(1) The most intensive level of care, outside of an acute care hospital, is defined as medically monitored care to clients whose withdrawal symptoms are sufficiently severe to require 24-hour inpatient care with observation, monitoring, and treatment available and delivered by a multidisciplinary team including 24-hour nursing care under the supervision of a Montana licensed physician.

(2) To be licensed to provide medically monitored detoxification (ASAM Level III.7), a provider must meet the following:

(a) facility requirements include but are not limited to the following:

(i) the facility shall be equipped for clients who are impaired due to substances and who require safety rails on beds, handrails on showers, and other related equipment to assure the safety of impaired clients; and

(ii) oxygen or other emergency equipment according to the physician-prescribed protocols for responding to client health emergencies.

(b) staffing requirements include but are not limited to the following:

(i) a physician licensed under Title 37, MCA, available on call 24 hours a day, 7 days a week to evaluate clients and prescribe medications;

(ii) staff available in sufficient numbers and trained to respond to substance-related and co-occurring disorders of admitted clients;

(iii) a registered nurse licensed under Title 37, MCA, who is responsible for the supervision of nursing staff and the administration of detox protocols; and

(iv) support staff such as licensed practical nurses, certified nurse assistants, rehabilitation aides etc. in sufficient numbers to assure the safety of clients.

(c) service requirements include but are not limited to the following:

(i) a written agreement with a state approved chemical dependency treatment facility to provide ongoing care following client discharge from the detoxification service;

(ii) there shall be a discharge note that addresses the referral and service needs of the client for follow-up treatment or care;

(iii) medication administration and on-going assessment of the client which are documented in the client record;

(iv) written medication orders specifying the name, dose, and route of administration signed by the prescribing physician;

(v) meals and snacks in sufficient quantities to assure the nutritional needs of the clients are met; and

(vi) written policies and procedures specifying how the facility will provide for the transfer of patients when indicated, to an acute care hospital.

(3) To be licensed to provide community-based social detoxification as defined as ASAM Level III-D, III.2-D, and III.7-D for individuals with substance use disorders as defined by ASAM, a provider must meet the following:

(a) facility requirements include but are not limited to the following:

(i) the facility shall be equipped for clients who are impaired due to substances and who require safety rails on beds, handrails on showers, and other related equipment to assure the safety of impaired clients.

(b) staffing requirements include but are not limited to the following:

(i) physician approved protocols for the monitoring of clients in withdrawal including when and under what circumstances clients should be transferred to a health care facility;

(ii) a written agreement with the health care facility or physician providing for emergency services when needed;

(iii) written procedures specifying how staff will respond to emergencies and for the transfer of medically unstable patients;

(iv) sufficient staff on duty trained in CPR and the detox protocols on each shift to be followed to assure clients safe withdrawal from substances; and

(v) if medications are provided, there is a current prescription in the client's name and staff are trained in medication administration procedures which are documented in policies and procedures.

(c) service requirements include but are not limited to the following:

(i) an initial physical examination by a qualified professional that assures the client can be safely detoxified in a nonmedical setting and documented in the client record;

(ii) regular vital signs are taken and recorded by staff trained to recognize symptoms indicating the client is becoming physically unstable;

(iii) meals and snacks in sufficient quantities to meet the nutritional needs of the client;

(iv) there shall be a written discharge plan that assures necessary referrals and continuing treatment services;

(v) all entries in the client record will be signed and dated by staff providing the service; and

(vi) a written agreement with an approved addiction treatment provider assuring acceptance of client for treatment upon discharge from the detoxification service.