(1) Patient placement criteria shall address the following:

(a) Persons able to receive services on a non-residential and less intensive basis shall be admitted to this component. Persons needing detoxification, inpatient or intermediate care services shall be referred to an appropriate treatment program. Persons manifesting signs and symptoms of a condition that warrants acute medical care shall not be admitted but shall be referred to a hospital.

(b) Persons should demonstrate stable physical or emotional/behavioral conditions, sufficient motivation, and supportive environmental factors to participate in this component. This level of care involves weekly sessions usually supplemented by involvement in self help groups. The intensity typically does not exceed 9 contact hours per week.

(c) Persons who have recently completed a more intensive level of care may utilize this level for aftercare services. This level of care also may be appropriate for protracted evaluation of patients who require some additional time to make a commitment to a more intensive recovery effort.

(d) Dimensional admission criteria must demonstrate compliance with the preceding descriptions and encompass the dimensions delineated in ARM 37.27.120(1) (j) (i) through (vi) .

(e) Continued stay criteria shall be based on the above criteria to justify continuance at this level of care or transfer to a more restrictive treatment environment. A continued stay/utilization review must be documented at 45 days.

(f) Discharge criteria shall be based on previous dimensional criteria to demonstrate successful completion of treatment or justification for an extension or transfer.

(2) Outpatient services shall include:

(a) Admission and screening services in accordance with dimensional admission criteria which substantiates the appropriateness of treatment based on a biopsychosocial assessment corresponding to the dimensional admission criteria via utilization review.

(b) Crisis intervention, screening evaluation, individual, group and family counseling, intervention services, structured educational presentation, referral and transportation services, discharge and follow-up services.

(c) A plan for outreach activities which includes: target groups, methodology, and special emphasis programs.

(d) Availability of 24-hour, 7-day a week coverage.

(e) Assessments and evaluations shall be conducted by a certified chemical dependency counselor based on at least 3 cross-referenced diagnostic tools.

(f) A minimum of 2.5 counseling contacts per month.

(g) Treatment plan assessment/staffing every 45 days.

(3) Staff requirements:

(a) Counseling staff shall be certified and trained in the field of chemical dependency counseling and education and shall demonstrate an ability to work with clients and a knowledge of the etiology of chemical dependency.

(b) Sufficient staff shall be available to provide 24-hour on-call services.

(c) Staff shall be familiar with community resources for referral, including medical, social, vocational, mental health, alcoholics anonymous, etc.

(4) The program shall develop policies and procedures to address the above listed services, staff requirements and criteria in ARM 37.27.115.

(5) Client recordkeeping and reporting requirements specific to the outpatient care component shall include:

(a) ADIS admission/discharge forms.

(b) Date of admission.

(c) Admission note/utilization review which justifies the admission to this level of care based on compliance with dimensional admission criteria are results of diagnostic tools, if applicable.

(d) Biopsychosocial assessment.

(e) Dimensional admission criteria checklist.

(f) Medical history.

(g) Documentation of all supportive service contacts.

(h) Individualized treatment plan which is reviewed and updated at least every 45 days and responds to ARM 37.27.120(g) .

(i) Progress notes shall be written following each contact (a minimum of once a month) and respond to ARM 37.27.120(h) .

(j) Discharge summary that includes: compliance with dimensional criteria or transfer, an account of the client's response to treatment which reviews the treatment plan and documents the client's progress in accomplishing treatment goals and a follow-up plan.

(6) Program effectiveness and quality assurance efforts which include individual case review and utilization and effectiveness review.

(a) Individual case review is a procedure for monitoring a client's progress and is designed to ensure the adequacy and appropriateness of the services provided to that client and shall:

(i) Be designed to ensure that the care provided to clients is evaluated and updated every 45 days, according to the needs of each client.

(ii) Be accomplished through staff meetings and/or quarterly staff reviews. All involved treatment staff must participate. In small rural programs with only one staff member, files shall be reviewed by that staff member.

(b) Utilization and effectiveness - review is a process of using patient placement criteria to evaluate the necessity and appropriateness of allocated services and resources to ensure that the programs services are necessary, cost efficient and effectively utilized. Utilization and effectiveness reviews shall:

(i) Utilize patient placement criteria to justify the necessity of admissions, continued stay, transfer and discharge at timely intervals and to document justification via a utilization review note.

(ii) Ensure the collection, analysis and utilization of information which demonstrates program effectiveness. This shall include, but not be limited to, completion of goals and objectives, average monthly caseloads, average contacts per client per month, completion ratios, employment and follow-up data.