eLaws | eCases | State of Alaska | Counties & Cities of Alaska |
 Alaska Administrative Code (Last Updated: January 12, 2017)
 Title 7. Health and Social Services.
 Part 7.1. Administration.
 Chapter 7.70. Behavioral Health Services.
 Article 7.70.2. Behavioral Health Services Provider Qualifications.

  Section 7.70.110. Additional requirements for providing alcohol and drug detoxification services.  

Latest version. 
  • 	(a)  The department will approve a community behavioral health services provider that meets the requirements of this section to provide one or more of the following alcohol and drug detoxification services:  
		(1) ambulatory detoxification with extended on-site monitoring;  
		(2) clinically managed residential detoxification;  
		(3) medically monitored residential detoxification.  
	(b)  Ambulatory detoxification with extended on-site monitoring must  
		(1) be delivered as an outpatient service on the premises of the community behavioral health services provider;  
		(2) include 24-hour access to medical consultation and emergency medical care in a general acute care hospital;  
		(3) include periodic evaluation of the recipient's condition and treatment to confirm that ambulatory detoxification with extended on-site monitoring continues to be safe for the recipient;  
		(4) be provided directly to a recipient by an individual with an active license under AS 08  to practice as  
			(A) a physician;  
			(B) a physician assistant;  
			(C) an advanced nurse practitioner;  
			(D) a registered nurse supervised by a physician or advanced nurse practitioner; or  
			(E) a licensed practical nurse supervised by a physician or advanced nurse practitioner;  
		(5) include, at admission and during the course of active treatment as needed,  
			(A) a substance use intake assessment conducted in accordance with 7 AAC 135.110(c);  
			(B) a medical evaluation; of the individuals listed in (4) of this subsection, only a physician, physician assistant, or advanced nurse practitioner may provide a medical evaluation;  
			(C) monitoring, assessment, and management of intoxication; and  
			(D) evaluating a recipient's withdrawal by applying the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) or Clinical Opiate Withdrawal Scale (COWS), adopted by reference in 7 AAC 70.910; and  
		(6) include at least three of the component services listed in (e) of this section.  
	(c)  Clinically managed residential detoxification must  
		(1) be delivered as a residential service on the premises of the community behavioral health services provider;  
		(2) include 24-hour access to medical consultation and care;  
		(3) be provided directly to a recipient by  
			(A) a substance use disorder counselor;  
			(B) a behavioral health clinical associate;  
			(C) a mental health professional clinician; or  
			(D) an individual with an active license under AS 08  to practice as  
				(i) a physician;  
				(ii) a physician assistant;  
				(iii) an advanced nurse practitioner;  
				(iv) a registered nurse supervised by a physician or advanced nurse practitioner; or  
				(v) a licensed practical nurse supervised by a physician or advanced nurse practitioner;  
		(4) include at least three of the component services listed in (e) of this section; if the component services include medication administration services, and of the individuals listed in (3) of this subsection, only a physician, a physician assistant, an advanced nurse practitioner, a registered nurse supervised by a physician or advanced nurse practitioner, or a licensed practical nurse supervised by a physician or advanced nurse practitioner may provide medication administration services;  
		(5) include a substance use intake assessment, at admission and during the course of active treatment as needed, and conducted in accordance with 7 AAC 135.110(c); and  
		(6) include a medical evaluation; of the individuals listed in (3) of this subsection, only a physician, physician assistant, or advanced nurse practitioner may provide a medical evaluation.  
	(d)  Medically monitored residential detoxification must  
		(1) be delivered as a residential service on the premises of the community behavioral health services provider;  
		(2) include medical consultation available daily by telephone 24 hours per day;  
		(3) be provided directly to a recipient by an individual with an active license under AS 08  to practice as  
			(A) a physician;  
			(B) a physician assistant;  
			(C) an advanced nurse practitioner;  
			(D) a registered nurse supervised by a physician or advanced nurse practitioner; or  
			(E) a licensed practical nurse supervised by a physician or advanced nurse practitioner;  
		(4) include, no later than 24 hours after admission, and during the course of active treatment as needed, a medical evaluation; of the individuals listed in (3) of this subsection, only a physician, physician assistant, or advanced nurse practitioner may provide a medical evaluation; if methadone is used in treatment, a physician must perform a reevaluation no later than 24 hours after admission;  
		(5) include daily monitoring of each recipient on the premises; of the individuals listed in (3) of this subsection, only a physician, physician assistant, or advanced nurse practitioner may perform that daily monitoring;  
		(6) include, if medically necessary and clinically appropriate, hourly monitoring 24 hours per day of a recipient's medication administration and progress;  
		(7) include, at admission and during the course of active treatment as needed,  
			(A) a substance use intake assessment conducted in accordance with 7 AAC 135.110(c);  
			(B) the following services performed by a nurse:  
				(i) monitoring, assessment, and management of intoxication;  
				(ii) evaluation of a recipient's withdrawal by applying the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) or Clinical Opiate Withdrawal Scale (COWS), adopted by reference in 7 AAC 70.910; and  
			(C) medically supervised evaluation and consultation available 24 hours per day; and  
		(8) include at least three of the component services listed in (e) of this section.  
	(e)  Ambulatory detoxification with extended on-site monitoring, clinically managed residential detoxification, and medically monitored residential detoxification must include at least three of the following component services:  
		(1) medication administration services;  
		(2) referrals to other behavioral, medical, social, or educational agencies, as needed;  
		(3) discharge or transfer planning;  
		(4) evaluation and treatment of symptoms of intoxication and withdrawal;  
		(5) comprehensive community support services;  
		(6) crisis or relapse prevention planning;  
		(7) individual daily assessment;  
		(8) case management;  
		(9) management of a recipient's chronic disease, if medically necessary and clinically appropriate;  
		(10) urinalysis and breathalyzer testing, when specifically related to detoxification;  
		(11) development of coping skills in the recovery environment.  
	(f)  Each employee of a community behavioral health services provider who provides detoxification services directly to a recipient must  
		(1) be currently certified by the American Red Cross, or other certifying organization, in  
			(A) cardiopulmonary resuscitation;  
			(B) basic first aid; and  
			(C) blood-borne and airborne pathogens;  
		(2) work within the scope of that employee's education, training, license, credentials, and experience;  
		(3) work under the supervision of a physician, a physician assistant, or an advanced nurse practitioner, if the employee is not a physician, a physician assistant, or an advanced nurse practitioner;  
		(4) be capable of  
			(A) implementing  
				(i) physician-approved protocols for observation and supervision; and  
				(ii) protocols for medical intervention and crisis management developed by the provider under (g) of this section;  
			(B) assisting in the determination of an appropriate level of care and in transitioning the recipient to that level of care;  
			(C) monitoring, identifying, treating, or assisting with the treatment of symptoms of intoxication or withdrawal from alcohol or drugs using the materials listed in (h) of this section;  
			(D) following provider protocol on when to seek medical care for any symptom or treatment need of a recipient;  
			(E) observing a recipient self-administer medication and verifying that self-administration was done in accordance with the physician's prescription and all other laws, policies, and procedures; and  
			(F) monitoring a recipient's stabilized behavioral health problems and recognizing instability in a recipient with co-occurring disorders.  
	(g)  To be approved to provide any service under this section, a community behavioral health services provider must establish a  
		(1) protocol for determining when and what kind of medical intervention may be needed, including  
			(A) nursing or physician care;  
			(B) emergency procedures; and  
			(C) transferring a recipient to a higher level of care; and  
		(2) crisis management protocol and train staff in using that protocol.  
	(h)  All detoxification services must be medically necessary and clinically appropriate in accordance with  
		(1) the ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, adopted by reference in 7 AAC 70.910;  
		(2) one or more of the following:  
			(A) the Diagnostic and Statistical Manual of Mental Disorders, adopted by reference in 7 AAC 70.910;  
			(B) the International Classification of Diseases, adopted by reference in 7 AAC 70.910;  
		(3) the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar), adopted by reference in 7 AAC 70.910; and  
		(4) the Clinical Opiate Withdrawal Scale (COWS), adopted by reference in 7 AAC 70.910.  
	(i)  In this section, "individual daily assessment" means the ongoing daily process of collecting information regarding the recipient's treatment needs, preferences, and desired outcomes.

Authorities

47.05.010;47.30.470;47.30.475;47.30.477;47.30.530;47.30.540;47.30.570;47.37.130;47.37.140

Notes


Authority
AS 47.05.010 AS 47.30.470 AS 47.30.475 AS 47.30.477 AS 47.30.530 AS 47.30.540 AS 47.30.570 AS 47.37.130 AS 47.37.140
History
Eff. 10/1/2011, Register 199; am 6/16/2016, Register 218