(a) Administrative requirements. Policies and procedures for the alcohol/drug program shall include, but are not limited to, the following:

1. (1) Staffing. Clinical staff shall be licensed or certified by appropriate state licensure or certification boards;
2. (2) Admission procedures, including a procedure for accepting emergency admissions;

3. (3) Patient evaluation procedures, including:

   1. (A) Preliminary evaluation; and
   2. (B) Establishment of an individual treatment plan;
4. (4) Treatment procedures and services that are consistent with accepted standards of treatment for alcohol/drug abuse illness;
5. (5) Procedures for referral and follow-up of patients’ outside services;
6. (6) Procedures for involvement of family in counseling process;
7. (7) Provision for aftercare plan;
8. (8) Program quality assurance/performance improvement;
9. (9) Provision for an education program acceptable to local school officials for patients of school age that would also include suitable recreational needs of adolescents;

10. (10) Provision for coordination of services with:

    1. (A) Community mental health centers;
    2. (B) Substance abuse treatment programs; and
    3. (C) Other appropriate facilities or programs; and

11. (11)

    1. (A) Clinically relevant educational programs shall be conducted on a regularly scheduled basis of not less than twelve (12) per year.
    2. (B) There shall be evidence of:

(i) Program dates;

1. (ii) Attendance; and

   1. (iii) Subject matter.

(b) Medical services.

1. (1) A physician licensed in the State of Arkansas shall be responsible for diagnosis and all medical care and treatment.
2. (2) Medical services shall be provided directly or on call twenty-four (24) hours per day, seven (7) days per week.

3. (3) Upon admission, there shall be written orders for the immediate care of the patient.

   1. (c) Nursing services.
4. (1) Nursing services shall be under the direct supervision of a registered nurse qualified by education and experience in psychiatric, mental health, or chemical dependency nursing.
5. (2) The number of registered nurses, licensed practical nurses, and other personnel shall be adequate to formulate and carry out the nursing components of the individual treatment plan for each patient.

6. (3) There shall be a registered nurse on duty twenty-four (24) hours per day, seven (7) days per week to:

   1. (A) Plan, assign, supervise, and evaluate nursing care; and

   2. (B) Provide for the delivery of nursing care to patients.

      1. (d) Psychiatric services.
7. (1) Patients shall be provided with psychiatric services in accordance with their needs by a psychiatrist licensed in the State of Arkansas.

8. (2) Services to patients include:

   1. (A) Evaluations;
   2. (B) Consultations;
   3. (C) Therapy; and
   4. (D) Program development.

(e) Psychological services.

1. (1) Patients shall be provided with psychological services in accordance with their needs by a qualified psychologist.

2. (2) Services to patients include:

   1. (A) Evaluations;
   2. (B) Consultation;
   3. (C) Therapy; and
   4. (D) Program development.
3. (3) A qualified psychologist is an individual licensed by the Arkansas Psychology Board with a specialty area in clinical or counseling psychology.

(f) Social services.

1. (1) Social work services are under the supervision of a qualified social worker.
2. (2) The director of the service or department shall be a licensed social worker in the State of Arkansas.
3. (3) If the director does not have a master’s degree from an accredited school of social work or has not been certified by the Academy of Certified Social Workers, there shall be documented monthly supervisory consultation by such a qualified social worker.

(g) Social work staff. Social work staff is qualified and numerically adequate to provide the following services:

1. (1) Psychosocial data for diagnosis and treatment planning;
2. (2) Direct therapeutic services to individual patients, patient groups, or families;
3. (3) Develop community resources; and

4. (4) Participate in interdisciplinary conferences and meetings concerning treatment planning, including:

   1. (A) Identification and utilization of other facilities; and
   2. (B) Alternative forms of care and treatment.

(h) Activity services.

1. (1) Activity services staff shall be sufficient in number and skills to:

   1. (A) Meet the needs of patients; and
   2. (B) Achieve the goals of the service.
2. (2) The activity service shall be supervised by a qualified activity director.
3. (3) A qualified activity director is an individual with a bachelor’s degree who has at least one (1) year of experience in assessing, planning, and coordinating activity services in a healthcare setting.

4. (4) In the absence of such a qualified activity director, this requirement may be met with a documented monthly supervisory consultation visit by a qualified activity therapist.

   1. (i) Substance abuse counselor.
5. (1) There shall be at least one (1) certified substance abuse counselor on the treatment staff, as certified by the Arkansas Substance Abuse Certification Board.

6. (2) Substance abuse counselor staff is qualified and numerically adequate to provide the following services:

   1. (A) Direct counseling services to:

      1. (i) Individual patients;
      2. (ii) Patient groups; and
      3. (iii) Families;
   2. (B) Participate in interdisciplinary conferences and meetings concerning treatment planning, including alternative forms of care and treatment;
   3. (C) Develop treatment resources; and
   4. (D) Participate in casework processes.

(j) Facility and program evaluation.

1. (1) Program evaluation is a management tool primarily utilized by the facility’s administrator to assess and monitor, on a priority basis, a variety of facility services and programmatic activities that shall be a component of the quality assurance/performance improvement program.
2. (2) The facility shall have a written statement of goals and objectives established as a result of a planning process and provided to the governing body for approval.
3. (3) There shall be documentation that the goals and objectives of facility services and programmatic activities are evaluated at least annually and revised as necessary.

(k) Individualized comprehensive treatment planning.

1. (1) Intake. Written policies and procedures governing the intake process shall specify the following:

   1. (A) The information to be obtained on all applicants or referrals for admission;
   2. (B) The treatment required can be appropriately provided by the facility or program component;
   3. (C) The statistical data to be kept on the intake process; and
   4. (D) The procedures to be followed when an applicant or a referral is found ineligible for admission.
2. (2) Criteria for determining the eligibility of individuals for admission shall be clearly stated in writing.
3. (3) The intake procedure shall include an initial assessment of the patient by professional staff.

4. (4) Acceptance of a patient for treatment shall be based on an intake procedure that results in the following conclusions:

   1. (A) The treatment required by the patient is appropriate to the intensity and restrictions of care provided by the facility or program component;
   2. (B) The treatment required can be appropriately provided by the facility or program component; and
   3. (C) The alternatives for less intensive and restricted treatment are not available.
5. (5) The patient record shall contain the source of any referral.

6. (6) During the intake process, every effort shall be made to ensure that applicants understand the following:

   1. (A) The nature and goals of the treatment program;
   2. (B) The treatment costs to be borne by the patient, if any; and

   3. (C) The rights and responsibilities of patients, including the:

      1. (i) Rules governing patient conduct; and
      2. (ii) Types of infractions that can result in disciplinary action or discharge from the facility or program component.

7. (7) Facilities shall have policies and procedures that adequately address the following items for each patient:

   1. (A) Responsibility for medical and dental care, including consents for medical or surgical care and treatment;
   2. (B) When appropriate, arrangements for family participation in the treatment program;
   3. (C) Arrangements for clothing, allowances, and gifts;
   4. (D) Arrangements regarding the patient’s departure from the facility or program; and
   5. (E) Arrangements regarding the patient’s departure from the facility or program against medical advice.

8. (8)

   1. (A) When a patient is admitted on court order, the rights and responsibilities of the patient and the patient’s family shall be explained to them.
   2. (B) This explanation of the rights and responsibilities of the patient and the patient’s family shall be documented in the patient’s record.
9. (9) Sufficient information shall be collected during the intake process to develop a preliminary treatment plan.

10. (10) Staff members who shall be working with the patient but who did not participate in the initial assessment shall be informed about the patient prior to the meeting.

    1. (l) Assessments.

11. (1)

    1. (A) Within seventy-two (72) hours of admission, the staff shall conduct a complete assessment of each patient’s needs.
    2. (B) The assessment shall include, but shall not necessarily be limited to, physical, emotional, behavioral, social, recreational, and nutritional needs.

12. (2)

    1. (A) A physician shall be responsible for assessing each patient’s physical health.

    2. (B) The health assessment shall include a:

       1. (i) Medical, alcohol, and medication history;
       2. (ii) Physical examination;
       3. (iii) Neurological examination when indicated; and
       4. (iv) Laboratory workup.
    3. (C) The physical examination shall be completed within forty-eight (48) hours after admission.

13. (3)

    1. (A) In facilities serving children and adolescents, each patient’s physical health assessment shall also include evaluations of the following:

       1. (i) Motor development and functioning;
       2. (ii) Sensorimotor functioning;
       3. (iii) Speech, hearing, and language function;
       4. (iv) Visual functioning; and
       5. (v) Immunization status.
    2. (B) Facilities serving children and adolescents shall have all necessary diagnostic tools and personnel available to perform physical health assessments.
14. (4) A registered nurse shall be responsible for obtaining a nursing history and assessment at the time of admission.

15. (5)

    1. (A) An emotional and behavioral assessment of each patient shall be completed and entered in the patient’s record.

    2. (B) The assessment shall include, but not be limited to, the following items:

       1. (i) A history of previous emotional, behavioral, and substance abuse problems and treatment;
       2. (ii) The patient’s current emotional and behavioral functioning; and
       3. (iii) When indicated, psychological assessments, including intellectual and personality testing.

16. (6)

    1. (A) A social assessment of each patient shall be completed by the qualified social worker and entered in the patient’s record.

    2. (B) The assessment shall include information relating to the following areas, as necessary:

       1. (i) Environment and home;
       2. (ii) Religion;
       3. (iii) Childhood history;
       4. (iv) Military service history;
       5. (v) Financial status;
       6. (vi) The social, peer group, and environmental setting from which the patient comes; and
       7. (vii) The patient’s family circumstances, including:

(b) (b) The current living situation; and

1. (c) (c) Social, ethnic, cultural, emotional, and health factors, including drug and alcohol use.

2. (7) When appropriate, an activities assessment of each patient shall be completed by the qualified activity director and shall include information relating to the individual’s current:

   1. (A) Skills;
   2. (B) Talents;
   3. (C) Aptitudes; and
   4. (D) Interests.

3. (8) A nutritional assessment shall be:

   1. (A) Conducted by the food service supervisor or registered dietitian; and
   2. (B) Documented in the patient’s record.

4. (9) An educational assessment shall be performed by personnel approved by the Department of Education.

   1. (m) Treatment plans.
5. (1) Each patient shall have a written individual treatment plan that is based on assessments of their clinical needs.
6. (2) Overall development and implementation of the treatment plan shall be assigned to an appropriate member of the professional staff.

7. (3)

   1. (A) The treatment plan shall be developed as soon as possible after the patient’s admission.
   2. (B) Appropriate therapeutic efforts may begin before a fully developed treatment plan is finalized.
8. (4) Upon admission, a preliminary treatment plan shall be formulated on the basis of the intake assessment.

9. (5)

   1. (A) Within seventy-two (72) hours following admission, a designated member of the treatment team shall develop an initial treatment plan based on at least an assessment of the patient’s:

      1. (i) Presenting problems;
      2. (ii) Physical health;
      3. (iii) Emotional status; and
      4. (iv) Behavioral status.
   2. (B) This initial treatment plan shall be utilized to implement immediate treatment objectives.
   3. (C) If a patient’s stay in a facility is ten (10) days or less, only a discharge summary shall be required in addition to the initial treatment plan.
   4. (D) If a patient’s stay in a facility exceeds ten (10) days, the interdisciplinary team shall develop a master treatment plan that is based on a comprehensive assessment of the patient’s needs.
   5. (E) The master treatment plan shall contain objectives and methods for achieving them.

10. (6) The treatment plan shall reflect the:

    1. (A) Facility’s philosophy of treatment; and
    2. (B) Participation of staff from appropriate disciplines.
11. (7) The treatment plan shall specify the services necessary to meet the patient’s needs.
12. (8) The treatment plan shall include referrals for needed services that are not provided directly by the facility.

13. (9)

    1. (A) The treatment plan shall contain specific goals the patient shall achieve to attain, maintain, and/or reestablish emotional and/or physical health as well as maximum growth and adaptive capabilities.
    2. (B) These goals shall be based on assessments of the patient and, as appropriate, the patient’s family.

14. (10) The treatment plan shall:

    1. (A) Contain specific objectives that relate to the goals, written in measurable terms; and
    2. (B) Include expected achievement dates.

15. (11) The treatment plan shall:

    1. (A) Describe the services, activities, and programs planned for the patient; and
    2. (B) Specify the staff members assigned to work with the patient.
16. (12) The treatment plan shall specify the frequency of treatment procedures.

17. (13)

    1. (A) The treatment plan shall delineate the specific criteria to be met for termination of treatment.
    2. (B) Such criteria shall be a part of the initial treatment plan.

18. (14) When appropriate:

    1. (A) The patient shall participate in the development of his or her treatment plan; and
    2. (B) Such participation shall be documented in the patient’s record.
19. (15) A specific plan for involving the family or significant others shall be included in the treatment plan when indicated.

(n) Progress notes.

1. (1)

   1. (A) Progress notes shall be recorded:

      1. (i) By the physician, nurse, social worker; and
      2. (ii) When appropriate, by others significantly involved in treatment.

   2. (B) The frequency of progress notes is determined by the condition of the patient but shall be recorded at least:

      1. (i) Weekly for the first two (2) months; and
      2. (ii) Monthly thereafter.

2. (2) Progress notes shall be entered in the patient’s record and shall include the following:

   1. (A) Documentation of implementation of the treatment plan;
   2. (B) Documentation of all treatment rendered to the patient;
   3. (C) Description of change in the patient’s condition; and

   4. (D) Descriptions of the:

      1. (i) Response of the patient to treatment;
      2. (ii) Outcome of treatment; and
      3. (iii) Response of significant others to important intercurrent events.
3. (3) Progress notes shall be dated and signed by the individual making the entry.
4. (4) All entries involving subjective interpretation of the patient’s progress shall be supplemented with a description of the actual behavioral observation.

(o) Treatment plan review.

1. (1) Interdisciplinary case conferences shall be documented and the results of the review and evaluation shall be recorded in the patient’s treatment plan, and his or her progress in attaining the stated treatment goals and objectives.

2. (2)

   1. (A) Interdisciplinary case conferences shall be documented and the results of the review and evaluation shall be recorded in the patient’s record.

   2. (B) The review and update shall be completed:

      1. (i) No later than thirty (30) days following the first ten (10) days of treatment; and
      2. (ii) At least sixty (60) days thereafter.

(p) Discharge planning/aftercare.

1. (1) The facility shall maintain a centralized coordinated program to ensure each patient has a planned program of continuing care that meets his or her postdischarge needs.

2. (2)

   1. (A) Each patient shall have an individualized discharge plan that reflects input from all disciplines involved in his or her care.
   2. (B) The patient, patient’s family, and/or significant others shall be involved in the discharge planning process.

3. (3) Discharge planning data shall be collected:

   1. (A) At the time of admission; or
   2. (B) Within seven (7) days thereafter.
4. (4) The chief executive officer shall delegate the responsibility for discharge planning, in writing, to one (1) or more staff members.

5. (5) The facility shall maintain written discharge planning policies and procedures that describe:

   1. (A) How the discharge coordinator shall function, and his or her authority and relationships with the facility’s staff;
   2. (B) The time period in which each patient’s need for discharge planning is determined (within seven (7) days after admission);
   3. (C) The maximum time period after which reevaluation of each patient’s discharge plan is made;
   4. (D) Local resources available to the facility and the patient to assist in developing and implementing individual discharge plans; and
   5. (E) Provisions for period review and reevaluation of the facility’s discharge planning program at least annually.

6. (6)

   1. (A) An interdisciplinary case conference shall be held prior to the patient’s discharge.

   2. (B) The discharge/aftercare plan shall be reviewed with:

      1. (i) The patient;
      2. (ii) The patient’s family; and/or
      3. (iii) Significant others.
7. (7) The facility shall have documentation of follow-ups to ensure referrals to appropriate community agencies.

(q) Discharge summary.

1. (1) A discharge summary shall be entered in the patient’s record within thirty (30) days following discharge.

2. (2) The discharge summary shall include, but not be limited to:

   1. (A) Reason for admission;
   2. (B) Brief summary of treatment;
   3. (C) Reason for discharge;
   4. (D) Assessment of treatment plan goals and objectives; and
   5. (E) Recommendations and arrangements for further treatment, including prescribed medications and aftercare.