Outpatient Substance Abuse Treatment Licensure Regulations

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• Outpatient Substance Abuse Treatment Licensure
  Regulations
• July 2009

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DAS Mission Statement

• The Division of Addiction Services (DAS) promotes
  the prevention and treatment of substance abuse
  and supports the recovery of individuals affected
  by the chronic disease of addiction. As the
  Single State Agency for substance abuse, DAS is
  responsible for regulating, licensing,
  monitoring, planning and funding substance abuse
  prevention, treatment and recovery support
  services in New Jersey.
• To achieve its mission, DAS provides leadership
  and collaborates with providers, consumers, and
  other stakeholders to develop and sustain a
  system of client-centered care that is
  accessible, culturally competent, accountable to
  the public, and grounded in best practices that
  yield measurable results.

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Changes from N.J.A.C. 843A to N.J.A.C. 10161B

• Staff Qualifications
• Staff Supervision
• Treatment Services
• Quality Assurance
• Volunteer Services
• Drug Screening

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Staff Qualifications

• Administrator-N.J.A.C. 843A-1.4
• A baccalaureate degree and two years of full-time
  or full-time equivalent, administrative or
  supervisory experience in a health care facility.
  Each additional year of full-time or full-time
  equivalent, administrative or supervisory
  experience and/or training in a health care
  facility may be substituted for each year of the
  four-year degree requirement. Four years of such
  experience and/or training may be used to satisfy
  the degree requirement.

• Administrator-N.J.A.C. 10161B-1.7
• A masters degree and two years full-time or
  full-time equivalent, administrative or
  supervisory experience in a substance abuse
  treatment facility.
• Individuals who do not meet the above
  qualifications shall have a Bachelors degree and
  five years of full-time or full-time equivalent,
  administrative or supervisory experience in a
  substance abuse treatment facility.

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Staff Qualifications

• Director of Nursing-N.J.A.C. 843A-110
• Shall be a registered professional nurse and
  shall have at least one year of full-time, or
  full-time equivalent, experience in nursing
  supervision and/or nursing administration in a
  licensed health care facility

• Director of Nursing-N.J.A.C. 10161B-1.5
• Registered Professional Nurse licensed in New
  Jersey
• In facilities not required but electing to
  appoint a Director of Nursing, at least six (6)
  months of full-time experience, or the full-time
  equivalent, in nursing supervision or nursing
  administration in the management of addictions in
  a licensed substance abuse treatment facility
• In an opioid treatment facility must have one (1)
  year of supervisory experience or three (3) years
  of experience working in a substance abuse
  treatment program or facility

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Staff Qualifications

• Director of Substance Abuse Counseling Services
• No requirements specified in N.J.A.C. 843A

• Director of Substance Abuse Counseling Services
  N.J.A.C. 10161B-1.8
• A New Jersey licensed psychologist with a
  Certification of Proficiency from APA in Alcohol
  and other Psychoactive Substance Use Disorders
  with a CCS or LCADC
• A New Jersey licensed clinical social worker with
  a CCS or LCADC
• A New Jersey licensed professional counselor with
  a CCS or LCADC
• A New Jersey licensed clinical alcohol and drug
  counselor with a Masters degree recognized by
  the New Jersey Board of Marriage and Family
  Therapy Examiners
• A New Jersey licensed, ASAM certified physician
  or board-certified psychiatrist
• A New Jersey licensed advanced practice nurse
  with CCS or LCADC

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Staff Qualifications

• Qualifications of drug counselors-N.J.A.C.
  843A-1.11
• Staffing ratio of 75/25 credentialed to
  non-credentialed staff
• CADC certified
• Certified by the American Academy of Health Care
  Providers in the Addictive Disorders
• Social Worker in accordance with N.J.A.C.
  843A-1.27
• Baccalaureate in Social Sciences and one (1) year
  experience in drug counseling
• Currently enrolled in a program leading to one of
  the above

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Staff Qualifications

• Substance Abuse Counselors-N.J.A.C. 10161B-1.9
• Staffing ratio of 50/50 credentialed to
  non-credentialed staff
• Recognizes licensed healthcare credentials,
  including LCADCs and CADCs, for which work of an
  alcohol and drug counseling nature is within the
  scope of practice.
• Non-credentialed staff are counselor interns
  actively working towards CADC, LCADC, or another
  healthcare professional license that includes
  work of an alcohol or drug counseling nature
  within its scope of practice.
• Counselor interns must be enrolled in a course of
  study leading to the CADC, LCADC or another
  healthcare professional license regulated by the
  New Jersey State Board of Marriage and Family
  Therapy Examiners Alcohol and Drug Counselor
  Committee, Professional Counselor Committee,
  State Board of Social Workers, or State Board of
  Psychological Examiners.
• Counselor interns must have supervision per the
  New Jersey State Board of Marriage and Family
  Therapy Examiners Alcohol and Drug Counselor
  Committee.

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Treatment Services

• Nursing Services-N.J.A.C. 843A-Subchapter 8
• Nursing services shall be provided directly by
  the facility or by written agreement
• Shall have a designee in the absence of the
  Director of Nursing
• The Nursing care needs of the patient shall be
  assessed only by a registered professional nurse

• Nursing Services-N.J.A.C. 10161B-Subchapter 8
• Outpatient (OP), Intensive Outpatient (IOP) and
  Partial Care (PC) programs are not required to
  provide nursing services.
• Primary counselors (or designee) are responsible
  for obtaining health related information from the
  client and record such information in the
  clinical chart in the above programs.
• Provide a mechanism for referring clients for
  medical services as needed.
• Opioid Treatment and Detoxification programs
  shall appoint a Director of Nursing
  Services-10161B-8.2.

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Treatment Services

• Responsibilities of the Director of Substance
  Abuse Counseling Services
• No requirements specified in N.J.A.C. 843A

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Treatment Services

• Responsibilities of the Director of Substance
  Abuse Counseling Services-N.J.A.C. 10161B-1.8
• Must provide clinical supervision as per N.J.A.C.
  1334C-6.0
• If not providing clinical supervision, shall
  ensure that direct clinical supervision is
  provided by a staff person who meets the
  requirements under N.J.A.C. 1334C-6.3
• Is responsible for ensuring that direct clinical
  supervision is provided at least one hour per
  week to all clinical staff, individually or in a
  group setting, with group supervision not to
  exceed 50 percent of supervision time
• Ensure documentation of direct clinical
  supervision
• Develop written objectives, policies and
  procedures, and quality assurance
  measures/activities for the provision of
  substance abuse counseling services to be
  reviewed by the administrator
• Ensure that assessment, and treatment for clients
  with co-occurring disorders is provided by
  appropriately trained and qualified clinical
  staff

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Treatment Services

• Responsibilities of the Substance Abuse
  Counseling Staff
• No requirements specified in N.J.A.C. 843A

• Responsibilities of the Substance Abuse
  Counseling Staff-N.J.A.C. 10161B-1.9
• Must be supervised by appropriately credentialed
  staff
• Assess clients using ASI or other standardized
  clinical assessment tool
• Diagnose clients for a substance abuse disorder
  using the DSM-IV TR as permitted within scope of
  practice
• Recommend appropriate level of care using ASAM
  PPC2-R
• Develop treatment plans that are client-centered,
  with measurable objectives and recovery oriented
• Conduct ongoing review of treatment plans and
  reviewing clients throughout treatment episodes
  according to ASAM PPC2-R
• Provide discharge planning
• Participate as a member of the multi-disciplinary
  treatment team

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Treatment Services

• Provision of Counseling Services-N.J.A.C. 843A
• The facility shall provide counseling services
  through written agreement or referral
• Develop policies and procedures
• Coordination and integration of counseling
  services
• Documentation of clinical services

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Treatment Services

• Provision of Substance Abuse Counseling-N.J.A.C.
  10161B-10.1
• Provide counseling services on site and assign
  every client to a primary substance abuse
  counselor at admission
• Individual Sessions OP-Monthly, IOP-Weekly,
  PC-Weekly (based upon determination of
  multi-disciplinary treatment team)
• Family Sessions OP-Monthly, IOP-Monthly,
  PC-Weekly (unless clinically contraindicated or
  the client and/or family members refuse to
  participate)
• Group counseling sessions shall not exceed an
  average of 12 clients and shall not exceed 14
  clients in any one session. This does not apply
  to psychoeducational or family counseling
  services.

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Treatment Services

• Provision of Substance Abuse Counseling-N.J.A.C.
  10161B-10.1
• Primary counselor to client ratio
• Outpatient 135
• Intensive Outpatient 124
• Partial Care 112
• Outpatient Detoxification 124
• Opioid Treatment Program 150
• (no single OTP counselor caseload of up to 50
  clients shall include more than 35 clients in
  Phases I-III)

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Treatment Services

• Co-Occurring Services
• No requirements specified in N.J.A.C. 843A

• Co-Occurring Services-N.J.A.C. 10161B-10.4
• Must have clearly written policies governing the
  treatment of individuals with co-occurring
  disorders (COD) in a coordinated fashion
• Ensure clinical supervision is provided by
  appropriately credentialed supervisors
• Must have appropriately qualified clinical and
  medical staff assessing/treating individuals with
  COD
• Provide case consultation and coordination and,
  where appropriate, referrals to mental health
  programs

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Opioid Treatment Services

• Opioid Treatment Services-N.J.A.C. 843A-26.5
• Drug counselors caseload cannot exceed 50
  patients
• Stage 1 One (1) counseling session per week
  (first 3 months of treatment)
• Stage 2 At least one (1) counseling session
  every two weeks (four to nine months of
  treatment)
• Stage 3 One (1) counseling session per month
  (10th month to end of two years of treatment)
• Stage 4 One (1) counseling session every three
  months (after two years of treatment)
• Availability of group, family, and/or vocational
  counseling

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Opioid Treatment Services

• Opioid Treatment Services-N.J.A.C. 10161B
  Subchapter 11
• Medical Director required, ASAM certified by June
  1, 2012 per 10161B11.2(a)
• Must employ a full-time Director of Substance
  Abuse Counseling Services as per N.J.A.C.
  10161B-11.2(b)
• Opioid Treatment Program Client to Staff Ratios
  150
• no single OTP counselor caseload of up to 50
  clients shall include more than 35 clients in
  Phases I-III
• Comply with CSAT publication TIP-43
  Medication-Assisted Treatment for Opioid
  Addiction in Opioid Treatment Programs.
• Opioid Treatment Programs shall participate in
  registry or other data management system
  implemented by DAS.

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Opioid Treatment Services

• Opioid Treatment Services-N.J.A.C. 10161B
  Subchapter 11
• Phase I-A Clients in Phase I for a period of at
  least 12 months who have failed to progress in
  treatment.
• Phase I One (1) counseling session per week (a
  total of four counseling sessions per month with
  one (1) session being an individual session).
  Phase I shall be three (3) months.
• Phase II Two (2) counseling session per month
  (one (1) being an individual session). Phase II a
  minimum of six (6) months.
• Phase III One (1) counseling session per month.
  Phase III shall be a minimum of nine (9) months.
• Phase IV A minimum of one (1) individual
  session every three (3) months. Phase IV shall
  be a minimum of six (6) months.
• Phase V Clients with 24 consecutive months of
  negative drug screen and meets other program
  criteria will receive counseling services as
  determine by the multi-disciplinary treatment
  team.
• Phase VI Clients with 36 consecutive months of
  negative drug screens and meets other program
  criteria will receive counseling consistent with
  clinical needs as determined by the
  multi-disciplinary treatment team.

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Detoxification Services

• Detoxification Services
• No requirements specified in N.J.A.C. 843A

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Detoxification Services

• Detoxification Services-N.J.A.C.
  10161B-Subchapter 12
• Must be licensed by DAS to provide outpatient
  detoxification services
• Clients must meet ASAM PPC-2R Level I-D or II-D
  criteria
• Medical Director required, ASAM certified by June
  1, 2012
• Advanced Practice Nurses (APNs) and/or Physician
  Assistants (PAs) can provide services
• Registered Nurse (RN) must be on duty all hours
  of operation when clients being detoxed are
  present
• Must employ a full time Director of Substance
  Abuse Services as per N.J.A.C. 10161B-1.8
• Twenty-Four (24) hour access to a nurse on call
  for clients and family
• Clients shall participate in IOP or PC programs
  as soon as medically possible
• AA or NA 12-Step support group strongly
  encouraged
• Drug screenings done at least weekly during the
  detoxification process
• DAS does not condone ultra rapid opioid
  detoxification or rapid detoxification as a means
  for detoxification from opioids or other
  substances
• Policy and Procedures shall be consistent with
  ASAM PPC-2R criteria and CSAT Treatment
  Improvement Protocol, TIP 45 Detoxification from
  Alcohol and Other Drugs formerly known as TIP 19
• Treatment interventions shall be clearly
  documented in clients clinical record

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Licensure Implementation Plan

• Application process
• Surveys and renewals in the next six months
• What happens when current licenses expire?
• Citing deficiencies under N.J.A.C. 10161B
• Provisional and conditional licenses
• Technical assistance

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Questions and Answers