R432.  Health, Family Health and Preparedness, Licensing.
R432-102.  Specialty Hospital - Chemical Dependency/Substance Abuse.
R432-102-1.  Legal Authority.
	This rule is adopted pursuant to Title 26, Chapter 21.

R432-102-2.  Purpose.
	This rule applies to the hospital that chooses to be licensed as a specialty hospital and which has as its major single service the treatment of patients with chemical dependency/substance abuse.  If a specialty hospital chooses to have a dual major service, e.g., chemical dependency/substance abuse and psychiatric care, then both of the appropriate specialty hospital rules apply.

R432-102-3.  Time for Compliance.
	All specialty hospitals, - chemical dependency/substance abuse, obtaining licensure for the first time shall fully comply with this rule.

R432-102-4.  Definitions.
	(1)  Refer to Common Definitions in R432-1-3.
	(2)  Refer to R432-101-4(2) definition of "specialty hospitals".

R432-102-5.  Licensure.
	License required.  Refer to R432-2.

R432-102-6.  General Construction Rules.
	Specialty Hospital - Chemical Dependency/Substance Abuse Hospital Construction Rules, R432-8, apply to construction and remodel of the facility.

R432-102-7.  Organization.
	Refer to R432-100-5, Governing Body.

R432-102-8.  Administrator.
	Refer to R432-100-6, Administrator.

R432-102-9.  Medical and Professional Staff.
	(1)  Refer to R432-100-7, Medical and Professional Staff.
	(2) Medical and Professional staff members may be retained either on a full-time basis, a part-time basis or by contract to fulfill the requirements and needs of the treatment programs offered.
	(3) Medical and Professional staff shall be assigned specific responsibilities on the treatment team as qualified by training and educational experience and as permitted by hospital policy and the scope of their license.

R432-102-10.  Nursing.
	Refer to R432-100-12, Nursing Care Services.

R432-102-11.  Personnel Management Service.
	(1)  The hospital shall provide sufficient medical and professional staff and support personnel who are able and competent to perform their respective duties, services, and functions to meet hospital service and patient care needs.
	(2)  Written personnel policies and procedures shall include:
	(a) job descriptions for each position, including job title, job summary, responsibilities, minimum qualifications, required skills and licenses, and physical requirements;
	(b)  a method to handle and resolve grievances from the staff.
	(3)  All employees shall be oriented as to job requirements and personnel policies, and provided with job training beginning the first day of employment.  Documentation shall be signed by the employee and supervisor to indicate basic orientation has been completed during the first month of employment.
	(a)  Registered nurses and licensed practical nurses shall receive additional orientations to include the following:
	(i)  concepts of treatment provided within the hospital for patients with chemical dependency/substance abuse diagnoses;
	(ii)  roles and functions of nurses in treatment programs for patients with chemical dependency/substance abuse diagnoses;
	(iii)  medications used in the treatment of chemical dependency/substance abuse diagnoses.
	(b)  In-service sessions shall be planned and held at least quarterly.
	(c)  Documentation shall be maintained to demonstrate that all staff have attended an annual in-service on the reporting requirements for abuse, neglect and exploitation for adults and children.
	(4)  The hospital shall ensure that all personnel are licensed, certified or registered as required by the Utah Department of Commerce.  Copies of the license, registration, or certificate shall be maintained for Department review in the personnel files.
	(5) Volunteers may be utilized in the daily activities of the hospital but shall not be included in the hospital's staffing plan in lieu of hospital employees.
	(a)  Volunteers shall be screened by the administrator or designee and supervised according to hospital policy.
	(b)  Volunteers shall be familiar with the hospital's policies and procedures on volunteers, including patient rights and facility emergency procedures.

R432-102-12.  Clinical Services.
	(1)  The hospital shall organize and establish an inpatient clinical services program that includes the following elements: detoxification; counseling; and, a referral process to outpatient programs.
	(a)  Detoxification services i.e., the systematic reduction or elimination of a toxic agent in the body by use of rest, fluids, medication, counseling and nursing care shall be provided according to medical orders and facility protocols.
	(b)  Counseling services i.e, individual, group, or family therapy shall be provided as indicated in the individual treatment plan.  There shall be provision for educational, employment, or other counseling as needed.
	(c)  There shall be a referral process to outpatient treatment services coordinated with other hospital and community services for continuity of care.  Counselors shall refer clients to public or private agencies for substance abuse rehabilitation, employment and educational counseling, as indicated in the individual treatment plan.
	(2)  The hospital may provide therapy programs and services on an outpatient basis.  These programs and services shall be organized, staffed and managed according to the requirements and needs of the services offered.  The therapy programs and services shall be subject to the same medical, administrative and quality assurance oversight as inpatient clinical services programs.

R432-102-13.  Crisis Intervention Services.
	(1)  If offered, the crisis intervention service shall be organized under the direction of the medical director or designee.
	(a)  Services shall be available at any hour to persons presenting themselves for assistance.
	(b)  The following public areas shall be available in the crisis intervention service area:
	(i)  an interview and treatment area for both individuals and families;
	(ii)  a reception and control area;
	(iii)  a public waiting area with telephone, drinking fountain and toilet facilities.
	(2)  If the hospital chooses not to offer crisis intervention services, the hospital shall have a written referral plan for persons making inquiry regarding such services or presenting themselves for assistance.
	(3)  The crisis intervention service shall have physician coverage 24 hours a day.
	(a)  Nursing and other allied health professional staff shall be available in the hospital.
	(b)  Staff may have collateral duties elsewhere in the hospital, but must be able to respond when needed without adversely affecting patient care or treatment elsewhere in the hospital.
	(4)  The crisis intervention service shall implement policies and procedures which include admission, treatment, medical procedures and applicable reference materials.  Involuntary detention of a person must be done according to hospital policy and Utah Law.

R432-102-14.  Patient Record.
	(1)  Refer to R432-100-33, Medical Records.
	(2)  The content of the patient record shall contain in addition:
	(a)  progress notes, including description and date of service, with a summary of client progress, signed by the therapist or service provider;
	(b)  a discharge summary, including final evaluation of treatment and goals attained and signed by the therapist.
	(3)  A written individual treatment plan shall be initiated for each patient upon admission and completed no later than seven working days after admission.
	(a)  The individual treatment plan shall be part of the patient record and signed by the person responsible for the patient's care.  Patient care shall be administered according to the individual treatment plan.
	(b)  Individual treatment plans must be reviewed on a weekly basis for the first three months, and thereafter at intervals determined by the treatment team, but not to exceed every other month.
	(c)  The written individual treatment plan shall be based on a comprehensive functional medical, psycho-social, substance abuse, and treatment history assessment of each patient.  When appropriate, the patient and family shall be invited to participate in the development and review of the individual treatment plan.  Patient and family participation shall be documented.
	(d)  The individual treatment plan shall be available to all personnel who provide care for the patient.
	(e)  The Utah State Hospital is exempt from the time frames for initiating and reviewing the individual treatment plan.  The Utah State Hospital shall initiate for each patient admitted an individual treatment plan within 14 days and shall review the plan on a monthly basis.
	(4)  The confidentiality of the records of substance abuse patients shall be maintained according to the federal guidelines is adopted and incorporated as reference 42 CFR, Part 2, "Confidentiality of Alcohol and Drug Abuse Patient Records."

R432-102-15.  Required Hospital Services.
	The following sections of the General Hospital Standards, R432-100, and the Specialty Hospital - Psychiatric Standards, R432-101, are adopted by reference.  These services shall be provided as part the of the hospital's patient care service milieu:
	(1)  R432-100-31, Dietary Services;
	(2)  R432-100-35, Laundry Services;
	(3)  R432-100-37, Maintenance Services;
	(4)  R432-100-36, Housekeeping Services;
	(5)  R432-101-11, Quality Assurance;
	(6)  R432-101-15, Patient Rights;
	(7)  R432-101-16, Emergency and Disaster;
	(8)  R432-101-17, Admission and Discharge Policy;
	(9)  R432-101-18, Transfer Agreement;
	(10)  R432-101-19, Pets in Hospitals;
	(11)  R432-101-23, Physical Restraints, Seclusion, and Behavior Management;
	(12)  R432-101-28, Laboratory;
	(13)  R432-101-29, Pharmacy;
	(14)  R432-101-30, Social Services; and,
	(15)  R432-101-31, Activity Therapy.

R432-102-16.  Optional Hospital Services.
	The following sections of the General Hospital Standards, R432-100, and the Specialty Hospital - Psychiatric Standards, R432-101, are adopted by reference.  These sections shall apply when these services are adopted into, or are required by, the hospital's patient care service milieu.
	(1)  R432-100-13, Critical Care Unit;
	(2)  R432-100-18, Pediatric Services;
	(3)  R432-750, Inpatient Hospice;
	(4)  R432-100-20, Rehabilitation Therapy Services;
	(5)  R432-100-21, Radiology Services;
	(6)  R432-100-19, Respiratory Services;
	(7)  R432-100-34, Central Supply Services; and,
	(8)  R432-101-20(1), Inpatient (Psychiatric) Services.

R432-102-17.  Penalties.
	Any person who violates any provision of this rule may be subject to the penalties enumerated in 26-21-11 and R432-3-6 and be punished for violation of a class A misdemeanor as provided in 26-21-16.

KEY:  health care facilities
Date of Enactment or Last Substantive Amendment:  June 26, 1998
Notice of Continuation:  November 5, 2015
Authorizing, and Implemented or Interpreted Law:  26-21-5; 26-21-2.1; 26-21-20