1. (1) Counseling is essential to promote and guide the service recipient to a more productive lifestyle of abstinence from illicit medications or drugs. The assigned qualified counseling provider is responsible for developing and implementing the service recipient’s ITP, in coordination with the treatment team. The ITP shall include S.M.A.R.T. goals or a similar treatment planning method, developed by the qualified counseling provider, the service recipient, and the treatment team. The qualified counseling provider is responsible for assisting the service recipient to alter lifestyles and patterns of behavior to improve the service recipient’s quality of life.

2. (2) The qualified counseling provider caseload shall:

   1. (a) Be no larger than one (1) qualified counseling provider to fifty (50) service recipients;

      1. 1. The Facility can petition the SOTA office, in writing, for a consideration to exceed the ratio for a period no longer than six (6) months. The Facility shall include justification and documentation for requiring the adjustment; and
      2. 2. An extension can be submitted, for a period not to exceed an additional six (6) months, to the SOTA office with sufficient documentation outlining why an extension is necessary;

   2. (b) Allow the Facility to provide adequate:

      1. 1. Psychosocial assessment;
      2. 2. Treatment planning; and
      3. 3. Individualized counseling;
   3. (c) Allow for regularly scheduled counseling sessions; and

   4. (d) Allow service recipients access to their primary counselor if more frequent contact is merited by need or is requested by the service recipient.

      1. 1. Telehealth is available as an option for more frequent contact with the counselor if desired or needed by the service recipient. Telehealth visits shall not exceed fifty percent (50%) of the service recipient’s total visits.
      2. 2. In extraordinary situations, telehealth sessions may account for more than fifty percent (50%) of a patient’s counseling sessions if first approved by the SOTA.
3. (3) The qualified counseling provider supervisor caseload shall be no larger than one (1) qualified counseling provider supervisor to twenty-five (25) service recipients. The Facility can petition the SOTA office, in writing, for consideration to exceed the ratio for a period no longer than six (6) months. The Facility shall include justification and documentation for requiring the adjustment. OPIOD TREATMENT PROGRAM FACILITIES
4. (4) The Facility shall take service recipient preferences into account when assigning their qualified counseling provider, as appropriate.

5. (5) For all service recipients, the following counseling schedule shall be followed:

   1. (a) During the first thirty (30) days of treatment, counseling session(s) shall be scheduled to take place at least two (2) times per week. The initial counseling session shall be conducted in person, and counseling sessions conducted via telehealth shall not exceed twenty-five percent (25%) of the required sessions.
   2. (b) During the next ninety (90) days of treatment (day thirty-one (31) to day one hundred twenty (120)), counseling session(s) shall be scheduled to take place either via telehealth or in person at least one (1) time per week.
   3. (c) During the following ninety (90) days of treatment (day one hundred twenty-one (121) to day two hundred ten (210)), counseling session(s) shall be scheduled to take place either via telehealth or in person at least two (2) times per month.
   4. (d) For subsequent ninety (90)-day periods of treatment (day two hundred eleven (211) forward), counseling session(s) shall be scheduled to take place either via telehealth or in person as needed or indicated in the service recipient’s ITP, but not less frequently than monthly.
   5. (e) Counseling sessions occurring on day thirty-one (31) and forward can utilize telehealth visits for up to fifty percent (50%) of the service recipient’s sessions. Session type shall be based on counselor evaluation and service recipient needs and be clearly documented in the service recipient’s medical record. In extraordinary situations, telehealth sessions accounting for more than fifty percent (50%) of a patient’s counseling sessions may be approved by the SOTA upon request.
6. (6) Exceptions to the frequency of counseling sessions shall be service recipient-specific and clearly justified and documented in the patient’s ITP.
7. (7) The program provider evaluating the service recipient’s eligibility for take-home doses shall carefully consider the service recipient’s participation in the counseling sessions as a factor in their decision.
8. (8) The qualified counseling provider or program provider is responsible for documentation of their significant contact with each service recipient, which shall be filed in the service recipient’s medical record. Significant contact can include, but not be limited to, in-person counseling, telephone calls, telehealth calls, or web-based calls.

9. (9) The counseling session documentation shall include a thorough and detailed description of:

   1. (a) The reason for or nature of the contact;
   2. (b) The service recipient’s current condition;
   3. (c) Significant events occurring since prior contact;
   4. (d) The assessment of the service recipient’s status;
   5. (e) A description of the therapeutic technique used during the session; and OPIOD TREATMENT PROGRAM FACILITIES
   6. (f) A plan for action or further treatment that addresses the goals of the treatment plan.
10. (10) Each entry shall be completed within twenty-four (24) hours of the contact and shall be clearly dated and initialed or signed by the staff person involved.
11. (11) Opportunities for family involvement in counseling shall be provided and documented.

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404. Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.