Sec. 818.7. Staffing

(a) Medical Director and medical staff.

(1) The medical director, as defined in Part 800 of this Title, shall oversee the development and revision of medical policies, procedures and ongoing training for matters such as routine medical care, specialized services, and medical and psychiatric emergency care, and supervision of medical staff.

(2) Programs providing treatment for persons with co-existing medical or psychiatric conditions in addition to their substance use disorder shall have an appropriately qualified physician, physician's assistant, nurse practitioner, psychiatrist or psychologist on-site or through telepractice, pursuant to Part 830 of this Title, providing coverage as adequate and necessary to provide evaluation, treatment and supervision of such other services for these patients.

(3) There shall be at least one full-time registered professional nurse and additional licensed practical nurses, registered nurses, registered physician's assistants, and nurse practitioners sufficient to provide the services required. Such personnel shall be available to all patients at all times.

(4) The medical director may also serve as a physician of another service which is provided by the facility.

(b) Staff sharing.

Staff may be either specifically assigned to the inpatient service or may be part of the staff of the facility within which the inpatient service is located. However, if these staff members are part of the general facility staff, they must have specific training and experience in the treatment of substance use disorder specific to the services provided. The percentage of time that each shared staff is assigned to the inpatient service must be documented.

(c) Supervision and training.

Each program must provide clinical supervision and ensure and document a plan for staff training based on individual employee needs. Subject areas appropriate for training shall be identified by the office.

(d) Program director.

There shall be a director of the program who is a qualified health professional with at least three years-experience in the provision of alcoholism, substance abuse, and/or chemical dependence services, and at least two additional years of supervisory experience prior to appointment as director.

(e) Other clinical staff.

(1) At least 50 percent of all clinical staff shall be qualified health professionals as defined in Part 800 of this Title. CASAC Trainees may be counted towards satisfying the 50 percent requirement provided, however, that such individuals shall not be considered qualified health professionals for any other purpose under this Part.

(2) Clinical staff members who are not qualified health professionals shall have qualifications appropriate to their assigned responsibilities as set forth in the inpatient service's written personnel policies, shall be subject to appropriate staff supervision, and shall receive regular and continuing education and training.

(3) There shall be at least one clinical staff member, as defined in Part 800 of this Title, designated to provide activities therapy.

(4) There shall be at least one counselor for every 8 patients, at least 50 percent of whom shall be qualified health professionals. Counseling staff shall be scheduled for a minimum of 1½ shifts 5 days per week, and 1 shift per day for the remaining 2 days per week.

(5) There shall be clinical staff available to all patients at all times. During late evening and night shifts, there shall be at least two clinical staff members on duty. This staff shall be awake at all times, make frequent rounds and be available to patients who awaken during the night.

(6) There shall be sufficient clinical staff, allocated based on clinical demands of each shift, to achieve an overall program ratio of at least the following:

(i) if the program has 80 patients or more, 1 full time equivalent staff for each 4 patients;

(ii) if the program has between 31 and 79 patients, at least 1 full time equivalent staff for each 3½ patients; and

(iii) if the program has 30 or fewer patients, at least 1 full time equivalent staff for each 3 patients.

(f) Additional required staff.

(1) Maintenance and security.

There shall be sufficient staff available to ensure that the inpatient program and all equipment utilized therein is maintained in such a manner as to provide patients with a clean and safe environment.

(2) Volunteers and interns.

In addition to staffing requirements of this Part, an inpatient service may utilize volunteers, students and trainees, on a salaried or non-salaried basis. Such personnel shall be provided close professional staff supervision and appropriate education from both internal and external sources.

(3) Health coordinator.

Each inpatient program shall have a qualified individual designated as the health coordinator who will ensure the provision of education, risk reduction, counseling and referral services to all patients regarding HIV and AIDS, tuberculosis, hepatitis, sexually transmitted diseases, and other communicable diseases.