Outpatient Substance Abuse Treatment Licensure Regulations July 2009

DAS Mission Statement The Division of Addiction Services (DAS) promotes the prevention and treatment of substance abuse and supports the recovery of individuals affected by the chronic disease of addiction. As the Single State Agency for substance abuse, DAS is responsible for regulating, licensing, monitoring, planning and funding substance abuse prevention, treatment and recovery support services in New Jersey. To achieve its mission, DAS provides leadership and collaborates with providers, consumers, and other stakeholders to develop and sustain a system of client-centered care that is accessible, culturally competent, accountable to the public, and grounded in best practices that yield measurable results.

Changes from N.J.A.C. 8:43A to N.J.A.C. 10:161B Staff Qualifications Staff Supervision Treatment Services Quality Assurance Volunteer Services Drug Screening

Staff Qualifications Administrator-N.J.A.C. 8:43A-1.4 A baccalaureate degree and two years of full-time or full-time equivalent, administrative or supervisory experience in a health care facility. Each additional year of full-time or full-time equivalent, administrative or supervisory experience and/or training in a health care facility may be substituted for each year of the four-year degree requirement. Four years of such experience and/or training may be used to satisfy the degree requirement. Administrator-N.J.A.C. 10:161B-1.7 A master’s degree and two years full-time or full-time equivalent, administrative or supervisory experience in a substance abuse treatment facility. Individuals who do not meet the above qualifications shall have a Bachelor’s degree and five years of full-time or full-time equivalent, administrative or supervisory experience in a substance abuse treatment facility.

Staff Qualifications Director of Nursing-N.J.A.C. 8:43A-1:10 Shall be a registered professional nurse and shall have at least one year of full-time, or full-time equivalent, experience in nursing supervision and/or nursing administration in a licensed health care facility Director of Nursing-N.J.A.C. 10:161B-1.5 Registered Professional Nurse licensed in New Jersey In facilities not required but electing to appoint a Director of Nursing, at least six (6) months of full-time experience, or the full-time equivalent, in nursing supervision or nursing administration in the management of addictions in a licensed substance abuse treatment facility In an opioid treatment facility must have one (1) year of supervisory experience or three (3) years of experience working in a substance abuse treatment program or facility

Staff Qualifications Director of Substance Abuse Counseling Services No requirements specified in N.J.A.C. 8:43A Director of Substance Abuse Counseling Services –N.J.A.C. 10:161B-1.8 A New Jersey licensed psychologist with a Certification of Proficiency from APA in Alcohol and other Psychoactive Substance Use Disorders with a CCS or LCADC A New Jersey licensed clinical social worker with a CCS or LCADC A New Jersey licensed professional counselor with a CCS or LCADC A New Jersey licensed clinical alcohol and drug counselor with a Master’s degree recognized by the New Jersey Board of Marriage and Family Therapy Examiners A New Jersey licensed, ASAM certified physician or board-certified psychiatrist A New Jersey licensed advanced practice nurse with CCS or LCADC

Staff Qualifications Qualifications of drug counselors-N.J.A.C. 8:43A-1.11 Staffing ratio of 75/25 credentialed to non-credentialed staff CADC certified Certified by the American Academy of Health Care Providers in the Addictive Disorders Social Worker in accordance with N.J.A.C. 8:43A-1.27 Baccalaureate in Social Sciences and one (1) year experience in drug counseling Currently enrolled in a program leading to one of the above

Staff Qualifications Substance Abuse Counselors-N.J.A.C. 10:161B-1.9 Staffing ratio of 50/50 credentialed to non-credentialed staff Recognizes licensed healthcare credentials, including LCADCs and CADCs, for which work of an alcohol and drug counseling nature is within the scope of practice. Non-credentialed staff are counselor interns actively working towards CADC, LCADC, or another healthcare professional license that includes work of an alcohol or drug counseling nature within its scope of practice. Counselor interns must be enrolled in a course of study leading to the CADC, LCADC or another healthcare professional license regulated by the New Jersey State Board of Marriage and Family Therapy Examiners Alcohol and Drug Counselor Committee, Professional Counselor Committee, State Board of Social Workers, or State Board of Psychological Examiners. Counselor interns must have supervision per the New Jersey State Board of Marriage and Family Therapy Examiners Alcohol and Drug Counselor Committee.

Treatment Services Nursing Services-N.J.A.C. 8:43A-Subchapter 8 Nursing services shall be provided directly by the facility or by written agreement Shall have a “designee” in the absence of the Director of Nursing The Nursing care needs of the patient shall be assessed only by a registered professional nurse Nursing Services-N.J.A.C. 10:161B-Subchapter 8 Outpatient (OP), Intensive Outpatient (IOP) and Partial Care (PC) programs are not required to provide nursing services. Primary counselors (or designee) are responsible for obtaining health related information from the client and record such information in the clinical chart in the above programs. Provide a mechanism for referring clients for medical services as needed. Opioid Treatment and Detoxification programs shall appoint a Director of Nursing Services-10:161B-8.2.

Treatment Services Responsibilities of the Director of Substance Abuse Counseling Services No requirements specified in N.J.A.C. 8:43A

Treatment Services Responsibilities of the Director of Substance Abuse Counseling Services-N.J.A.C. 10:161B-1.8 Must provide clinical supervision as per N.J.A.C. 13:34C-6.0 If not providing clinical supervision, shall ensure that direct clinical supervision is provided by a staff person who meets the requirements under N.J.A.C. 13:34C-6.3 Is responsible for ensuring that direct clinical supervision is provided at least one hour per week to all clinical staff, individually or in a group setting, with group supervision not to exceed 50 percent of supervision time Ensure documentation of direct clinical supervision Develop written objectives, policies and procedures, and quality assurance measures/activities for the provision of substance abuse counseling services to be reviewed by the administrator Ensure that assessment, and treatment for clients with co-occurring disorders is provided by appropriately trained and qualified clinical staff

Treatment Services Responsibilities of the Substance Abuse Counseling Staff No requirements specified in N.J.A.C. 8:43A Responsibilities of the Substance Abuse Counseling Staff-N.J.A.C. 10:161B-1.9 Must be supervised by appropriately credentialed staff Assess clients using ASI or other standardized clinical assessment tool Diagnose clients for a substance abuse disorder using the DSM-IV TR as permitted within scope of practice Recommend appropriate level of care using ASAM PPC2-R Develop treatment plans that are client-centered, with measurable objectives and recovery oriented Conduct ongoing review of treatment plans and reviewing clients throughout treatment episodes according to ASAM PPC2-R Provide discharge planning Participate as a member of the multi-disciplinary treatment team

Treatment Services Provision of Counseling Services-N.J.A.C. 8:43A The facility shall provide counseling services through written agreement or referral Develop policies and procedures Coordination and integration of counseling services Documentation of clinical services

Treatment Services Provision of Substance Abuse Counseling-N.J.A.C. 10:161B-10.1 Provide counseling services on site and assign every client to a primary substance abuse counselor at admission Individual Sessions: OP-Monthly, IOP-Weekly, PC-Weekly (based upon determination of multi-disciplinary treatment team) Family Sessions: OP-Monthly, IOP-Monthly, PC-Weekly (unless clinically contraindicated or the client and/or family members refuse to participate) Group counseling sessions shall not exceed an average of 12 clients and shall not exceed 14 clients in any one session. This does not apply to psychoeducational or family counseling services.

Treatment Services Provision of Substance Abuse Counseling-N.J.A.C. 10:161B-10.1 Primary counselor to client ratio Outpatient 1:35 Intensive Outpatient 1:24 Partial Care 1:12 Outpatient Detoxification 1:24 Opioid Treatment Program 1:50 (no single OTP counselor caseload of up to 50 clients shall include more than 35 clients in Phases I-III)

Treatment Services Co-Occurring Services No requirements specified in N.J.A.C. 8:43A Co-Occurring Services-N.J.A.C. 10:161B-10.4 Must have clearly written policies governing the treatment of individuals with co-occurring disorders (COD) in a coordinated fashion Ensure clinical supervision is provided by appropriately credentialed supervisors Must have appropriately qualified clinical and medical staff assessing/treating individuals with COD Provide case consultation and coordination and, where appropriate, referrals to mental health programs

Opioid Treatment Services Opioid Treatment Services-N.J.A.C. 8:43A-26.5 Drug counselor’s caseload cannot exceed 50 patients Stage #1 One (1) counseling session per week (first 3 months of treatment) Stage #2 At least one (1) counseling session every two weeks (four to nine months of treatment) Stage #3 One (1) counseling session per month (10th month to end of two years of treatment) Stage #4 One (1) counseling session every three months (after two years of treatment) Availability of group, family, and/or vocational counseling

Opioid Treatment Services Opioid Treatment Services-N.J.A.C. 10:161B Subchapter 11 Medical Director required, ASAM certified by June 1, 2012 per 10:161B11.2(a) Must employ a full-time Director of Substance Abuse Counseling Services as per N.J.A.C. 10:161B-11.2(b) Opioid Treatment Program Client to Staff Ratios 1:50 no single OTP counselor caseload of up to 50 clients shall include more than 35 clients in Phases I-III Comply with CSAT publication TIP-43 “Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs.” Opioid Treatment Programs shall participate in registry or other data management system implemented by DAS.

Opioid Treatment Services Opioid Treatment Services-N.J.A.C. 10:161B Subchapter 11 Phase: I-A Clients in Phase I for a period of at least 12 months who have failed to progress in treatment. Phase I: One (1) counseling session per week (a total of four counseling sessions per month with one (1) session being an individual session). Phase I shall be three (3) months. Phase II: Two (2) counseling session per month (one (1) being an individual session). Phase II a minimum of six (6) months. Phase III: One (1) counseling session per month. Phase III shall be a minimum of nine (9) months. Phase IV: A minimum of one (1) individual session every three (3) months. Phase IV shall be a minimum of six (6) months. Phase V: Clients with 24 consecutive months of negative drug screen and meets other program criteria will receive counseling services as determine by the multi-disciplinary treatment team. Phase VI: Clients with 36 consecutive months of negative drug screens and meets other program criteria will receive counseling consistent with clinical needs as determined by the multi-disciplinary treatment team.

Detoxification Services No requirements specified in N.J.A.C. 8:43A

Detoxification Services Detoxification Services-N.J.A.C. 10:161B-Subchapter 12 Must be licensed by DAS to provide outpatient detoxification services Clients must meet ASAM PPC-2R Level I-D or II-D criteria Medical Director required, ASAM certified by June 1, 2012 Advanced Practice Nurses (APNs) and/or Physician Assistants (PAs) can provide services Registered Nurse (RN) must be on duty all hours of operation when clients being detoxed are present Must employ a full time Director of Substance Abuse Services as per N.J.A.C. 10:161B-1.8 Twenty-Four (24) hour access to a nurse on call for clients and family Clients shall participate in IOP or PC programs as soon as medically possible AA or NA 12-Step support group strongly encouraged Drug screenings done at least weekly during the detoxification process DAS does not condone ultra rapid opioid detoxification or rapid detoxification as a means for detoxification from opioids or other substances Policy and Procedures shall be consistent with ASAM PPC-2R criteria and CSAT Treatment Improvement Protocol, TIP 45 “Detoxification from Alcohol and Other Drugs” formerly known as TIP 19 Treatment interventions shall be clearly documented in client’s clinical record

Licensure Implementation Plan Application process Surveys and renewals in the next six months What happens when current licenses expire? Citing deficiencies under N.J.A.C. 10:161B Provisional and conditional licenses Technical assistance

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