Virginia Association of Medication Assisted Recovery Programs
Department for Behavioral Health and Developmental Services
1220 Bank Street
Richmond, VA 23219
Re: Amendments to draft regulations
Dear DBHDS Colleagues:
We would first like to express our appreciation for considering feedback from providers and making amendments that will allow us to better provide appropriate substance use disorder treatment services. Please find below the recommended amendments and rationales we are requesting be considered.
Section A.2.g States: Providers shall implement screening policies and procedures that include: Medications currently being used including recent increases, decreases, or discontinuation, misuse, or overdose of prescription medication.
Recommend just saying, “Medications currently being used.”
12VAC35-109-50. Secondary Screening
Section A States: In the event that an individual was placed on a waitlist prior to receiving services, a secondary screening shall be performed prior to admission to the service.
Recommend adding “for 90 days or more” after the word “waitlist”
Section A Requires artificial lighting to be “by electricity”
Recommend removing this section
12VAC35-109-200. Standards for the evaluation of new licenses for providers of services to individuals with opioid addiction.
Section E.3. States: The medical director shall be a physician. The medical director shall be a board-certified
addictionologist or have successfully completed or will complete within one year a course of
study in opiate addiction that is approved by the department, shall have completed an accredited
residency training program, and shall have at least one year of experience in addiction medicine
or addiction psychiatry.
Recommend removing the stipulation of having one year in addiction medicine or psychiatry
Section E.5. States: A minimum of one registered nurse (RN) staffed with licensed practical nurses (LPNs), if
warranted to meet the needs and number of patients served. All LPNs hired shall be supervised by
Recommend removing the criteria of having an RN
Section E.6. States: Counselors shall be licensed or certified by the applicable Virginia health regulatory board eligible for this license or certification, and a minimum of two thirds (63%) of counselors working with individuals in an outpatient treatment program (OTP) program must be licensed or certified. No more than one third (33%) of counselors in a program can be eligible for license or certification.
Recommend removing “minimum of two thirds (63%) of counselors working with individuals in an outpatient treatment program (OTP) program must be licensed or certified. No more than one third (33%) of counselors in a program can be eligible for license or certification.”
Section E.7. States: Personnel to provide support services which shall include at least one security guard trained in accordance with 12VAC35-105-440, 12VAC35-105-450, and 12VAC35-105-460
Recommend removing this section entirely as a requirement
Section G States: If there is a change in or loss of any staff in the positions listed in subsection E, the department
requires written notification and a plan for immediate coverage within one week
We agree with these criteria as it pertains to section E. 1-4.
Recommend removing this requirement for all other subsections under E
Section H.3. States: The medical director shall be responsible for ensuring all medical, psychiatric, nursing, pharmacy, toxicology, and other services offered by the OTP are conducted in compliance with federal regulations at all times; and, shall be present at the program for a sufficient number of hours to ensure regulatory compliance and carry out those duties specifically assigned to the medical director by regulation. The medical director shall be present at a minimum one hour per every 50 patients
Recommend removing the last line stating the medical director shall be present at a minimum of one hour per every 50 patients
Section H.4. States: Counselors shall meet the following caseload requirements: The caseload size for a licensed or certified counselor shall not exceed 45 patients. The caseload size for a nonlicensed or noncertified counselor shall be assigned from the licensed counselor's caseload and caseload size shall not exceed 30 patients.
Recommend removing caseload limit
Section I.4. States: Plans for on-site onsite security and services adequate to ensure the safety of patients, staff, and property
Recommend removing “on-site security”
Section J.7. States: All staff shall be certified in First Aid, CPR, and Naloxone administration
Recommend changing the word “certified” to “trained”
12VAC35-109-250. Service operation schedule
Section B.2. States: The provider receives prior approval from the state opioid treatment authority (SOTA) for Sunday closings. Each program must have a policy that addresses medication for the newly inducted patients and those who are deemed at risk, i.e., still actively using illicit substances or medical issues that may warrant closer monitoring of medication. This policy must include openings on Sundays for the population described above
Recommend keeping the first sentence and eliminating the rest; or change the wording to state that programs will follow federal guidelines regarding Sunday closings.
12VAC35-109-260. Initial and periodic assessment services
Section C States: Upon admission and annually, all individuals shall sign an authorization for disclosure of information to allow programs access to the Virginia Prescription Monitoring System (PMP). Failure to comply with this requirement shall be grounds for denial of admission to the program. Programs shall run a PMP report each month on every individual served. The program physician shall provide this report. The report shall be stored in the individual's file and must be marked "DO NOT DUPLICATE."
Recommend removing the sentence, “Programs shall run a PMP report each month on every individual served.”
Section E States: Initial tests conducted by the provider shall include viral hepatitis, HIV and other sexually transmitted infections. On admission, all individuals shall be offered testing for AIDS/HIV. The individual may sign a notice of refusal without prejudice. The individual shall be certified as tuberculosis (TB) free upon admission and annually by a qualified licensed professional
Recommend remove the requirement of the test being conducted at the facility.
Recommend programs provide patients with education about infectious diseases and offer referrals to places that can perform the testing
12VAC35-109-280. Counseling sessions
Section A.1. States: The provider shall conduct face-to-face counseling sessions (either individual, group, or family) of one hour minimum. The provider shall document details of each session including the length within the individual's service record. The counseling sessions shall occur:
1. Every week for the first six months of the first year of the individual's treatment.
Recommend keeping this regulation as it currently is stating counselors shall meet with individual 2x per month for the first year
12VAC35-109-290. Drug screens
Section 2 States: Perform a random weekly drug screen whenever an individual's drug screen indicates
continued illicit drug use or when clinically and environmentally indicated
Recommend removing this subsection
12VAC35-109-300. Take home medications
Section A-C Regarding criteria for and schedule of take home medications
Recommend removing these sections
Recommend using the wording, “Medications used for the treatment of opioid use disorder to be dispensed to patients for unsupervised or “take home” use shall comply with the scheduling requirements set forth in 42 CFR Part 8 MEDICATION ASSISTED TREATMENT FOR OPIOID USE DISORDERS
Thank you for your support and willingness to work with providers as these regulations are amended. Please feel free to contact us with any questions or if we can be of assistance in any other way.
Pinnacle Treatment Centers
Cc: Jodi Herndon, VAMARP Vice President
Melissa Brown, VAMARP Treasurer
Stacie Shifflett, VAMARP Secretary
VAMARP Member Programs