(1) In compliance with 53-6-109 , MCA, the following facility monitoring and referral standards for medications and treatments shall be used in the survey and certification process:

(a) the facility shall have a process in place to monitor all residents who receive a medication or treatment for excessive dose, duplicate therapy, excessive duration, inadequate monitoring based on current practice standards, inadequate indications or contraindications for use, adverse consequences which indicate the dose should be reduced or discontinued, or any combination of these reasons;

(b) the facility must notify the attending physician and, if appropriate, the facility medical director, the consulting pharmacist and/or other appropriate medical professionals when it identifies any of the conditions outlined in (1)(a) and request his or her review of continuing the medication or treatment as ordered. Such notifications, and any resulting conclusions about continuing the medication or treatment or any changes in medications or treatments must be documented in the resident's medical record by the facility staff;

(c) if the process described in (1)(a) is in place and is being fully implemented and utilized, but a violation of any federal or state standard or condition for participation in the Medicaid program still exists, the state survey agency will cite the deficiency on the facility's deficiency citation form. The state survey agency will also refer the attending physician to the board of medical examiners for review of the care provided by the physician; or

(d) if the process described in (1)(a) is not in place or is not being implemented or utilized fully and a violation of any federal or state standard or condition for participation in the Medicaid program exists, the state survey agency will cite the deficiency on the facility's deficiency citation form.