1. (1) Each provider shall:

   1. (a) develop and implement a plan on how to support opioid overdose reversal;
   2. (b) maintain proof of completion of the National Survey of Substance Abuse Treatment Services annually; and
   3. (c) ensure medical cannabis is not used as an enticement for a client or offered, referred, or recommended as treatment for substance use disorder.

2. (2) A provider providing medication for opioid use disorder (MOUD) shall:

   1. (a) maintain a program-wide ratio of one counselor for every 65 clients to provide adequate substance use counseling to each client as clinically necessary; and
   2. (b) ensure that, at least once yearly, each client sees a licensed practitioner that may prescribe controlled substances.

3. (3) Each MOUD provider that prescribes, administers, or dispenses methadone shall:

   1. (a) admit a client to the program only after the completion of a face-to-face visit with a licensed practitioner authorized to prescribe controlled substances who confirms that client's opioid dependence;
   2. (b) ensure that a licensed practitioner authorized to prescribe controlled substances approves every subsequent dose increase before the change;
   3. (c) require each client admitted to the program to participate in random drug testing performed at least eight times a year for each client in maintenance treatment, in accordance with generally accepted clinical practice and with 42 CFR 8 (2025); and
   4. (d) require and document at least one hour of prescribing practitioner time at the program site each month for every ten enrolled MOUD clients.

4. (4) Each MOUD program that prescribes, administers or dispenses methadone shall:

   1. (a) maintain Substance Abuse and Mental Health Services Administration certification and accreditation as an opioid treatment program;

   2. (b) employ:

      1. (i) a licensed physician who is an ASAM-certified physician;
      2. (ii) a prescribing licensed practitioner who can document specific training in current industry standards regarding methadone treatment for opioid addiction; or
      3. (iii) a prescribing licensed practitioner who can document specific training or experience in methadone treatment for opioid addiction; and
   3. (c) provide one covered provider, as defined in Section 58-17b-309.7, to dispense or administer medication for every 150 methadone clients dosing on an average of a daily basis.

5. (5) A provider may offer services from a mobile unit, as defined in Section 58-17b-309.7, under the provider's physical site license if:

   1. (a) the existing licensed site provides MOUD services;
   2. (b) the provider maintains policy and procedures in accordance with department policy applicable to a mobile unit and Rule R523-10; and
   3. (c) the provider meets registration requirements of 21 CFR 1300, 1301, and 1304 (April 1, 2021), published by the Office of the Federal Register, incorporated by reference in this rule.
6. (6) An alcohol and drug education provider may only provide court-ordered education if certified to do so through the OSUMH in accordance with Rule R523-11.

7. (7) A licensed substance use disorder counselor (SUDC) in a substance use disorder outpatient treatment program may:

   1. (a) collect client information;
   2. (b) conduct the screening portion of an assessment;
   3. (c) make level of care recommendations; and
   4. (d) identify a substance use disorder.
8. (8) A SUDC may not diagnose a client.

9. (9) A OSUMH-certified alcohol and drug education provider shall:

   1. (a) complete and maintain a substance use screening:

      1. (i) for each client before providing the education course; and
      2. (ii) that may be shared between providers with written client consent;
   2. (b) provide a workbook to each client to keep upon completion of the course;
   3. (c) ensure at least 16 hours of course education; and
   4. (d) provide separate classes for adults and youth.

10. (10) A provider offering services to a justice-involved client shall:

    1. (a) operate in compliance with Rule R523-3;

    2. (b) maintain a validated criminogenic screen or risk assessment for each justice-involved client which is conducted with an accepted tool, including:

       1. (i) Level of Service Inventory-Revised (LSI-R);
       2. (ii) Risk and Needs Triage (RANT);
       3. (iii) Ohio Risk Assessment System (ORAS): or
       4. (iv) any other screen that the provider can demonstrate the validation to the OSUMH:
    3. (c) separate clients into treatment groups according to each client's assessed level of risk;
    4. (d) complete screenings that assess substance abuse and mental health comorbidity; and
    5. (e) treat, or refer to another licensed department program that serves justice-involved clients to treat, an array of disorders noted in the screening.

KEY: human services, licensing, outpatient treatment programs

Date of Last Change: January 26, 2026

Notice of Continuation: February 28, 2025

Authorizing, and Implemented or Interpreted Law: 26B-2-104