeting, as all on-duty ACT team staff are expected to attend.

(L) Each ACT team is responsible for crisis response twenty-four hours a day, seven days a week. Crisis response may be provided through written agreement with another agency, as long as at least one member of the ACT team is accessible to the provider agency, and is available to the client and/or essential other as needed. The agreement shall specify the responsibilities of the ACT team and the provider agency.

(M) The ACT team shall be involved in psychiatric hospital admissions and discharges.

(1) The team is involved in the decision for psychiatric inpatient admissions. The team shall document any instance in which they were unable to collaborate with psychiatric admitting staff.

(2) The team shall collaborate with the psychiatric inpatient treatment team for planning hospital discharges.

(N) For a minimum of ninety days, or until the client has stated his or her desire to discontinue ACT services, the ACT team shall attempt at least two face-to-face contacts per month for a client who has discontinued ACT services unexpectedly. Such attempts and client response, if any, shall be documented in the ICR.

(O) Assertive community treatment service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 03/22/2012
R.C. 119.032 review dates: 12/30/2011 and 03/22/2017
Promulgated Under: 119.03
Statutory Authority: 5119.61(A), 5119.611(C)
Rule Amplifies: 5119.61(A), 5119.611(C)
Prior Effective Dates: 7-1-2005, 1-9-2006, 8-23-2007, 12-13-2007, 7-1-2009

5122-29-30 Eligible providers and supervisors.

(A) Appendix A to this rule defines and appendix B to this rule identifies those individuals who are eligible to provide and supervise the following mental health and addiction services as described in Chapter 5122-29 of the Administrative Code, providers of alcohol and other drug services not listed in this rule may be subject to the provisons of rule 3793:2-1-08 of the Administrative Code:

(1) Behavioral health counseling and therapy service;

(2) Mental health assessment service;

(3) Pharmacologic management service;

(4) Partial hospitalization service;

(5) Forensic evaluation service;

(6) Behavioral health hotline service;

(7) Crisis intervention mental health service, including paragraph (C)(1) of rule 5122-29-10 of the Administrative Code;

(8) Employment/vocational service;

(9) Adult educational service;

(10) Social and recreational service;

(11) Community psychiatric supportive treatment (CPST) service;

(12) Consultation service;

(13) Prevention service;

(14) Mental health education service;

(15) Adjunctive therapy service;

(16) Occupational therapy service;

(17) School psychology service;

(18) Intensive home based treatment (IHBT) service; and

(19) Assertive community treatment (ACT) service.

(B) Licensed, certified or registered individuals shall comply with current, applicable scope of practice and supervisory requirements identified by appropriate licensing, certifying or registering bodies.

Appendix B to this rule contains a supplement which describes additional provider and supervisory requirements for the following individuals:

(1) Aide (Aide);

(2) Psychology aide (PSY Aide);

(3) Psychology fellow (PF);

(4) Psychology intern (PI);

(5) Psychology postdoctoral trainee (PPT);

(6) Psychology resident (PR);

(7) Psychology trainee (PT);

(8) School psychology intern (S. PSY I.);

(9) School psychology trainee (S. PSY T.);

(10) Social worker (SW); and

(11) Social worker assistant (SWA).

Click to view Appendix

Click to view Appendix

Effective: 4/1/2016
Five Year Review (FYR) Dates: 08/01/2018
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 7/1/2009, 3/4/2010, 8/1/2013

5122-29-33 Health home service for persons with serious and persistent mental illness.

(A) Health home service for persons with serious and persistent mental illness is a person-centered holistic approach that provides integrated behavioral health and physical health care coordination and care management for individuals with serious and persistent mental illness.

Health home service goals are to improve care coordination for individuals with serious and persistent mental illness, improve integration of physical and behavioral health care, reduce rates of hospital emergency department use and hospital admissions and readmissions, decrease reliance on long-term care facilities, and improve the experience of care, health outcomes and quality of life for consumers.

(B) The following definitions apply to this rule in addition to or in place of the definitions in rule 5122-24-01 of the Administrative Code:

(1) "Adult with serious and persistent mental illness" means an individual age eighteen or older with:

(a) A DSM-IV-TR (or its successor) diagnosis, with the exception of the following exclusionary diagnoses:

(i) Developmental disorders (tic disorders, mental retardation, pervasive developmental disorders, learning disorders, motor skills disorders and communication disorders);

(ii) Substance-related disorders;

(iii) Conditions or problems classified in DSM-IV-TR as "other conditions that may be a focus of clinical attention" (V codes); and

(iv) Dementia, mental disorders associated with known or unknown physical conditions such as hallucinosis, amnesic disorder or delirium sleep disorders; and

(b) Treatment history covers the consumer's lifetime treatment for the DSM IV-TR diagnoses other than those listed as "exclusionary diagnoses" in paragraph (B)(1)(a) of this rule and meets one of the following criteria:

(i) Continuous treatment of twelve months or more, or a combination of, the following treatment modalities: inpatient psychiatric treatment, partial hospitalization or twelve months continuous residence in a residential program (e.g., supervised residential treatment program, or supervised group home); or

(ii) Two or more admissions of any duration to inpatient psychiatric treatment, partial hospitalization or residential programming within the most recent twelve month period; or

(iii) A history of using two or more of the following services over the most recent twelve month period continuously or intermittently (this includes consideration of a person who might have received care in a correctional setting): psychotropic medication management, behavioral health counseling, community psychiatric supportive treatment, crisis intervention; or

(iv) Previous treatment in an outpatient service for at least twelve months, and a history of at least two mental health psychiatric hospitalizations; or

(v) In the absence of treatment history, the duration of the mental disorder is expected to be present for at least twelve months; and

(c) Global assessment of functioning (GAF) scale ratings of fifty or below.

(2) "Adult with serious mental illness" means an individual age eighteen or older with:

(a) A DSM-IV-TR (or its successor) diagnosis, with the exception of the following exclusionary diagnoses:

(i) Developmental disorders (tic disorders, mental retardation, pervasive developmental disorders, learning disorders, motor skills disorders and communication disorders);

(ii) Substance-related disorders;

(iii) Conditions or problems classified in DSM-IV-TR as "other conditions that may be a focus of clinical attention" (V codes); and

(iv) Dementia, mental disorders associated with known or unknown physical conditions such as hallucinosis, amnesic disorder or delirium sleep disorders; and

(b) Treatment history covers the consumer's lifetime treatment for the DSM IV-TR diagnoses other than those listed as "exclusionary diagnoses" in paragraph (B)(2)(a) of this rule and meets one of the following criteria:

(i) Continuous treatment of six months or more, or a combination of, the following treatment modalities: inpatient psychiatric treatment, partial hospitalization or six months continuous residence in a residential program (e.g., supervised residential treatment program, or supervised group home); or

(ii) Two or more admissions of any duration to inpatient psychiatric treatment, partial hospitalization or residential programming within the most recent twelve month period; or

(iii) A history of using two or more of the following services over the most recent twelve month period continuously or intermittently (this includes consideration of a person who received care in a correctional setting): psychotropic medication management, behavioral health counseling, community psychiatric supportive treatment, crisis intervention; or

(iv) Previous treatment in an outpatient service for at least six months, and a history of at least two mental health psychiatric hospitalizations; or

(v) In the absence of treatment history, the duration of the mental disorder is expected to be present for at least six months; and

(c) Global assessment of functioning (GAF) scale rating between forty and sixty.

(3) "Child or adolescent with serious emotional disturbance" means an individual age seventeen and younger, or an individual eighteen to twenty-one years of age enrolled in high school, in department of youth services or children services custody, or when it is otherwise developmentally/clinically indicated, and:

(a) A DSM-IV-TR (or its successor) diagnosis, with the exception of the following exclusionary diagnoses:

(i) Developmental disorders (tic disorders, mental retardation, pervasive developmental disorders, learning disorders, motor skills disorders and communication disorders);

(ii) Substance-related disorder;

(iii) Conditions or problems classified in DSM-IV-TR as "other conditions that may be a focus of clinical attention" (V codes) unless these conditions co-occur with another diagnosable mental or emotional disorder; and

(b) Assessment of impaired functioning at age appropriate levels and difficulty with age appropriate role performance with a global assessment of functioning (GAF) scale rating below sixty; and

(c) Duration of the mental health disorder has persisted or is expected to be present for six months or longer.

(4) "Community providers" means treatment providers including but not limited to alcohol and other drug (AoD) treatment providers, primary care providers, medical specialists, hospitals, and service providers, including but not limited to housing entities, nutritionists, courts, or others involved in the clinical or non-clinical care of the consumer.

(5) "SPMI" means a person with serious and persistent mental illness, serious mental illness, or serious emotional disturbance.

(C) Health home service may be provided to the consumer and may include any other individuals who will assist in the consumer's treatment, and may be delivered face-to-face, by telephone, and/or by video conferencing in individual, family and group format or as appropriate to perform the service in locations and settings that meet the needs of the health home consumer. Health home service includes the following components:

(1) Comprehensive care management:

(a) Identify consumers with SPMI who need and can benefit from health home service;

(b) Document consumer's informed consent specific to enrollment in the health home service prior to enrollment; informed consent shall include a description of the health home service, benefits and drawbacks of enrollment in the health home service, including the relationship between the health home service and other services, particularly other care coordination services (e.g. CPST, MCP care management, AoD case management), and the consumer's ability to opt out of enrollment in the health home service;

(c) Orient consumers by discussing the benefits of active participation;

(d) Within thirty days of enrollment in the health home service, conduct a comprehensive assessment of the individual's physical health, behavioral health (i.e., mental health disorders, substance abuse disorders, and developmental disabilities), long-term care (e.g. assistance with activities of daily living, functional status, self-care capability), and social service needs (e.g. financial assistance, housing, family or support system dynamics), incorporating relevant information from screening tools, medical records, the consumer and his/her family, guardian and/or significant others, other providers, health home team members, and other sources as applicable; develop a team of health care professionals to deliver health home service based on the consumer's needs; establish and negotiate roles and responsibilities, including the accountable point of contact;

(e) Within sixty days of enrollment in the health home service, develop a single, person-centered, integrated care plan that addresses and coordinates all of a consumer's clinical and non-clinical needs, and includes prioritized goals and actions with anticipated time frames for completion and reflects the individual's preferences; implement and monitor the integrated care plan to determine adherence to treatment and medication regiment; identify, and to the extent possible, remove barriers to care, or any clinical and non-clinical issues that may impact the individual's health status or progress in achieving the goals and outcomes outlined in the integrated care plan;

(f) At least once every ninety days:

(i) Reassess the consumer and update the comprehensive assessment as needed based upon the results of the reassessment. The reassessment may be based upon clinical interviews with the consumer and/or guardian and review of data or other information (e.g. progress notes, test results, reports from health home and other providers, etc.), and comparing the most recent data with the data collected at earlier assessments.

(ii) Review the integrated care plan, and update it when indicated by the results of the reassessment;

(g) Develop a communication plan to ensure that routine information exchange (clinical consumer summaries, medication profiles, updates on consumer progress toward meeting goals), collaboration, and communication occurs between the team members, providers, payors, and the consumer and the consumer's family, guardian, and/or significant others; and

(h) Develop a crisis management and contingency plan in collaboration with the consumer and the family, guardian, and/or significant others.

(2) Care coordination:

(a) Implement the integrated care plan;

(b) Assist consumer in obtaining health care, including primary, acute and specialty medical care, mental health, substance abuse services and developmental disabilities services, long-term care and ancillary services and supports;

(c) Perform medication management, including medication reconciliation;

(d) Track tests and referrals, and follow-up as necessary;

(e) Coordinate, facilitate and collaborate with the consumer, team of health care professionals and other providers, and the consumer's family, guardian and/or significant others;

(f) Share the crisis management and contingency plan, assist with and coordinate prevention, management and stabilization of crises and ensure post-crisis follow-up care is arranged and received;

(g) Assist consumer in obtaining referrals to community, social and recovery supports, making appointments and confirming that the consumer received the service(s);

(h) Provide clinical summaries and consumer information along with routine reports of integrated care plan compliance to the team of health care professionals, including the consumer and the consumer's family, guardian and/or significant others consistent with the communication plan.

(3) Health promotion.

(a) Provide education to the consumer and the consumer's family, guardian and/or significant others that is specific to the consumer's needs as identified in the assessment;

(b) Assist the consumer in acquiring symptom self-monitoring and management skills so that the consumer learns to identify and minimize the effects of the chronic illnesses that negatively impact his/her daily functioning;

(c) Provide or connect the consumer and the consumer's family, guardian and/or significant others with services that promote a healthy lifestyle and wellness through the use of evidence-based, evidence-informed, best, emerging, and/or promising practices;

(d) Actively engage the consumer and the consumer's family, guardian and/or significant others in developing, implementing and monitoring the integrated care plan;

(e) Connect the consumer with peer supports including self-help/self-management and advocacy groups;

(f) Manage consumer population through use of clinical and consumer data to remind consumers about services needed for both preventive and chronic care;

(g) Promote positive behavioral health and lifestyle choices; and

(h) Provide education to the consumer and the consumer's family, guardian and /or significant others about accessing care in appropriate settings.

(4) Comprehensive transitional care and follow-up.

(a) Coordinate and collaborate with providers;

(b) Facilitate and manage care transitions (e.g., inpatient-to-inpatient, residential, community setting(s) to prevent unnecessary inpatient admissions, inappropriate emergency department use and other adverse outcomes such as homelessness;

(c) Conduct or facilitate effective clinical hand-offs that include timely access to follow-up post discharge care in the appropriate setting, timely receipt and transmission of a transition/discharge plan from the discharging entity, and medication reconciliation. A clinical hand-off is the transfer of care and responsibility from the outgoing clinician/provider to the oncoming clinician/provider and includes verbal and written communication to relay vital information about the consumer and his/her anticipated needs.

(5) Individual and family supports.

(a) Provide expanded access to and availability of services;

(b) Provide continuity in relationships between consumer, family, guardian and/or significant others with physician and care manager;

(c) Outreach to the consumer and his/her family, guardian and/or significant others, and perform advocacy on the consumer's behalf to identify and obtain needed resources such as medical transportation and other benefits for which he/she may be eligible;

(d) Educate the consumer in self-management of his/her chronic condition:

(i) Facilitate further development of daily living skills;

(ii) Assist with obtaining and adhering to medication and other prescribed treatments;

(iii) Provide interventions that address symptoms and behaviors, and assist the health home consumer in eliminating barriers to seeking or maintaining education, employment or other meaningful activities related to his or her recovery-oriented goal;

(e) Provide opportunities for the family, guardian and/or significant others to participate in assessment and integrated care plan development, implementation and update;

(f) Ensure that health home service is delivered in a manner that is culturally and linguistically appropriate;

(g) Provide assistance in identifying and accessing needed community supports including self-help, peer support and natural supports, i.e. individual resources as identified by and available to the consumer which are independent from formal services, e.g. a relative, teacher, clergy member, etc.;

(h) Promote personal independence and empower the consumer to improve his/her own environment;

(i) Include the consumer's family, guardian and/or significant others in the quality improvement process including but not limited to, surveys to capture experience with health home service, establishment of a consumer and family advisory council; and

(j) Allow the consumer and his/her family, guardian and/or significant others access to the electronic health record or other clinical information.

(6) Referral to community and social support services.

(a) Provide referrals to community/social/recovery support services; and

(b) Assist the consumer in making appointments, confirm that the consumer attended the appointment, and determine the outcome of the visit and any needed follow-up.

(D) A health home provider must be certified by the Ohio department of mental health and addiction services in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code to provide each of the following services:

(1) Behavioral health counseling and therapy;

(2) Mental health assessment;

(3) Pharmacological management; and

(4) Community psychiatric support treatment.

(E) A health home provider shall demonstrate integration of physical and behavioral health care for a minimum of six months prior to the date of application by:

(1) Having an ownership or membership interest in a primary care organization where primary care services are fully integrated and embedded; or

(2) Entering into a written integrated care agreement which is a contract, memorandum of understanding, or other written agreement with a primary care provider for co-located bi-directional coordinated care at each health home site. For the purposes of this rule, when the health home service is co-located in a primary care setting, it is subject to the provisions of this rule and the primary care setting must be identified and reported to the department. The department reserves the right to visit primary care settings where the health home service is co-located.:

(a) Provide preventative and chronic primary care services, ensuring that specific medical screening and treatment services consistent with medical standards of care are provided to health home enrollees on-site;

(b) Participate in care coordination and care management activities (e.g. integrated care plan development, contributing to the assessment, participating in health home team meetings, etc.) with the health home provider; and

(c) Contribute to a shared medical record and/or a integrated care plan maintained by the health home provider

(F) A health home provider shall demonstrate integration of physical and behavioral health care by achieving one of the following:

(1) Successful implementation of accrediting body integrated physical health/primary care standards during the next accreditation survey process following Ohio department of mental health and addiction services certification as a health home provider in which the provider is eligible in accordance with its accrediting body policies and procedures to undergo a review of its integrated physical health/primary care services:

(a) Integrated behavioral health/primary care or health home core program accreditation by the commission on accreditation of rehabilitative facilities; or

(b) Primary physical health care standards by the joint commission behavioral health care accreditation program, or primary care medical home or behavioral health home certification by the joint commission; or

(c) Integrated behavioral health and primary care supplement standards by the council on accreditation; or

(d) Equivalent accreditation or certification approved by the Ohio department of mental health and addiction services; or

(2) Within eighteen months:

(a) Level one patient-centered medical home recognition by the national committee for quality assurance; or

(b) Patient-centered specialty practice recognition by the national committee for quality assurance; or

(c) Equivalent recognition approved by the Ohio department of mental health and addiction services.

(G) A health home provider shall:

(1) Support the delivery of person-centered care by:

(a) Providing expanded, timely access to the services as defined in this rule and provided by the health home provider;

(b) Utilizing a multi-disciplinary team-based approach for the delivery of health home service through the ongoing use of an established team of members as defined in this rule; and

(c) Providing facilitated referrals to specialists when medically necessary.

(2) Have the capacity to receive and utilize electronic data from a variety of sources to facilitate all components of health home service;

(3) Meet the following requirements:

(a) Implement and actively use in clinical services an electronic health record (EHR) product certified by the office of the national coordinator for health information technology , as evidenced by at least one of the following:

(i) Are submitting a minimum of forty per cent of prescriptions electronically;

(ii) Are receiving structured laboratory results;

(iii) Utilize continuity of care records;

(iv) Are participating in an Ohio regional extension center program; or

(v) Are participating in a health information exchange.

(b) Within twenty-four months, demonstrate an electronic health record is used to support all health home services, and

(c) Participate in the statewide health information exchanges when established;

(4) Participate in any health home learning communities;

(5) Allow the Ohio department of mental health and addiction services to conduct site visits to survey health home service standards;

(6) Maintain a comprehensive and continuous quality improvement program in accordance with rule 5122-28-03 (performance improvement) of the Administrative Code and/or the health home provider's national accrediting body;

(7) Collect and report data and meet health home performance measurement requirements which consist of mandatory centers for medicare and medicaid services core measures and measures established by the Ohio department of mental health and addiction services in conjunction with stakeholder input. To the extent possible, measures should be consistent with nationally recognized and other required standards, which may include national committee for quality assurance (NCQA) healthcare effectiveness data and information set (HEDIS) measures, national quality forum (NQF), agency for healthcare research and quality (AHRQ), substance abuse and mental health services administration (SAMHSA) national outcome measures (NOMS);

(8) Establish relationships with medicaid managed care plans (MCPs) in the service area and develop written policies and procedures that include the following:

(a) Notify the MCP of referrals received by the health home provider for the MCP's members, and of any MCP member who is currently receiving health home service. The health home provider will collaboratively develop a transition plan with the MCP for any plan member that will receive health home service in order to prevent unnecessary duplication of, and avoid gaps in, services;

(b) Form a care management team to effectively manage the consumer's needs that includes the health home provider team, the health home consumer and his/her family/supports and primary care provider, a representative from the consumer's MCP, and other providers, as appropriate;

(c) Work collaboratively with the MCP to ensure all of the consumer's needs identified in the health home integrated care plan are met. Ensure that the integrated care plan is accessible to the MCP and providers involved in managing the consumer's health care;

(d) Request care coordination supports from the MCP, if needed;

(e) Identify a designated contact to collaborate with the MCP's designated single point of contact on such activities as the following: exchanging information about the plan's member, soliciting input to the development of the integrated care plan, participating in health home team meetings, and facilitating to the extent possible, access to services that are outside the scope of the health home provider;

(f) Ensure that if the health home provider has direct ownership of or membership in a primary care provider, or practice, it seeks a contract with the MCPs in the service area for the provision of primary care services. If the health home provider has a co-located relationship with a primary care provider for the provision of primary care services, the health home provider shall encourage the provider to seek a contract with the MCPs in the service area;

(g) The health home provider shall also:

(i) Provide a list and periodic updates of primary care providers, specialists, inpatient facilities, and other providers, as appropriate, to the MCP, for which the health home provider has established relationships or collaboration;

(ii) Refer to the plan's panel of providers when assisting the consumer in obtaining necessary health care services; and

(iii) Collaborate with the MCP to ensure that the consumer's selected, or assigned, primary care provider is informed the MCP member is enrolled with a health home service provider and provided with information as required in paragraph (G)(11) of this rule. If the consumer requests a change to the selected primary care provider, the health home provider shall inform the MCP so that the plan's existing process to change the primary care provider is promptly initiated;

(h) Provide timely notification of all inpatient facility discharges and residential setting transitions to the MCP in order to ensure adequate and timely provision of follow-up care. The health home provider will ensure that a discharge or transition plan is in place prior to the consumer discharge or transition. The health home provider will work with the MCP to ensure that post discharge services are prior authorized, if appropriate, and provided by the plan's contracted providers. The health home provider must ensure that the discharge or transition plan is integrated into the integrated care plan and communicated to the care management team;

(i) Ensure the capacity to send electronic data to MCPs and to produce ad hoc reports to more effectively coordinate care; and

(9) Develop an outreach plan to facilitate establishing relationships and collaboration with providers as follows:

(a) The outreach plan developed by the health home provider shall:

(i) Educate providers, as identified in paragraph (G)(9)(b) of this rule, about the health home service, the health home service goals, and the value of a relationship or collaboration to support the delivery of the service components, as applicable and appropriate, and as outlined in paragraph (C) of this rule;

(ii) Describe how and what type of information will be exchanged between the health home provider and the provider; and

(iii) Describe the role of the provider in coordinating and managing care for the consumer including, but not limited to, integrated care plan development and updates, participation in team meetings, etc.

(b) The health home provider shall establish relationships or collaborations with the following providers, as appropriate:

(i) Specialty care providers including, but not limited to, other behavioral health care or substance abuse treatment providers, pharmacists, cardiologists, pulmonologists, and endocrinologists;

(ii) Long-term care providers including, but not limited to, nursing facilities and home health care providers;

(iii) Hospitals, including emergency departments;

(iv) Community providers;

(v) Alcohol, drug addiction and mental health services or community mental health boards; and

(vi) Third party payor sources as indicated to coordinate benefits; and

(10) Have the ability to track tests and referrals for health care services, and coordinate follow-up care as needed; and

(11) Establish point of care reminders for consumers about services needed for preventive care and/or management of chronic conditions by using consumer information and clinical data.

(12) A health home cannot require a consumer receiving health home services to receive primary care, behavioral health care, specialty care or other services from the health home in instances where the health home offers such service.

(H) A health home provider shall have the capacity to provide all service components described in paragraph (C) of this rule.

(I) A health home provider shall obtain consumer consent, when required, prior to implementing the provisions of this rule regarding involvement of the consumer's family members and/or significant others in the health home service.

(J) A health home provider shall utilize an integrated, multidisciplinary team to deliver health home service. Licensed, certified or registered individuals shall comply with current, applicable scope of practice and supervisory requirements identified by appropriate licensing, certifying or registering bodies. Each health home shall have at least one nurse care manager and each team shall include:

(1) Health home team leader:

(a) Minimum qualifications:

(i) Licensed independent social worker, professional clinical counselor, independent marriage and family therapist, registered nurse with a master of science in nursing, certified nurse practitioner, clinical nurse specialist, psychologist or physician.

(ii) Supervisory, clinical and administrative leadership experience.

(iii) Health management experience, and competence in practice management, data management, managed care and quality improvement.

(b) Responsibilities:

(i) Provide administrative and clinical leadership and oversight to the health home team, and monitor provision of health home service.

(ii) Monitor and facilitate consumer identification and engagement, completion of comprehensive health and risk assessments, development of integrated care plans, scheduling and facilitation of treatment team meetings, provision of health home service, consumer status and response to health coordination and prevention activities, and development, tracking and dissemination of outcomes.

(2) Embedded primary care clinician:

(a) Qualifications:

Primary care physician, internist, family practice physician, pediatrician, gynecologist, obstetrician, certified nurse practitioner with primary care scope of practice, clinical nurse specialist with primary care scope of practice, or physician assistant.

(b) Responsibilities:

(i) Provide health home service including identification of consumers, assessment of service needs, development of integrated care plan and treatment guidelines, and monitor health status and service use.

(ii) Provide education and consultation to the health home team and other team members regarding best practices and treatment guidelines in screening and management of physical health conditions as well as engage with, and act as a liaison between, the treating primary care provider and the team.

(iii) Meet individually as needed with care managers to review challenging and complex cases.

(iv) It is preferred, but not required, that the embedded primary care clinician also functions as the treating primary care clinician and thus may hold dual roles on the health home team.

(3) Care manager:

(a) Minimum qualifications:

(i) Licensed social worker, independent social worker, professional counselor, professional clinical counselor, marriage and family therapist, independent marriage and family therapist, registered nurse, certified nurse practitioner, clinical nurse specialist, psychologist or physician.

(ii) Possess core and specialty competencies and skills in working with persons with SPMI, including assessment and treatment planning.

(iii) Demonstrate either formal training or a strong knowledge base in chronic physical health issues and physical health needs of persons with SPMI and be able to function as a member of an inter-disciplinary team.

(iv) Knowledge of community resources and social support services for persons with SPMI.

(b) Responsibilities:

(i) Accountable for overall care management and care coordination, and both provide and coordinate all of the health home service.

(ii) Responsible for overall management and coordination of the consumer's integrated care plan, including physical health, behavioral health, and social service needs and goals.

(iii) Conduct comprehensive assessments and develop integrated care plans.

(iv) Conduct case reviews on a regular basis.

(4) Qualified health home specialist:

(a) Minimum qualifications:

Pharmacist, licensed practical nurse; qualified mental health specialist with a four-year degree, two-year associate degree or commensurate experience; wellness coach; peer support specialist; certified tobacco treatment specialist, health educator or other qualified individual (e.g., community health worker with associate degree).

(b) Responsibilities:

Assist with care coordination, referral/linkage, follow-up and consumer, family, guardian and/or significant others support and health promotion services.

Effective: 07/01/2014
R.C. 119.032 review dates: 04/15/2014 and 07/01/2019
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 10/01/2012

5122-29-34 Outpatient treatment program certification.

(A) The purpose of this rule is to state the minimum requirements for a program to be certified by the Ohio department of alcohol and drug addiction services as an alcohol and drug addiction services outpatient treatment program.

(B) The provisions of the rule are applicable to all alcohol and drug addiction outpatient treatment programs in Ohio subject to program certification in accordance with division (A) of section 3793.06 of the Revised Code, public or private, regardless whether they receive any public funds that originate and/or pass through the Ohio department of alcohol and drug addiction services.

(1) This rule does not prohibit a program from operating an outpatient treatment program and a separate, distinct housing component at the same address if local zoning/building codes permit.

(2) This rule does not prohibit a program from operating an outpatient treatment program as part of a local jail.

(C) Each outpatient treatment program certified by the Ohio department of alcohol and drug addiction services shall be organized and clinically managed to provide one or more of the following levels of care. All treatment programs that receive public funds shall use the Ohio department of alcohol and drug addiction services' protocols for levels of care (youth and adult) for publicly-funded clients. For non-publicly-funded clients, the department's protocols for levels of care or other objective placement criteria shall be used.

(1) Outpatient

(2) Intensive outpatient

(D) Alcohol and drug programming for outpatient levels of care does not include time for meals, unstructured, non-therapeutic activities and free time. Time spent while attending self-help groups, such as alcoholics anonymous or narcotics anonymous, shall not be included in the minimum daily programming required for outpatient levels of care.

(E) Each alcohol and drug addiction outpatient program certified by the Ohio department of alcohol and drug addiction services shall, at a minimum, have available and provide the following alcohol and drug addiction treatment services in accordance with rule 3793:2-1-08 of the Administrative Code:

(1) Assessment

(2) Individual and or group counseling

(3) Crisis intervention

(4) Case management

(F) The program shall refer a client for a physical examination if indicated after a review of the client's medical history.

(G) An outpatient program that is certified by the Ohio department of alcohol and drug addiction services may provide ambulatory detoxification services that are supervised by a physician.

Transferred from 3793:2-2-01 on 5/3/2016

R.C. 119.032 review dates: 11/10/2010 and 07/15/2015
Promulgated Under: 119.03
Statutory Authority: 3793.02(D), 3793.06, 3793.11
Rule Amplifies: 3793.06
Prior Effective Dates: 7/1/91, 7/1/01, 11/17/05

5122-29-35 Licensure to conduct an opioid agonist program.

(A) The purpose of this rule is to state the minimum requirements that a program must meet in order to be licensed to conduct an opioid agonist program by the department.

(B) Definitions:

(1) "Administration" means the direct application of an opioid agonist medication to a client. Opioid agonists shall only be administered orally.

(2) "Detoxification" means the administering of an opioid agonist treatment medication in decreasing doses to an individual to alleviate adverse physiological or psychological effects of withdrawal from the continuous use of a narcotic drug and as a method of bringing the individual to an opiate drug-free state.

(3) "Dispense", as used in this Chapter means the final association of an opioid agonist medication for take home doses with a particular client pursuant to the prescription, drug order or other lawful order of the prescriber and the professional judgment of and responsibility for: interpreting, preparing, compounding, labeling and packaging of opioid agonist medication.

(4) "Interim opioid agonist maintenance" means maintenance provided in conjunction with appropriate medical/somatic services while a client is awaiting transfer to a program that provides comprehensive maintenance.

(5) "Long-term detoxification" means the administering of an opioid agonist medication for detoxification of a client for a period of more than thirty days but not in excess of one hundred eighty days.

(6) "Medical director" is a physician, licensed to practice medicine in Ohio by the state of Ohio medical board, who assumes the responsibility for the administration of all medical services performed by the program, either by performing them directly or by delegating specific responsibility to authorized program physicians and healthcare professionals functioning under the medical director's direct supervision.

(7) "Medication unit" means a unit established by an opioid agonist maintenance program solely to dispense opioid agonist medication for observed ingestion.

(8) Opioid agonist means methadone or levomethadyl acetate hydrochloride (LAAM).

(9) "Opioid agonist maintenance" means the administering or dispensing of methadone opioid agonist medication at stable dosage levels for a period in excess of twenty-one days in the treatment of a client for opioid addiction

(10) "Program sponsor" is a person or representative of the program, who is responsible for the operation of the opioid agonist program and who assumes responsibility for all of its employees, including any practitioners, agents or other persons providing medical, rehabilitative or counseling services at the program.

(11) "Short-term detoxification" means the administering of an opioid agonist medication for detoxification of a client for a period not to exceed thirty days.

(C) This rule is applicable to any program subject to opioid agonist program licensure in accordance with section 3793.11 of the Revised Code, which includes:

(1) Any program that administers or dispenses an opioid agonist medication for the treatment of opioid addiction.

(2) Any physician who administers or dispenses an opioid agonist medication for the treatment of opioid addiction. A physician is considered a program if she/he administers or dispenses an opioid agonist medication for the treatment of narcotic addiction and is required to meet the requirements of this rule to be licensed as opioid agonist program.

(D) An alcohol and drug addiction program desiring to be licensed as an opioid agonist program shall apply to the department for licensure in accordance with rule 3793:2-1-01 of the Administrative Code, program certification process. A license to conduct an opioid agonist program is for a one-year time period.

(E) The provision of an interim opioid agonist maintenance program is prohibited under this rule.

(F) Each site applying for or maintaining a license to conduct an opioid agonist program shall:

(1) Be owned and operated by an agency that has owned and operated an alcohol and drug addiction treatment program that has been certified by the Ohio Department of Alcohol and Drug Addiction Services for a minimum of two years.

(2) Be accredited as an opioid treatment program by an accreditation body that has been approved by the substance abuse and mental health services administration.

(3) Be certified by the Ohio department of alcohol and drug addiction services as an:

(a) Alcohol and drug addiction outpatient program in accordance with rule 3793:2-2-01 of the Administrative Code or

(b) Alcohol and drug addiction residential program in accordance with rule 3793:2-5-01 of the Administrative Code.

(4) Have a current certification from the substance abuse and mental health services administration to use an opioid agonist in the maintenance treatment of opioid addiction.

(5) Have a terminal distributor of dangerous drugs license from the Ohio state board of pharmacy.

(6) Have a security and alarm system that is approved by the U.S. drug enforcement administration.

(7) Meet the security requirements for the distribution and storage of controlled substances as required by 21 CFR 1301.72 through 21 CFR 1301.76.

(8) Have a program sponsor who has signed and submitted form SMA-162, application for certification to use opioid drugs in a treatment program under 42 C.F.R. 4095, to the substance abuse and mental health services administration.

(9) Have a physician who is the medical director for the program

(a) The physician must be licensed by the Ohio state medical board.

(b) The physician must have a current U.S. drug enforcement administration registration certificate for prescribing controlled substances.

(10) Operate the program in accordance with 21 CFR 291.505, conditions for the use of narcotic drugs; appropriate methods of professional practice for medical treatment of the narcotic addiction of various classes of narcotic addicts under section 4 of the "Comprehensive Drug Abuse Prevention and Control Act of 1970."

(G) An alcohol and drug addiction program that provides opioid agonist administration services must be licensed by the department as an opioid agonist program.

(H) Opioid agonist administration services shall consist of face-to-face interactions with clients, and opioid agonist medication shall only be administered or dispensed in oral, liquid doses.

(I) An individual must be a client of an opioid agonist program licensed by the department in order to receive opioid agonist medication under the provisions of this rule except as otherwise provided in this rule.

(J) Opioid agonist administration services shall be provided in a manner to ensure privacy.

(K) Opioid agonist administration services shall be provided by individuals who have one or more of the following credentials from the applicable state of Ohio board:

(1) Licensed physician.

(2) Registered nurse.

(3) Licensed practical nurse who has proof of completion of a course in medication administration approved by the Ohio board of nursing.

(L) Dispensing of opioid agonist medication shall only be done by individuals who have one or more of the following credentials from the applicable state of Ohio board:

(1) Licensed physician.

(2) Pharmacist.

(M) Providers of opioid agonist administration services shall be supervised by individuals who have one of the following credentials from the applicable state of Ohio board:

(1) Licensed physician.

(2) Registered nurse.

(N) The program's opioid agonist medical services component shall be supervised by an individual who:

(1) Is a physician licensed by the state of Ohio medical board.

(2) Is identified as the "medical director" of the opioid agonist program as required by 42 C.F.R. 4096.

(O) A written, signed, and dated physician's order shall be required and a copy maintained in the client's record, for all opioid agonist medication administered or dispensed. The prescribing physician must be a staff member or contract employee of the opioid agonist program.

(P) Labels for dispensing opioid agonist medication shall be prepared in accordance with 21 C.F.R. 1306.14 and section 3719.08 of the Revised Code.

(Q) Opioid agonist client records shall be maintained for at least seven years from the last date of administering or dispensing a controlled substance.

(R) Each opioid agonist program shall have written policies and/or procedures that include, but are not limited to, the following:

(1) Admission criteria for adolescents and adults for opioid agonist maintenance and detoxification, including at a minimum:

(a) Determination by an individual qualified to diagnose per rule 3793:2-1-08 of the Administrative Code that the client is currently dependent on an opioid drug according to the current diagnostic and statistical manual for mental disorders.

(b) The client became dependent on an opioid drug at least one year before admission to the opioid program. This requirement may be waived by the medical director or other authorized program physician if the client has been released from a penal institution within the past six months, is pregnant (as verified by the medical director or other authorized program physician) or has been discharged from an opioid agonist program within the last two years.

(c) A client under eighteen years of age shall have two documented unsuccessful attempts at short-term detoxification or alcohol and other drug treatment within a twelve-month period and must have written consent for maintenance from a parent or legal guardian.

(2) Admission procedures for opioid agonist maintenance and detoxification.

(3) Procedures for providing counseling on preventing exposure to and the transmission of tuberculosis, hepatitis type B and C, and human immunodeficiency virus (HIV) disease for each client admitted or readmitted to maintenance or detoxification treatment.

(4) Procedures for the ordering, delivery, receipt and storage of opioid agonist medication.

(5) Policy and/or procedure for the security alarm system that includes, but is not limited to, the following:

(a) Provisions for testing the alarm system.

(b) Provisions for documenting the testing of the alarm system.

(6) Procedures for administering opioid agonist medication.

(7) Procedures for dispensing medication.

(8) Policy and/or procedure for the involuntary termination of opioid agonist clients.

(9) Policy and/or procedure for referring or providing prenatal services to pregnant opioid agonist clients.

(10) Policy and/or procedure for take-home doses of opioid agonist medication if dispensed.

(11) Policy and/or procedure for urinalysis for methadone clients.

(12) Policy and/or procedure for urinalysis for employees of the opioid agonist program.

(13) Policy and/or procedure for cleaning the opioid agonist medication areas.

(14) Policy and/or procedure for missed opioid agonist administration appointments

(15) Policy and/or procedure stating that opioid agonist medication shall not be provided to a client who is known to be currently receiving opioid agonist medication from another opioid agonist program with the exception of transient clients whose need for opioid agonist maintenance has been verified by the medical director or other authorized program physician of both the opioid agonist maintenance program where the client is currently enrolled and at the program where the client is requesting to receive services.

(S) Opioid agonist programs shall provide the following services in addition to those services required by an outpatient program in accordance with rule 3793:2-2-01 and /or a residential program in accordance with rule 3793:2-5-01 of the Administrative Code:

(1) Opioid agonist administration which meets the requirements of rule 3793:2-3-01 of the Administrative Code, opioid agonist administration.

(2) Urinalysis services which meet the requirements of rule 3793:2-3-01 of the Administrative Code, urinalysis services.

(3) Medical/somatic services.

(4) Vocational rehabilitation, education and employment services for clients who either request these services or who have been determined by the program staff to be in need of these services.

(T) All services shall be provided at the opioid agonist program site unless the program sponsor has entered into a written agreement with another entity to provide certain services (e.g., vocational, educational, etc.) for clients enrolled in the opioid agonist program. The program sponsor shall document that these services are fully and reasonably available to all clients.

(U) Each opioid agonist maintenance program shall, as part of its quality improvement plan, conduct ongoing assessment of client outcomes.

(V) Each opioid agonist maintenance program shall, as part of its quality improvement plan, have a diversion control plan that contains specific measures to reduce the possibility of diversion of controlled substances from legitimate treatment use and that assigns specific responsibility for implementing the plan to the medical and administrative staff of the program.

(W) Each opioid agonist program shall have a medical director whose responsibilities include, but are not limited to, the following:

(1) Ensuring that the opioid agonist program is in compliance with all federal, state and local laws and regulations regarding the medical treatment of opiate addiction.

(2) Ensuring that evidence of current physiologic dependence on an opiate, length of opiate dependence and exceptions to admission criteria are documented in the client's clinical record before the client receives the initial dose of opioid agonist medication.

(3) Ensuring that a medical history and a physical examination have been done before a client receives the initial dose of opioid agonist medication.

(4) Ensuring that appropriate laboratory studies have been performed and reviewed. The initial dose of opioid agonist medication may be administered before the results of the laboratory tests are reviewed.

(5) Ensuring all medical orders are signed as required by federal, state or local laws and regulations.

(6) Developing a policy and procedures for take-home doses of opioid agonist medication.

(7) Ensuring that justification for take-home doses is recorded in the client's clinical record.

(8) Ensuring individuals are appropriately admitted to the opioid agonist program.

(9) Ensuring all medical/somatic services are appropriately performed by the opioid agonist program.

(X) Each opioid agonist program shall have a program sponsor who is the person named in the application for certification described in 42 C.F.R. 4095 as responsible for the operation of the opioid agonist treatment program and who assumes responsibility for all its employees, including any practitioners, agents or other persons providing medical, rehabilitative or counseling services at the program. The program sponsor need not be a licensed physician but shall employ a licensed physician for the position of medical director.

(Y) Opioid agonist programs are prohibited from establishing medication units as described in 42 CFR Part 8 Subsection 8.11.

(Z) The requirements of this rule apply to short-term and long-term opiate detoxification.

(1) Short-term opiate detoxification shall not exceed thirty calendar days.

(2) Long-term opiate detoxification shall not exceed one hundred eighty calendar days.

(3) Take-home doses of opioid agonist medication shall not be permitted for clients who are on short-term opiatedetoxification.

(AA) Each opioid agonist program shall have written pharmacy procedures that include:

(1) Requirement that accurate records for opioid agonist medication administered and dispensed be traceable to specific clients and show the date, quantity and batch or lot number of the opioid agonist medication bottle used for preparing individual doses of opioid agonist medication. These records shall be maintained for at least seven years from the last date of administering or dispensing the methadone.

(2) Requirement that the opioid agonist program meet the security standards for the distribution and storage of controlled substances as required by the U.S. drug enforcement administration as outlined in 21 CFR 1301.72 through 21 CFR 1301.76.

(3) Requirement that opioid agonist medication be stored in accordance with 21 CFR 1301.72.

(a) Opioid agonist medicationshall be stored in a safe having the following specifications or the equivalent: thirty man-minutes against surreptitious entry, ten man-minutes against forced entry, twenty man-hours against lock manipulation and twenty man-minutes against radiological techniques.

(b) If the safe weighs less than seven hundred fifty pounds, it shall be bolted or cemented to the floor or to a wall in such a way that it cannot be readily removed.

(c) The safe shall be equipped with an alarm system which, upon attempted unauthorized entry, shall transmit a signal directly to a central protection company or a local or state police agency which has a legal duty to respond.

(d) The safe shall be housed in a room equipped with an alarm system which, upon attempted unauthorized entry, shall transmit a signal directly to a central protection agency or a local or state police agency which has a duty to respond.

(4) Requirement that the acceptance of delivery of opioid agonist medication shall only be made by a physician, pharmacist, registered nurse or licensed practical nurse who has proof of completion of a course in medication administration approved by the Ohio board of nursing and does so under the direction of a licensed physician.

(a) The person accepting delivery of opioid agonist medication must be an employee of the opioid agonist program.

(b) The opioid agonist program shall maintain a current list of those employees who are authorized to receive delivery of opioid agonist medication. The list shall indicate the name and license number of each person and be signed and dated by the medical director of the opioid agonist program.

(5) Requirement that the program shall not employ a physician or other employee who has access to controlled substance, including opioid agonist medications, who has had an application for registration with the U.S. drug enforcement administration denied or has had her/his registration revoked at any time.

(6) Requirement that the program notify the field division of the U. S. drug enforcement administration for its geographical area of any theft or significant loss of any controlled substance, including opioid agonist medication upon the discovery of the loss or theft.

(a) The program shall complete DEA form 106 regarding any loss or theft.

(b) The Ohio state board of pharmacy, in accordance with rule 4729-9-15 of the Administrative Code, the Ohio department of alcohol and drug addiction services and the local law enforcement authorities shall be immediately notified of any loss or theft.

(7) Statement that adequate precautions shall be taken to store medications under proper conditions of sanitation, temperature, light, moisture, ventilation, segregation and security.

(8) Requirement that clients be required to wait in an area physically separated from the opioid agonist storage and dispensing area.

(9) Requirement that opioid agonist storage and dispensing areas shall:

(a) Be located where personnel will not be unduly interrupted when handling drugs.

(b) Be maintained in a clean and orderly manner.

(c) Not be cleaned by a current client of the program.

(BB) Opioid agonist medication orders shall be written by a program physician who is licensed by the Ohio state medical board and registered with the U.S. drug enforcement administration to order opioid agonist treatment medications. The following procedures shall be followed in writing physician orders for opioid agonist medication.

(1) A physician's order for opioid agonist medication shall be valid for a maximum time period of ninety days.

(2) A physician's order for opioid agonist medication shall be reviewed at least every ninety days and adjusted, reordered or a notation made that opioid agonist medication is to be discontinued.

(CC) Opioid agonist programs shall be open at least six days per week every week, except that programs may close on state holidays indicated in paragraph (II) of this rule.

(DD) The take-home supply for clients enrolled in the opioid agonist program during the first ninety days of treatment is limited to a single dose each week. The client shall ingest all other doses under appropriate supervision in accordance with this rule. At the discretion of the medical director or other authorized program physician, a client may receive one additional take-home dose for those holidays listed in paragraph (II) of this rule if the opioid agonist program is closed in observance of the holiday.

(EE) Clients enrolled in the opioid agonist program in the second ninety days of treatment are eligible for consideration by the medical director or other authorized program physician for a maximum of two take-home doses per week including the holidays listed in paragraph (II) of this rule.

(FF) Clients enrolled in the opioid agonist program in the third ninety days of treatment are eligible for consideration by the medical director or other authorized program physician for a maximum of three take-home doses per week including the holidays listed in paragraph (II) of this rule.

(GG) Clients enrolled in the opioid agonist program in the remaining months of the first year of treatment are eligible for consideration by the medical director or other authorized program physician for a maximum of a six-day supply of take-home medication per week including the holidays listed in paragraph (II) of this rule.

(HH) Clients enrolled in the opioid agonist program after one year of continuous treatment are eligible for consideration by the medical director or other authorized program physician for a maximum two-week supply of take-home medication per week including the holidays listed in paragraph (II) of this rule.

(II) If the opioid agonist program is closed for any of the following state holidays, all clients may be given a one day take-home dose of opioid agonist at the discretion of the medical director.

(1) Thanksgiving day.

(2) Christmas day.

(3) New year's day.

(4) Martin Luther King day.

(5) Presidents' day

(6) Memorial day

(7) Fourth of July

(8) Labor day

(JJ) The program shall have written procedures for take-home opioid agonist doses that include:

(1) Statement that the opioid agonist program decisions on dispensing take-home doses of opioid agonist medication shall be determined by the medical director or other authorized program physician.

(2) Statement that a take-home dose of opioid agonist medication is an earned privilege and not a right.

(3) Requirement that take-home doses of opioid agonist medication shall be given only to an opioid agonist client, who, in the opinion of the medical director or other authorized program physician, is responsible in handling opiate drugs.

(4) Statement that before a medical director or other authorized program physician authorizes take-home doses of opioid agonist medication, the medical director or other authorized program physician shall record the rationale for this decision in the client's clinical record and consider, at a minimum, the following criteria:

(a) Absence of recent abuse of opioid or other drugs and alcohol.

(b) Regularity of clinic attendance for opioid agonist medication administration.

(c) Regularity of clinic attendance for counseling sessions.

(d) Absence of serious behavioral problems at the clinic.

(e) Absence of known recent criminal activity, for example, drug dealing.

(f) Stability of the client's home environment.

(g) Stability of the client's social relationships.

(h) Length of time in comprehensive maintenance treatment.

(i) Assurance that take-home doses of opioid agonist can be safely stored within the client's home.

(j) Determination if the rehabilitation benefit to the client by receiving a take-home dose of opioid agonist medication outweighs the potential risks of diversion.

(k) Employment status of client.

(5) Statement that physician orders for take-home opioid agonist medication shall expire every ninety days.

(6) Requirement that child-proof bottles and caps be used for take-home doses of opioid agonist medication.

(a) If a take-home bottle is returned by a client for refills, the opioid agonist program shall accept the bottle and dispose of it.

(b) Bottles used for take-home doses of opioid agonist medication shall only be used once.

(c) Under no circumstance is opioid agonist medication to be placed in a container provided by a client (including previous take-home bottle).

(7) Requirement that each take-home bottle of opioid agonist medication have a label that contains the following information:

(a) The opioid agonist program's name, address and telephone number.

(b) Name of client.

(c) Name of program physician prescribing the opioid agonist medication.

(d) The name of the opioid agonist medication.

(e) The dosing instructions and schedule.

(f) Date that the take-home opioid agonist dose was prepared.

(g) The label shall contain the following warning "Caution: Federal law prohibits the transfer of this drug to any person other than the client for whom it was prescribed."

(KK) Each opioid agonist program shall have written procedures for urinalysis that include, at a minimum:

(1) Requirement that an initial urinalysis be performed for each prospective opioid agonist client as part of the documented physical evaluation completed by a physician prior to admission. The results of all tests must be received within fourteen days following admission.

(2) Requirement that a urinalysis be performed monthly for each opioid agonist client.

(3) Requirement that programs shall have a standing physician's order for client urinalysis.

(4) Requirement that urinalysis be performed by a laboratory that is in compliance with all applicable federal proficiency testing and licensing standards.

(5) Requirement that urine specimens be collected in a manner to minimize falsification and that urine collection procedures include the following:

(a) A program employee shall monitor each specimen collected.

(b) Each urine specimen shall be labeled to reflect the identification of the person from whom it was obtained and reflect the date the specimen was obtained.

(6) Chain of custody for urine specimens.

(7) Requirements that each urinalysis include, at a minimum analysis for the following:

(a) Opiates.

(b) Methadone.

(c) Amphetamines.

(d) Cocaine.

(e) Barbiturates.

(f) Marijuana

(8) Results of urinalysis testing shall be reviewed by the program staff with the client with documentation of such and a copy of the results placed in the client's file.

(9) Provisions for ensuring that presumptive laboratory results are distinguished from definitive laboratory results.

(10) Provisions for discontinuing opioid agonist maintenance if a person continues to use alcohol and/or other drugs. The policy shall include provisions for continuing to provide counseling and other rehabilitation services if opioid agonist maintenance is discontinued.

(LL) Each opioid agonist program shall have written procedures for pregnant female clients that include at least the following:

(1) Requirement that each woman admitted to the opioid agonist program be informed of the possible risks to herself or to her unborn child from the use of opioid agonist medication.

(2) Statement that a pregnant woman, regardless of age, who has a documented past opioid dependency and who may be in direct jeopardy of returning to opioid dependency with all of its attendant dangers during pregnancy, may be placed on an opioid agonist regimen.

(a) Statement that for such pregnant women, evidence of current physiological dependence on opioid drugs is not needed if the medical director or other authorized program physician certifies the pregnancy, determines and documents that the woman may resort to the use of opioid drugs and determines that opioid agonist treatment is justified in her/his clinical opinion.

(b) Requirement that the admission of each pregnant woman to a an opioid agonist program be approved by the medical director or other authorized program physician prior to admitting the woman to the program.

(3) Procedures for prenatal care that include:

(a) Provisions for providing prenatal care by the program or by referral to an appropriate health care provider.

(b) Requirement that if a woman is referred to prenatal care outside the agency, the name, address and telephone number of the health care provider shall be recorded in the woman's clinical record.

(c) If prenatal care is provided by the opioid agonist program, the clinical record shall include documentation to reflect services provided

(d) Requirement that if a client is referred outside of the agency for prenatal services, the provider to whom she has been referred shall be notified that she is in methadone treatment; however, such notice shall only be given after the client has signed a release of information.

(4) Statement that if a client refuses prenatal service by the opioid agonist program and by an outside provider:

(a) The medical director or other authorized program physician shall note this in the clinical record.

(b) The client will be asked to sign a statement that says "I have been offered the opportunity for prenatal care by the opioid agonist program or by a referral to a prenatal clinic or by a referral to the physician of my choice. I refuse prenatal counseling by the opioid agonist program. I refuse to permit the opioid agonist program to refer me to a physician or prenatal clinic for prenatal services." If the client refuses to sign the statement, the medical director or other authorized program physician shall indicate in the signature block that "client refused to sign" and affix her/his signature and the date on the statement.

(MM) Each client file shall contain the following:

(1) Date of each visit that the client makes to the program.

(2) Date, time, name and amount of opioid agonist medication administered or dispensed with the original signature of the service provider.

(3) Medical history.

(4) Documentation of physical examination and results.

(5) Results of a serological test for syphilis.

(6) Results of tubercular skin test.

(7) Results of a urinalysis for drug determination at the time of admission and the results of each subsequent urinalysis.

(8) Documentation of any significant psychological or physical disability.

(9) An individualized treatment plan shall be written for each client within seven days of completion of the assessment or at the time of the first face-to-face contact following assessment. Programs shall have written policies and procedures that specify criteria and time frames for reviewing and updating an individualized treatment plan, which take into account the client's changing clinical needs and response to treatment. The treatment plan shall be reviewed and counter-signed by a program physician at least once a year.

(10) An account of the client's progress.

(11) Documentation of counseling on preventing exposure to tuberculosis, hepatitis type B and C, and the transmission of human immunodeficiency virus (HIV) disease.

(12) Documentation of provision of the following either directly or through referral to adequate and reasonably accessible community resources:

(a) Vocational rehabilitation services.

(b) Employment services.

(c) Education services.

(13) Documentation to reflect that the program has attempted to determine whether or not the client is enrolled in any other opioid agonist maintenance program.

(14) Documentation to reflect verification by the medical director or other authorized program physician of the need for opioid agonist medication for transient clients.

(15) Information required by rule 3793:2-1-06 of the Administrative Code, client records.

(NN) Programs licensed as opioid agonist program by the department at the time of the effective date of this rule shall remain licensed until the expiration of its current licensure. If it wants to continue to operate as a licensed opioid agonist program, then it is required to apply to the department for licensure in accordance with this rule and rule 3793:2-1-01 of the Administrative Code, program certification process.

Transferred from 3793:2-3-01 on 5/3/2016

R.C. 119.032 review dates: 08/31/2010 and 07/15/2015
Promulgated Under: 119.03
Statutory Authority: 3793.11 ; 3793.02(D) ; 3793.06
Rule Amplifies: 3793.06 ; 3793.11
Prior Effective Dates: 7/1/01, 10/1/03

5122-29-36 Residential treatment program certification.

(A) The purpose of this rule is to state the minimum requirements for a program to be certified by the Ohio department of alcohol and drug addiction services as an alcohol and drug addiction services residential treatment program.

(B) The provisions of this rule are applicable to all alcohol and drug addiction residential and halfway house treatment programs in Ohio subject to program certification in accordance with division (A) of section 3793.06 of the Revised Code, public or private, regardless of whether they receive any public funds that originate and/or pass through the Ohio department of alcohol and drug addiction services.

(C) Each residential treatment program certified by the Ohio department of alcohol and drug addiction services shall provide:

(1) Structured alcohol/drug addiction services and activities for at least thirty hours for adults and twenty hours for adolescents per seven-day week. These services and activities shall be provided at the certified residential treatment program site.

(2) Individual and/or group counseling services shall be provided at a certified program site of the agency at least five days per week.

(3) Housing for clients, twenty-four hours per day, seven days per week and food for clients, to include at least three nutritionally-balanced meals per day, seven days per week.

(4) The opportunity for clients to get eight hours of sleep per night.

(5) A staff member who is at the program site to actively supervise and monitor clients twenty-four hours per day, seven days per week.

(D) Each halfway house treatment program certified by the department shall provide:

(1) Structured alcohol/drug addiction services and activities for at least ten hours per seven-day week. All structured alcohol and drug services and activities shall occur at the certified halfway house treatment program site.

(2) Individual and/or group counseling services shall be provided at a certified program site of the agency at least two days per week.

(3) Housing for clients twenty-four hours per day, seven days per week and food for clients, to include at least three nutritionally-balanced meals per day, seven days per week.

(4) The opportunity for clients to get eight hours of sleep per night.

(5) A staff member who is at the program site to monitor clients twenty-four hours per day, seven days per week.

(E) Time for meals, unstructured activities, "free time," time spent in attendance of self help groups, such as alcoholics anonymous or narcotics anonymous, is not included in the minimum hours of services and activities for a residential or halfway house treatment program.

(F) Interpersonal and group living skills shall be promoted in residential and halfway house treatment programs. Clients shall be transitioned to the general community for education, job training, job interviews, employment stabilization and obtaining alternative living arrangements.

(1) A program may require clients to perform tasks of a housekeeping nature without compensation as specified within program guidelines.

(2) Housekeeping tasks shall not be considered as meeting the alcohol/drug addiction services and activities requirement.

(G) Each residential and halfway house treatment program shall be organized and clinically managed to provide non-medical community residential level of care. Non-medical community residential treatment means a twenty-four hour rehabilitation facility without twenty-four hour-per-day medical/nursing monitoring. It is a planned program of professionally-directed evaluation, care and treatment for the restoration of functioning for persons with alcohol and other drug problems and/or addiction.

(1) Residential treatment services shall be provided in a residential program certified by the Ohio department of alcohol and drug addiction services.

(H) A residential or halfway house treatment program that has twenty-four hours per day nursing and medical staff may provide one or more of the following levels of care:

(1) Medical community residential.

(2) Twenty-three hour observation bed.

(3) Sub-acute detoxification.

(I) A residential and halfway house treatment program may provide ambulatory detoxification services that are supervised by a physician. Department certified halfway house and residential treatment programs that want to provide ambulatory detoxification services need not obtain outpatient certification from the department.

(J) Each residential and halfway house treatment program shall provide, at a minimum, the following alcohol and drug addiction services at the program site in accordance with rule 3793:2-1-08 of the Administrative Code:

(1) Assessment services,

(2) Individual and group counseling services,

(3) Crisis intervention services, and

(4) Case management.

(K) A medical history, including food allergies and drug reactions, shall be completed on or before admission to a residential or halfway house treatment program.

(1) Physical examinations shall be obtained within twenty-one calendar days of admission by a physician, clinical nurse specialist or certified nurse practitioner.

(2) A physician, clinical nurse specialist or certified nurse practitioner may accept a physical examination that has been done ninety days or less before the admission date of a client; however, a copy of the physical examination must be filed in the client's record and the individual accepting the physical exam must date and sign the physical examination.

(3) Each program shall refer a client for tuberculosis screening when indicated.

(4) Each program shall refer a client for hepatitis screening when indicated.

(5) Programs shall ascertain if pregnant clients are receiving prenatal care and document who is providing prenatal care.

(a) If a client is not receiving prenatal care, a program is required to offer assistance in obtaining prenatal care.

(b) If a client refuses to obtain prenatal care, the program shall document in her clinical record that she was offered assistance to obtain prenatal care.

(L) Each adult residential and halfway house treatment program shall provide adequate space for the comfort and security of its clients in accordance with local occupancy rules and regulations.

(M) Each residential and halfway house treatment program that serves children shall provide adequate space for the comfort and security of its clients in accordance with local occupancy rules and regulations.

Transferred from 3793:2-5-01 on 5/3/2016

Effective: 02/14/2011
R.C. 119.032 review dates: 11/10/2010 and 07/15/2015
Promulgated Under: 119.03
Statutory Authority: 3793.02(D), 3793.06
Rule Amplifies: 3793.06
Prior Effective Dates: 7/10/92, 7/1/01, 6/13/04, 11/17/05

5122-29-37 Detoxification program certification.

(A) The purpose of this rule is to state the minimum requirements for a program to be certified by the Ohio department of alcohol and drug addiction services as a detoxification program.

(B) The provisions of the rule are applicable to all programs that provided sub-acute detoxification and/or acute hospital detoxification services in Ohio subject to program certification in accordance with division (A) of section 3793.06 of the Revised Code, public and private, regardless of whether they receive any public funds that originate and/or pass through the Ohio department of alcohol and drug addiction services.

(C) Deemed status shall be granted to waive sections of the administrative code if the sub-acute detoxification and/or acute hospital detoxification program has achieved national accreditation from joint commission on accreditation of healthcare organizations, american osteopathic association or commission on accreditation of rehabilitation facilities. Deemed provisions include paragraphs (E), (F), (H), (I), (J), (M), (N), (O), (P), (Q), (R), (S), (T), (U), (V), (W), (X), (Y), (Z) and (AA) of this rule.

(D) A facility that operates an alcohol and drug addiction hospital detoxification program shall be registered as a hospital with the Ohio department of health in accordance with section 3701.07 of the Revised Code and be accredited by one or more of the following:

(1) Joint committee on accreditation of healthcare organizations

(2) American osteopathic association

(3) Commission on accreditation of rehabilitation facilities

(E) Each program requesting detoxification certification by the Ohio department of alcohol and drug addiction services shall have one or more beds designated for the purpose of alcohol and other drug detoxification.

(F) Each hospital detoxification program certified by the Ohio department of alcohol and drug addiction services shall provide an "acute hospital detoxification" level of care. Acute hospital detoxification services are delivered based on treatment protocols for detoxification in a hospital setting and are delivered by medical and nursing professionals who provide twenty-four-hour medically-directed assessment and withdrawal management. Acute hospital detoxification services are indicated for individuals whose intoxication/withdrawal signs and symptoms are sufficiently severe to require primary medical and nursing care service and medical management. Acute hospital detoxification services are to be delivered under a defined set of physician-approved policies and physician-managed procedures and medical protocols.

(G) An acute hospital detoxification program certified by the Ohio department of alcohol and drug addiction services may also provide one or more of the following:

(1) Twenty-three-hour observation bed

(2) Sub-acute detoxification

(H) Sub-acute detoxification refers to detoxification services provided with twenty-four-hour medical monitoring. Services are of brief duration and linkage to other formal and informal services shall be made. Sub-acute detoxification may be provided in a hospital setting as a step-down service from acute detoxification, or may be provided in a free-standing setting with medical monitoring. This service shall be supervised, under a defined set of policies and procedures, by a physician who is licensed by the state of Ohio medical board.

(I) Detoxification services shall be provided by individuals who have one or more of the following credentials and have documented experience and/or education in substance use disorder treatment:

(1) Physician who is licensed by the state of Ohio medical board.

(2) Registered nurse licensed by the Ohio board of nursing in accordance with Chapter 4723. of the Revised Code.

(3) Licensed practical nurse licensed by the Ohio board of nursing in accordance with Chapter 4723. of the Revised Code.

(J) Providers of detoxification services shall be supervised by individuals who have one or more of the following credentials and have documented experience and/or education in substance use disorder treatment:

(1) Physician who is licensed by the state of Ohio medical board.

(2) Nurse registered with the Ohio board of nursing.

(K) If a detoxification program provides ambulatory detoxification, the program shall provide the outpatient, halfway house or residential level of care and shall also apply to the Ohio department of alcohol and drug addiction services for certification as an outpatient or residential program in accordance with rule 3793:2-2-01 of the Administrative Code.

(L) If a detoxification program provides residential treatment, the program shall also apply to the Ohio department of alcohol and drug addiction services for certification as a residential program in accordance with rule 3793:2-5-01 of the Administrative Code.

(M) Each detoxification program certified by the Ohio department of alcohol and drug addiction services is required to have an affiliation agreement with at least one alcohol and drug addiction services treatment program certified by the Ohio department of alcohol and drug addiction services for the purpose of referral to less intensive levels of care. Each program shall have written policies and procedures to ensure its referral process is appropriately implemented and managed and shall include, at a minimum, the following:

(1) Referral decisions made to the appropriate level of care based on the Ohio department of alcohol and drug addiction services' protocols for levels of care (youth and adult) for publicly-funded clients. For non-publicly funded clients the referral decision made to the appropriate level of care shall be based on the Ohio department of alcohol and drug addiction services' protocols or other objective placement criteria. Documentation of referral shall appear in the client record.

(2) Discharge plan stipulating specific recommendations and referrals for alcohol and drug addiction treatment. The discharge plan shall be documented in the client record.

(3) Telephone contact with client and program to which client is referred to follow up on the referral. These contacts shall be documented in the client's record.

(N) Each detoxification program certified by the Ohio department of alcohol and drug addiction services shall:

(1) Participate in the reporting requirements of the department.

(2) Operate in accordance with 42 C.F.R. part 2, confidentiality of alcohol and drug abuse client records.

(3) Have written policies and/or procedures for maintaining a uniform client records system that include, at a minimum, the following:

(a) Program staff shall not convey to a person outside of the program that a client attends or receives services from the program or disclose any information identifying a client as an alcohol or other drug services client unless the client consents in writing for the release of information, the disclosure is allowed by a court order, or the disclosure is made to a qualified personnel for a medical emergency, research, audit or program evaluation purposes.

(b) Federal laws and regulations do not protect any threat to commit a crime, any information about a crime committed by a client either at the program or against any person who works for the program.

(c) Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities.

(4) Access to client records:

(a) By clients.

(b) By staff.

(c) By individuals other than clients or staff.

(5) Release of client information.

(6) Components of client records and time lines, when applicable, for completing each component.

(7) Storage of client records that requires client records be maintained in accordance with 42 C.F.R. part 2, confidentiality of alcohol and drug abuse client records.

(8) Destruction of client records to include the requirement that records be maintained for at least seven years after clients have been discharged from the program. Client records shall be destroyed to maintain client confidentiality as required by state and federal law.

(O) Detoxification programs shall maintain documentation for services provided. All documentation completed by registered candidates and student interns shall be countersigned by an individual qualified to supervise detoxification services pursuant to this rule.

(P) Components of client records shall include, at a minimum, the following:

(1) Identification of client (name and/or client identification number).

(2) Assessment.

(3) Consent for alcohol and other drug treatment services.

(4) Client fee agreement, if applicable.

(5) Documentation to reflect that the client was given a copy of the following:

(a) Program rules or expectations of clients.

(b) Client rights and grievance procedures.

(c) Written summary of the federal laws and regulations that indicate the confidentiality of client records are protected as required by 42 C.F.R. part B, paragraph 2.22.

(6) Diagnosis.

(7) Treatment plans.

(8) Progress notes.

(9) Disclosure of client information forms, when applicable.

(10) Termination summary/discharge plan including referral information.

(Q) Disclosure of client information forms shall include the following information as required by 42 C.F.R., part 2:

(1) Name of the program making the disclosure.

(2) Name or title of the individual or the name of the organization to which the disclosure is to be made.

(3) Name of client.

(4) Purpose of the disclosure.

(5) Type and amount of information to be disclosed.

(6) Original signature of the client or person authorized to give consent.

(7) Date client or other authorized person signed the form.

(8) Statement that the consent is subject to revocation at any time except to the extent the program or person who is to make the disclosure has already acted in reliance on it.

(9) The date, event or condition upon which the consent will expire, unless revoked before that specified time.

(R) Each disclosure made with the client's written consent must be consistent with 42 C.F.R., part 2, by including the following written statement: "This information has been disclosed to you from records protected by federal confidentiality rules. The federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 C.F.R., part 2. A general authorization for the release of medical or other information is not sufficient for this purpose. The federal rules restrict any use of information to criminally investigate or prosecute any alcohol or drug abuse client."

(S) A diagnosis shall be made by a clinician who can independently diagnose substance-related disorders as authorized by the Ohio Revised Code, and shall be recorded in each client's record upon completion of assessment. Supporting documentation in the client record shall include:

(1) Identification of the client.

(2) Diagnosis and DSM code number.

(3) Signs and symptoms justifying the diagnosis.

(4) Date the diagnosis was made.

(5) Original signature and credentials of the clinician making the diagnosis.

(T) An individualized treatment plan shall be written for each client within twenty-four hours of completion of the assessment. Individualized treatment plans shall be based on assessment and include, at a minimum, the following:

(1) Client identification (name and/or identification number).

(2) Level of care to which client is admitted.

(3) Problem(s) to be addressed.

(4) Measurable goals that address client's needs.

(5) Measurable treatment objectives with time frame for achievement of each objective.

(6) Frequency, duration and types of treatment services.

(7) Original signature of the client.

(8) Date, original signature and credentials of the person who completed the plan and is qualified to provide alcohol and drug addiction services.

(U) Detoxification programs shall have written policies and procedures that specify criteria and time frames for reviewing and updating an individualized treatment plan, which take into account the client's changing clinical needs and response to treatment.

(V) Progress notes shall be written to reflect the implementation and evaluation of treatment plans for clients admitted to detoxification programs. Progress notes are required to include sufficient content to justify the client's continuing need for services. Each service delivered to the client shall be documented in the client's record with a progress note.

(1) Progress notes shall indicate progress the client is making towards achieving the goals and objectives that are identified in the individualized treatment plan.

(2) Progress notes shall indicate the outcomes of treatment interventions which are stated in the client's individualized treatment plan.

(W) Progress notes shall include, at a minimum, the following:

(1) Client identification (name and/or identification number).

(2) Date of service contact or service delivery.

(3) Length of time of service contact or service delivery (calculated by the number of hours, minutes and/or start and ending time of service delivery).

(4) Type of service (for example, case management, individual counseling, group counseling, etc.).

(5) Summary of what occurred during the service contact or service delivery.

(6) Date, original signature and credentials (registration, certification and/or license) of the staff member providing the service.

(X) The following modalities and/or activities shall be documented in each client's record: occupational therapy, recreation therapy, activity therapies, parenting skills training, alcoholism and drug addiction client education, expressive therapies (art, drama, poetry, music, movement) and nutrition counseling. A progress note is not required for each of these modalities and/or activities delivered to a client; however, documentation verifying the client's participation is necessary.

(Y) A termination summary shall be prepared within thirty calendar days after treatment has been terminated. Termination summaries/discharge summaries shall include, at a minimum, the following:

(1) Client identification (name and/or identification number).

(2) Date of admission.

(3) Date of discharge.

(4) Diagnosis.

(5) The degree of severity at admission and at discharge for the following dimensions shall be based on the ODADAS protocols for levels of care (youth and adult) for publicly-funded clients. For non-publicly-funded clients, the degree of severity at admission and discharge shall be based on the Ohio department of alcohol and drug addiction services' protocols for levels of care or other objective placement criteria:

(a) Intoxication and withdrawal.

(b) Biomedical conditions and complications.

(c) Emotional/behavioral/cognitive conditions and complications.

(d) Treatment acceptance/resistance.

(e) Relapse potential.

(f) Recovery environment.

(g) Family or care giver functioning (for youth).

(6) Level of care and service(s) provided during course of treatment.

(7) Client's response to treatment.

(8) Recommendations and/or referrals for additional alcohol and drug addiction treatment or other services.

(9) Date, original signature and credentials of a person qualified to provide counseling services.

(Z) If a detoxification program maintains electronic client records, the program must be able to produce hard copies of client records upon legally valid requests and have a written policy and procedure indicating how client original signatures and staff original signatures are obtained and verified for documentation.

(AA) If a detoxification program discontinues operations or is taken over or acquired by another entity, it shall comply with 42 C.F.R., part 2, subsection 2.19 which governs the disposition of records by discontinued programs.

(BB) Each detoxification program shall comply with all applicable federal, state and local laws and regulations in addition to the requirements of agency-level 3793 of the Administrative Code.

(CC) Detoxification programs certified by the Ohio department of alcohol and drug addiction services at the time of the effective date of this rule shall remain certified until the expiration of their current certification, unless the certification were to be revoked or terminated by the Ohio department of alcohol and drug addiction services. If a program desires to continue to operate a detoxification program, the program shall apply to the Ohio department of alcohol and drug addiction services for detoxification program certification in accordance with this rule.

Transferred from 3793:2-6-01 on 5/3/2016

Effective: 02/14/2011
R.C. 119.032 review dates: 11/10/2010 and 07/15/2015
Promulgated Under: 119.03
Statutory Authority: 3793.02(D), 3793.06
Rule Amplifies: 3793.06
Prior Effective Dates: 7/10/92, 7/1/01, 11/17/05, 7/1/06