INCIDENTAL MEDICAL SERVICES AUGUST 21, 2018 SUMMARY OF DHCS AUTHORITY DHCS has the sole authority to license 24-hour residential adult alcoholism or drug abuse recovery or treatment facilities. DHCS oversight activities include: Initial Licensure and Initial Certification Onsite Compliance Reviews (i.e., Initial, Biennial, Relocations, Capacity Increase/Decrease, Adding Treatment Services, Complaint Investigations and Follow-Up Visits) TOTAL TREATMENT FACILITIES: 1,931 (as of June 30, 2018) Total Facilities 900 430 601 LICENSED RESIDENTIAL FACILITIES LICENSED AND CERTIFIED RESIDENTIAL FACILITIES CERTIFIED NON-RESIDENTIAL PROGRAMS 1
TOTAL RESIDENTIAL TREATMENT CAPACITY: 19,066 (as of June 30, 2018) Total Beds 5484 7582 3533 2467 6 OR FEWER BEDS (601 FACILITIES) 7 TO 20 BEDS (180 FACILITIES) 21 TO 50 BEDS (167 FACILITIES) OVER 50 BEDS (83 FACILITIES) REVISED AOD STANDARDS The AOD Standards were revised and became effective on May 1, 2017. All certified programs must be in compliance with the revised standards The AOD Standards and Information Notice 17-017 are available on DHCS website: http://www.dhcs.ca.gov/documents/dhcs_aod_certification_ Standards_1.pdf http://www.dhcs.ca.gov/provgovpart/pages/licensing_and_cer tification_resources.aspx REVISED AOD STANDARDS As a reminder, at least 120 days prior to the expiration of the certification, the program is required to submit: Request for License and/or Certification Extension, DHCS Form 5999 All required supporting documentation Renewal fees IMPORTANT! If the above documents and fees are not received 120 days prior to expiration, the certification will expire on the expiration date and an initial application and initial fees will have to be submitted. 2
INCIDENTAL MEDICAL SERVICES (IMS) INFORMATION NOTICE IMS Information Notice 18-031 Supersedes Information Notice 16-039 Released on July 20, 2018 IMS Guidelines document no longer available Provides guidance to applicants and licensed alcoholism or drug abuse recovery or treatment facilities seeking approval from DHCS to provide IMS DEFINITIONS Assessment means an in-depth review of a resident in order to determine the appropriate level of care and resident s strengths and needs including, but not limited to, alcohol and/or other drug use, physical and mental health, employment, legal, social, family, environment and ancillary needs. Health Care Practitioner (HCP) means a person duly licensed and regulated under Division 2 (commencing with Section 500) of the Business and Professions Code, who is acting within the scope of their license or certificate. DEFINITIONS Incidental Medical Services (IMS) means optional services provided at a facility by a health care practitioner, or staff under the supervision of a health care practitioner, to address medical issues associated with detoxification, treatment, or recovery services. Must be provided at the facility in compliance with the community standard of practice. It does not include general primary care or medical services required to be performed in a licensed health care facility as defined by Health and Safety Code Section 1200 or 1250. 3
DEFINITIONS Medication Assisted Treatment (MAT) means the use of any drug approved by the United States Food and Drug Administration (FDA) for the treatment of substance use disorders prescribed to assist an individual in detoxification services, treatment services, or recovery services. IMS REQUIREMENTS Upon approval by DHCS, the following IMS must be provided: Obtaining medical histories Monitoring health status Testing associated with detoxification from alcohol or drugs Providing alcoholism or drug abuse recovery or treatment services Overseeing patient self-administered medications Treating substance abuse disorders, including detoxification. APPLICATION PROCESS Initial Applicants: Initial Treatment Provider Application (DHCS 6002) Fees Supporting Documentation DHCS Licensed Residential Facility: Supplemental Application (DHCS 5255) Fees Supporting Documentation 4
APPROVAL TO PROVIDE IMS IMS may only be provided following approval from DHCS IMS is an additional service available to all residents Any change to the licensed residential facility s HCP requires a written notice to DHCS. DHCS shall notify a licensee if a proposed change of HCP staffing is denied. DHCS decision shall be deemed final COMPLIANCE DHCS may suspend or revoke a licensed residential facility for violations of Chapter 7.5 of the Health and Safety Code and regulations adopted pursuant to that chapter. Licensed residential facilities that provide IMS without prior approval from DHCS shall be cited and subject to disciplinary action, including but not limited to license suspension and/or revocation. REQUIRED DOCUMENTS & FEES Initial Treatment Provider Application (DHCS 6002) or Supplemental Application (DHCS 5255) Fee (MHSUD Information Notice No: 14-022) Fire clearance form STD 850 (if applicable) Floor plan Facility Staffing Data (DHCS 5050), including all facility staff who provide or oversee IMS Job description for each staff position at the facility 5
REQUIRED DOCUMENTS & FEES Health Care Practitioner (HCP) Incidental Medical Services Acknowledgement (DHCS 5256) for all HCP s who provide or oversee IMS Copy of all HCP s valid license to practice in California and proof of addiction medicine training Organizational Chart, including all facility staff Services and Activities written description, including IMS Program description, including IMS REQUIRED DOCUMENTS & FEES Admission, Readmission, and Intake Criteria, including IMS Admission Agreement, including IMS Detoxification Services Policies and procedures, including IMS Medication Policy Policy, procedures, and tasks for all forms of prescribed and over-the-counter medications Incidental Medical Services (IMS) - Policies, procedures, and tasks for IMS IMS POLICIES AND PROCEDURES Initial applicants and currently licensed facilities seeking to provide IMS must submit: IMS Policies Description of IMS medications and storage Written statement verifying IMS room meets minimum requirements Policies and Procedures that address: Biofluids Referrals 6
IMS POLICIES AND PROCEDURES Modifications to previously approved policies/ procedures, shall be reported to DHCS through submission of the revised policies and procedures within 30 calendar days after the date such change becomes effective Within 45 working days of receipt to amend the policies and procedures, DHCS shall notify the licensee if the change was approved Failure of licensee to provide the missing information within 30 calendar days shall result in denial of the request OBTAINING MEDICAL HISTORIES Describe in detail and provide a policy and procedure for: Conducting resident screening and assessment Reviewing the Client Health Care Questionnaire and Initial Screening Questions form (DHCS 5103) Ensuring DHCS 5103 and the Incidental Medical Services Certification Form (DHCS 4026) are complete, current, signed, dated, and maintained in the resident s file MONITORING HEALTH STATUS Process for determining health status of a resident throughout treatment Specify all types of health assessments to be conducted Process for administering and reviewing health assessments Documentation of monitoring and assessments must be complete, signed, dated, and maintained in a resident s file 7
TESTING ASSOCIATED WITH DETOXIFICATION Specify all types of tests that will be used Process for administering and reviewing all tests associated with detoxification Process for assessing a resident s health status during detoxification Tests and results must be complete, current, signed, dated, and maintained in a resident s file PROVIDING ALCOHOLISM OR DRUG ABUSE RECOVERY OR TREATMENT SERVICES Process for monitoring the stabilization of residents through the provision of ongoing treatment Specify all types of tests that will be used Process for administering all tests Tests and results must be complete, current, signed, dated, and maintained in the resident s file OVERSEEING PATIENT SELF-ADMINISTERED MEDICATIONS Process for determining which approved medications will be used for a resident s detoxification, withdrawal, and management Process for storing medications Process for overseeing self-administration of medications Process for documenting all medications including sample medications Process for destroying medications 8
OVERSEEING PATIENT SELF-ADMINISTERED MEDICATIONS, CON T Plan when a resident refuses to take medications Process for documenting and returning medications to a resident upon discharge, including a policy for returning narcotics and/or medications for the treatment of addiction Process for the documentation of medications in a resident s file TREATING SUBSTANCE ABUSE DISORDERS, INCLUDING DETOXIFICATION Method for coordinating care for any complex conditions, which may impact a resident s success in treatment Specify approved medication for medication assisted treatment (MAT) to be used at the facility HCP must assess a resident prior to the initiation of MAT Method for storing scheduled narcotics TREATING SUBSTANCE ABUSE DISORDERS, INCLUDING DETOXIFICATION, CON T Method for administering, storing, and disposing injectable or implantable subdermal MAT medication Method for coordinating care with Narcotic Treatment Programs for any resident receiving methadone Staff training on the use, storage, and disposal of MAT medications 9
RESOURCES Chapter 744, Assembly Bill 848: http://leginfo.legislature.ca.gov/faces/billnavclient.xht ml?bill_id=201520160ab848 Information regarding IMS on the DHCS website: http://www.dhcs.ca.gov/provgovpart/pages/incidental- Medical-Services.aspx RESOURCES Information regarding MAT on the Substance Abuse and Mental Health Services Administration and DHCS website: https://www.samhsa.gov/medication-assistedtreatment/treatment QUESTIONS? Nadalie Meadows-Martin, Section Chief Nadalie.Meadows-Martin@dhcs.ca.gov Pelumi Abimbola, Section Chief Pelumi.Abimbola@dhcs.ca.gov Licensing and Certification Section 916-322-2911 10