A. The following words and terms when used in this chapter shall have the meanings ascribed in 12VAC35-270-20:

"Admission"

"Authorized representative"

"Behavior intervention"

"Brain injury"

"Case management service" or "support coordination"

"Clinically managed high-intensity residential care" or "Level of care 3.5"

"Clinically managed low-intensity residential care" or "Level of care 3.1"

"Clinically managed population-specific high-intensity residential services" or "Level of care 3.3"

"Commissioner"

"Correctional facility"

"Department"

"Developmental disability"

"Discharge"

"Discharge plan"

"Emergency services (crisis intervention)"

"Group home"

"Individual" or "individual receiving services"

"Individualized services plan" or "ISP"

"Informed choice"

"Initial assessment"

"Intermediate care facility/individuals with intellectual disability" or "ICF/IID"

"Medically managed intensive inpatient service" or "Level of care 4.0"

"Medically monitored intensive inpatient treatment" or "Level of care 3.7"

"Medication"

"Medication administration"

"Mental illness"

"Person-centered"

"Provider"

"Referral"

"Residential service"

"Screening"

"Seclusion"

"Service"

"Sponsored residential home"

"Substance abuse (substance use disorders)"

B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Allied health professional" means a professional who is involved with the delivery of health or related services pertaining to the identification, evaluation, and prevention of diseases and disorders, such as a certified substance abuse counselor, certified substance abuse counseling assistant, peer recovery support specialist, certified nurse aide, or occupational therapist.

"ASAM" means the American Society of Addiction Medicine.

"Care," "support," or "treatment" means the individually planned therapeutic interventions that conform to current acceptable professional practice and that are intended to improve or maintain functioning of an individual receiving services delivered by a provider.

"Clinical experience" means providing direct services to individuals with mental illness or the provision of direct geriatric services or special education services. Experience may include supervised internships, practicums, and field experience.

"Comprehensive assessment" means a comprehensive and written assessment that updates and finalizes the initial assessment. The comprehensive assessment shall consider the individual's needs, strengths, goals, preferences, and abilities within the individual's cultural context and shall be completed in a time period appropriate to the nature and scope of the service provided. The comprehensive assessment includes all relevant social, psychological, medical, and level of care information as the basis for the development of the person-centered comprehensive ISP. The comprehensive assessment may be completed at the time of initial assessment if it includes all elements of the comprehensive assessment. In the event a comprehensive assessment is completed at the time of an initial assessment the provider is not required to update the assessment.

"Co-occurring disorders" means the presence of more than one and often several of the following disorders that are identified independently of one another and are not simply a cluster of symptoms resulting from a single disorder: mental illness, a developmental disability, substance abuse (substance use disorders), or brain injury.

"Co-occurring services" means individually planned therapeutic treatment that addresses in an integrated concurrent manner the service needs of individuals who have co-occurring disorders.

"Credentialed addiction treatment professional" means a person who possesses one of the following credentials issued by the appropriate health regulatory board:

1. An addiction-credentialed physician or physician with experience or training in addiction medicine;

2. A licensed nurse practitioner or a licensed physician assistant with experience or training in addiction medicine;

3. A licensed psychiatrist;

4. A licensed clinical psychologist;

5. A licensed clinical social worker;

6. A licensed professional counselor;

7. A licensed psychiatric clinical nurse specialist;

8. A licensed psychiatric nurse practitioner;

9. A licensed marriage and family therapist;

10. A licensed substance abuse treatment practitioner;

11. A resident who is under the supervision of a licensed professional counselor (18VAC115-20-10), licensed marriage and family therapist (18VAC115-50-10), or licensed substance abuse treatment practitioner (18VAC115-60-10) and is registered with the Virginia Board of Counseling;

12. A resident in psychology who is under supervision of a licensed clinical psychologist and is registered with the Virginia Board of Psychology (18VAC125-20-10); or

13. A supervisee in social work who is under the supervision of a licensed clinical social worker and is registered with the Virginia Board of Social Work (18VAC140-20-10).

"Developmental services" means planned, individualized, and person-centered services and supports provided to individuals with developmental disabilities for the purpose of enabling the individual to increase self-determination and independence, obtain employment, participate fully in all aspects of community life, self-advocate, and achieve the individual's fullest potential to the greatest extent possible.

"Diagnostic and Statistical Manual of Mental Disorders" or "DSM" means the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, DSM-5, of the American Psychiatric Association.

"Initial individualized service plan" or "initial ISP" means a written plan developed and implemented 24 hours after admission to address immediate service, health, and safety needs as identified within the individual's initial assessment.

"Intensity of service" means the number, type, and frequency of staff interventions and other services provided during treatment at a particular level of care.

"Licensed mental health professional" or "LMHP" means a physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, certified psychiatric clinical nurse specialist, licensed behavior analyst, or licensed psychiatric/mental health nurse practitioner.

"Location" means a place where services are or could be provided.

"Medical screening" means the collection of information about the nonpsychiatric medical or surgical condition of an individual to determine whether there is a need for a physical assessment before a decision is made regarding admission to the provider's service.

"Medication-assisted treatment" or "MAT" means the use of FDA-approved medications in combination with counseling and behavioral therapies to provide treatment of substance use disorders. Medication-assisted treatment includes medication-assisted opioid treatment.

"Medication error" means an error in administering a medication to an individual and includes when any of the following occur:

1. The wrong medication is given to an individual;

2. The wrong individual is given the medication;

3. The wrong dosage is given to an individual;

4. Medication is given to an individual at the wrong time or not at all; or

5. The wrong method is used to give the medication to the individual.

"Medication storage" means any area where medications are maintained by the provider, including a locked cabinet, locked room, or locked box.

"Motivational enhancement" means a person-centered approach that is collaborative, employs strategies to strengthen motivation for change, increases engagement in substance use services, resolves ambivalence about changing substance use behaviors, and supports individuals to set goals to change substance use.

"Planning team" means the team that is consulted to plan the individual's plan for supports. The planning team shall, at a minimum, consist of the individual receiving services and the case manager and any legally required authorized representative, including a legal guardian. The planning team may include the individual's family or family of choice or other identified persons, as desired by the individual.

"Qualified mental health professional-adult" or "QMHP-A" means a person who by education and experience is professionally qualified and registered with the Board of Counseling in accordance with 18VAC115-80 to provide collaborative mental health services for adults. A QMHP-A shall provide such services as an employee or independent contractor of the department or a provider licensed by the department. A QMHP-A may be an occupational therapist who by education and experience is professionally qualified and registered with the Board of Counseling in accordance with 18VAC115-80.

"Qualified mental health professional-trainee" or "QMHP-T" means a person receiving supervised training to qualify as a QMHP-A or QMHP-C in accordance with 18VAC115-80 and who is registered with the Board of Counseling.

"Signed" or "signature" means a handwritten signature, an electronic signature, or a digital signature, as long as the signer showed clear intent to sign.

Providers shall be licensed to provide specific services as defined in 12VAC35-270, this chapter, or as determined by the commissioner. The following services shall require a residential license:

1. Clinically managed high-intensity residential services or level of care 3.5 for adults;

2. Clinically managed high-intensity residential services or level of care 3.5 for children and adolescents;

3. Clinically managed low-intensity residential services or level of care 3.1 for adults;

4. Clinically managed low-intensity residential services or level of care 3.1 for children and adolescents;

5. Clinically managed population-specific high-intensity residential services or level of care 3.3;

6. Group home for adults;

7. Group home for children and adolescents;

8. ICF/IID for adults;

9. ICF/IID for children and adolescents;

10. Inpatient;

11. Medically managed intensive inpatient service or level of care 4.0;

12. Medically monitored intensive inpatient service or level of care 3.7;

13. QRTP - Psychiatric rehabilitation treatment facility;

14. QRTP - Group home;

15. Respite residential for adults;

16. Respite residential for children and adolescents;

17. Sponsored residential home; and

18. Supervised living.

A. Clinically managed high-intensity residential services include services that provide 24-hour supportive treatment in an environment to initiate or continue a recovery process that has failed to progress. Clinically managed high-intensity residential services are characterized by reliance on the treatment community as a therapeutic agent. These services include therapeutic community with appropriately clinically trained staff or a residential treatment center.

B. Clinically managed low-intensity residential services include low-intensity treatment of substance-related disorders. Treatment is characterized by services such as individual, group, and family therapy; medication management; and psychoeducation. These services include halfway houses, group homes, and other supportive living environments with 24-hour staff and close integration with clinical services.

C. Clinically managed population-specific high-intensity residential services include a structured recovery environment in combination with high-intensity clinical services provided in a manner to meet the functional limitations of patients to support recovery from substance-related disorders. These services include therapeutic rehabilitation facilities and traumatic brain injury programs.

D. Group home services include 24-hour direct awake supervision in a community-based home having eight or fewer residents. Services include supervision, supports, counseling, and training in activities of daily living.

E. ICF/IID services include aggressive, consistent implementation of a program of specialized and generic training, treatment, health services, and related services that is directed toward the acquisition of the behaviors necessary for the individual to function with as much self-determination and independence as possible and the prevention or deceleration of regression or loss of current optimal functional status.

F. Inpatient services include intensive 24-hour medical, nursing, and treatment services provided to individuals with developmental disabilities, mental illness, or substance use disorders in a hospital or in a special unit of a hospital.

G. Medically managed intensive inpatient services include services delivered in an acute care inpatient setting. Such a program includes a regimen of medically directed evaluation and treatment services provided in a 24-hour treatment setting. These services include acute care general hospitals, acute psychiatric hospitals, psychiatric units within acute care general hospitals, and licensed addiction treatment specialty hospitals with acute care medical and nursing staff.

H. Medically monitored intensive inpatient services include a planned and structured regimen of 24-hour professionally directed evaluation, observation, medical monitoring, and addiction treatment in an inpatient setting. Medically monitored intensive inpatient services include an inpatient treatment center within the context of an acute care hospital or acute psychiatric unit, or a more intensive separate unit of a freestanding residential facility.

I. QRTP services include implementation of a trauma-informed treatment model designed to address the needs, including clinical needs as appropriate, of children with serious emotional or behavioral disorders or disturbances and, with respect to a child, that is able to implement the treatment identified for the child by assessment. QRTPs shall have registered or licensed nursing staff and other licensed clinical staff who provide care within the scope of their practice, are on site during business hours, and are available 24 hours a day and seven days a week. QRTPs shall, to the extent appropriate and in accordance with the child's best interests:

1. Facilitate participation of family members in the child's treatment program;

2. Facilitate outreach to the child's family members, including siblings;

3. Document how the outreach is made;

4. Maintain contact information for any known biological family and fictive kin; and

5. Document how family members are integrated into the treatment process for the child, including post-discharge, and how sibling connections are maintained.

QRTP services include discharge planning and family-based aftercare for at least six months post-discharge. QRTPs shall be accredited by an independent, not-for-profit accrediting organization approved by the U.S. Secretary of Health and Human Services.

J. Respite residential services include providing for a short-term, time-limited period of care of an individual for the purpose of providing relief to the individual's family, guardian, or regular caregiver within a residential setting.

K. Sponsored residential home services include a service where providers arrange for, supervise, and provide programmatic, financial, and service support to a family or sponsor providing care or treatment in the family's or sponsor's own home for individuals receiving services.

L. Supervised living services include the provision of direct supervision and community support services to individuals living in apartments or other residential settings.

A. Providers shall implement screening policies that include:

1. Identification, qualification, training, and duties of employees responsible for screening;

2. The following minimum required elements of screening for a residential setting:

a. Date of contact;

b. Legal name, preferred name, date of birth, sex, and gender of the individual;

c. Contact information for the individual, including address, telephone number, and email address, if applicable;

d. Reasons the individual is requesting services;

e. Current diagnoses and medical conditions;

f. Medical symptoms;

g. Psychoactive or other medications currently being used, including recent increases, decreases, discontinuation, misuse, or overdose of prescription medication;

h. Recent or current substance use or dependence, including risk for intoxication or substance withdrawal; and

i. Status of the individual, including the individual's referral to other services, further assessment, placement on a waiting list for service, or admission to the service; and

3. Methods to identify other appropriate services for referral to assist individuals who are not admitted to service after screening.

B. For an individual not admitted to the service, the provider shall retain documentation of the individual's screening for six months. For an individual who is admitted to service, documentation shall be included in the individual's record in accordance with 12VAC35-270-580.

C. The provider shall review all elements of the screening at the time of initial assessment and update as necessary.

A. The provider shall implement a written assessment policy. The policy shall define how assessments will be conducted and documented.

B. The provider shall actively involve the individual and the individual's authorized representative, if applicable, in the preparation of initial and comprehensive assessments. In these assessments, the provider shall consider the individual's needs, strengths, goals, preferences, and abilities within the individual's cultural context.

C. The assessment policy shall designate appropriately qualified employees or contractors who are responsible for conducting, obtaining, or updating assessments and medical screenings. These employees or contractors shall have experience in working with the needs of individuals who are being assessed, the assessment tools being utilized, and the provision of services that the individuals may require.

D. Assessment is an ongoing activity. The provider shall make reasonable attempts to obtain previous assessments or relevant history. The provider shall use previous assessments or relevant history in order to complete an individual’s initial or comprehensive assessment. The provider shall use previous assessments or relevant history within the course of treatment, if applicable.

E. Providers shall utilize an assessment tool that meets the requirements in subsection F of this section for initial assessments and subsection G of this section for comprehensive assessments. Providers may utilize a standardized state-sanctioned or federally sanctioned assessment tool that does not meet the criteria in these regulations if the tool is approved by the department prior to use.

F. Providers shall conduct an individual's initial assessment prior to or at admission to the service. The provider shall complete or obtain information from other qualified providers in order to complete an initial assessment detailed enough to determine whether the individual qualifies for admission and to initiate an ISP for those individuals who are admitted to the service.

1. The initial assessment of the individual's immediate service, health, and safety needs shall be conducted using an assessment tool that evaluates, at a minimum, the following criteria concerning the individual:

a. Diagnosis;

b. Presenting needs, including the individual's stated needs, psychiatric needs, support needs, and the onset and duration of needs;

c. Current medical issues;

d. Current medications;

e. Current and past substance use or abuse, including co-occurring mental health and substance abuse disorders;

f. At-risk behavior to self and others; and

g. Risk factors that may impact the individual's ability to seek treatment or continue to participate in services.

2. For individuals presenting with substance use disorder, at the time of the initial assessment the provider shall:

a. Identify any individual with a high risk for medical complications or who may pose a danger to himself or others;

b. Assess substances used and time of last use;

c. Document the time of the individual's last meal;

d. Analyze blood alcohol content or administer a breathalyzer; and

e. Record vital signs.

3. The comprehensive assessment may be completed at the time of initial assessment if it includes all elements noted within subsection G of this section. In the event a comprehensive assessment is completed at the time of an initial assessment, the provider is not required to update the assessment unless a reassessment is medically or clinically indicated.

G. Providers shall conduct a comprehensive assessment for each individual who is admitted to the service. A comprehensive assessment shall update and finalize the initial assessment, unless the comprehensive assessment is completed at the time of initial assessment as provided in subdivision F 3 of this section.

1. Completion of the comprehensive assessment shall be based upon the nature and scope of the service but shall occur no later than (i) 30 days after admission for providers of mental health and substance abuse services or (ii) 60 days after admission for providers of developmental services.

2. The comprehensive assessment may be completed at the time of initial assessment only if it includes all elements enumerated in subdivision 3 of this subsection. In the event a comprehensive assessment is completed at the time of an individual's initial assessment, the provider is not required to update the assessment unless a reassessment is medically or clinically indicated.

3. The comprehensive assessment shall be conducted using an assessment tool that evaluates, at a minimum, the following criteria:

a. Onset and duration of needs;

b. Social, behavioral, developmental, and family history and supports;

c. Cognitive functioning, including strengths and weaknesses;

d. Employment, vocational, and educational background;

e. Previous interventions and outcomes, including interventions and outcomes that were unsuccessful, with the provider ensuring that previous assessments are utilized to note prior interventions as required by subsection D of this section;

f. Overall financial situation, including resources, support and benefits, and whether the individual has the means to meet his financial needs;

g. Health history and current medical care needs, to include:

(1) Allergies, including allergies to food or medications;

(2) Recent physical complaints and medical conditions;

(3) Nutritional needs;

(4) Chronic conditions;

(5) Communicable diseases;

(6) Restrictions on physical activities, if any;

(7) Restrictive protocols or special supervision requirements;

(8) Past serious illnesses, serious injuries, and hospitalizations;

(9) Serious illnesses and chronic conditions of the individual's parents, siblings, and significant others in the same household; and

(10) Current and past substance use, including alcohol, prescription and nonprescription medications, and illicit drugs;

h. Psychiatric and substance use issues, including current mental health or substance use needs, presence of co-occurring disorders, history of substance use or abuse, and circumstances that increase the individual's risk for mental illness or substance use issues;

i. History of abuse, neglect, sexual or domestic violence, or other trauma, including psychological trauma;

j. Legal competency status, including authorized representative, commitment, and representative payee status;

k. Relevant criminal charges or convictions and probation or parole status;

l. Daily living skills;

m. Housing arrangements;

n. Ability to access services, including transportation; and

o. As applicable, fall risk, communication methods or needs, and mobility and adaptive equipment needs.

H. The provider shall retain documentation of the individual's assessments in the individual's record for a minimum of six years after the individual's discharge in accordance with § 54.1-2910.4 of the Code of Virginia and the provider's written records management policy pursuant to 12VAC35-270-580.

A. The provider shall actively involve the individual and authorized representative, as appropriate, in the development, review, and revision of a person-centered ISP. The individualized services planning process shall be consistent with laws protecting confidentiality, privacy, human rights of individuals receiving services, and rights of minors.

1. Providers of developmental services shall collaborate with the individual's planning team to develop and implement the initial plan for supports, which is a component of the comprehensive ISP, no later than 24 hours after admission. The initial plan for supports shall address the individual's immediate health and safety needs for the first 60 days, may include assessment activities, and shall continue in effect until the ongoing comprehensive plan for supports is developed or the individual is discharged, whichever occurs first. An ongoing comprehensive plan for supports shall be completed within 60 days of admission.

2. Providers of mental health or substance abuse services shall develop and implement an initial ISP no later than 24 hours after admission. The initial ISP shall address the individual's immediate service, health, and safety needs for the first 30 days and shall continue in effect until the comprehensive ISP is developed or the individual is discharged, whichever occurs first. An ongoing comprehensive ISP based upon the nature and scope of services shall be completed as soon as possible, but no later than (i) 48 hours after admission by providers of short-term intensive services typically provided for less than 30 days, such as inpatient, or (ii) 30 days after admission.

B. If an individual has a case manager, informed choice shall be governed by the service-specific requirements governing case management providers (12VAC35-280). If the individual does not have a case manager, development of the initial ISP and the comprehensive ISP shall be developed based on the respective assessment with the participation and informed choice of the individual receiving services.

1. To ensure the individual's participation and informed choice, the following shall be explained to the individual or the individual's authorized representative, as applicable, in a reasonable and comprehensible manner:

a. The proposed services to be delivered;

b. Any alternative services that might be advantageous for the individual; and

c. Any accompanying risks or benefits of the proposed alternative services.

2. If no alternative services are available to the individual, it shall be clearly documented within the ISP or within documentation attached to the ISP, that alternative services were not available as well as the steps taken to identify alternative services.

3. Whenever there is a change to an individual's ISP, it shall be clearly documented within the ISP or within documentation attached to the ISP that:

a. The individual participated in the development of or revision to the ISP;

b. The proposed and alternative services and their respective risks and benefits were explained to the individual or the individual's authorized representative; and

c. The reasons the individual or the individual's authorized representative chose the option included in the ISP.

A. The initial ISP shall be based on the individual's immediate service, health, and safety needs identified in the initial assessment. The initial ISP shall include:

1. Relevant and attainable goals, measurable objectives, and specific strategies for addressing needs and preferences documented within the individual's initial assessment, including documentation that the individual's needs and preferences are consistent with a residential setting;

2. Services, supports, and frequency of services planned to accomplish the individual's goals, including relevant psychological, mental health, substance abuse, behavioral, developmental, medical, rehabilitation, training, and nursing needs and supports;

3. The role of the individual and others, including the individual's family, if appropriate, in implementing the initial ISP; and

4. Target dates for the accomplishment of goals and objectives.

B. The comprehensive ISP shall be based on the individual's needs, strengths, abilities, personal preferences, goals, and natural supports identified in the comprehensive assessment. The comprehensive ISP shall include the following minimum provisions:

1. Relevant and attainable goals, measurable objectives, and specific strategies for addressing each need documented within the individual's comprehensive assessment, including documentation that the individual's needs require a provider-operated residential setting;

2. Services and supports required to accomplish the individual's goals, including relevant psychological, mental health, substance abuse, behavioral, developmental, medical, rehabilitation, training, and nursing needs and supports;

3. The frequency at which services and supports must be provided to accomplish the individual's goals;

4. The role of the individual and others, including the individual's family. if appropriate, in implementing the comprehensive ISP;

5. A communication plan for individuals with communication barriers, including language barriers;

6. A behavioral support or treatment plan, if applicable;

7. A physical safety plan that addresses identified risks to the individual or to others, including a fall risk plan if indicated by the individual's assessment;

8. A crisis or recovery plan, if applicable;

9. Target dates for accomplishment of goals and objectives;

10. Identification of employees or contractors responsible for coordination and integration of services, including employees of other agencies, if applicable;

11. A transportation plan, if applicable;

12. Services the individual elects to self-direct, if applicable; and

13. Projected discharge plan and estimated length of stay within the service.

C. Both the initial ISP and the comprehensive ISP shall be signed and dated, at a minimum, by (i) the person responsible for implementing the plan and (ii) the individual receiving services or the authorized representative, if applicable, in order to document agreement.

1. If the signature of the individual receiving services or the authorized representative cannot be obtained, the provider shall document attempts to obtain the necessary signature and the reason the signature was unattainable. The provider shall attempt to obtain the necessary signature, on a periodic basis, while each ISP is in effect. An attempt to obtain the necessary signature shall occur at a minimum each time the provider reviews the ISP as required by 12VAC35-272-80 E.

2. Each ISP shall be distributed to the individual and others authorized to receive it prior to implementation. The provider shall document dates of the distribution within the individual's record.

D. The provider shall designate an employee or contractor who shall be responsible for developing, implementing, reviewing, and revising each individual's ISP in collaboration with the individual or authorized representative, as appropriate.

E. Employees or contractors who are responsible for implementing the ISP shall demonstrate a working knowledge of the objectives and strategies contained in the individual's current ISP, including an individual's detailed health and safety protocols.

1. Providers shall educate and train employees or contractors who are responsible for ISP implementation on the objectives and strategies contained within the individual's current ISP.

2. When changes occur to an individual's ISP, the provider shall notify and train the appropriate employees or contractors who are responsible for ISP implementation. The provider shall ensure that the employee or contractor is competent to implement the revised ISP.

3. After training on the individual's current ISP, providers shall maintain documentation of the employee's or contractor's education, training, and competency as demonstrated through supervision.

F. When a provider provides more than one service to an individual, the provider may maintain a single ISP document that contains individualized objectives and strategies for each service provided.

G. Whenever possible, the identified goals in the ISP shall be written in the words of the individual receiving services.

H. The provider shall use signed and dated progress notes to document the implementation of the goals and objectives contained within the ISP.

I. The individual's most current ISP shall be located at the individual's residential setting.

A. A reassessment shall be completed at least annually and any time there is a need based on changes in the medical, psychiatric, behavioral, or other status of the individual. The reassessment shall include documentation justifying that the individual's needs continue to require a provider-operated residential setting.

B. The provider shall actively involve the individual and authorized representative, if applicable, in reassessments. The provider shall consider the individual's needs, strengths, goals, preferences, and abilities within the individual's cultural context.

C. Providers shall revise the ISP if the reassessment supports changes or if desired by the individual. If a reassessment does not support changes to the ISP, the provider shall document that no revisions are necessary and the reasoning.

D. If necessary as a result of reassessment, providers shall complete changes to medical protocols or collaborate with other providers to ensure changes to medical protocols are made, including medical equipment, behavioral, or other corresponding protocols, if appropriate.

E. The provider shall complete quarterly reviews in writing of the ISP at least every three months from (i) the date of the implementation of the most recent comprehensive ISP or (ii) the most recent reassessment, whichever occurs later. Documentation of the quarterly ISP review shall be added to the individual's record no later than 15 calendar days from the date the review was due to be completed. This subsection only applies to respite residential services if the individual has utilized the service within the quarter.

F. A quarterly ISP review shall be conducted in a person-centered manner to determine if services are being delivered as described within the ISP. The individual receiving services and the authorized representative, if applicable, shall be included in the ISP review to determine if the individual's treatment needs and preferences are being met and whether the individual is satisfied with the services provided.

1. A quarterly ISP review shall evaluate the individual's progress toward meeting the ISP goals and objectives and the continued relevance of the ISP objectives and strategies. The provider shall update the goals, objectives, and strategies contained in the ISP, if indicated, and implement any updates made.

2. A quarterly ISP review shall document evidence of progress toward or achievement of a specific targeted outcome for each goal and objective.

3. For goals and objectives that were not accomplished by the identified target date, or for which the individual did not demonstrate sufficient progress, the provider shall meet and collaborate with other service providers and appropriate treatment team members to review the reasons for lack of progress and provide the individual an opportunity to make an informed choice of how to proceed. The provider shall retain documentation of this meeting and the individual's informed choice within the individual's record.

4. A quarterly ISP review shall note:

a. the individual's family involvement, if any, in the individual's treatment;

b. whether the individual no longer needs the intensity of care provided within a residential setting;

c. the individual's progress towards discharge; and

d. the status of the individual's discharge planning.

G. The provider shall ensure after each reassessment that the individual's most current ISP is located at the individual's residential setting.

A. The documentation system implemented by the provider pursuant to subdivision E of 12VAC35-270-580 shall ensure that progress notes are (i) maintained in a consistent format that satisfies the minimum provisions of subsection B of this section and (ii) entered into the individual's record in accordance with the provider's record management policy.

B. The provider shall use signed and dated progress notes or other documentation to document the services provided to the individual. Progress notes shall, at a minimum:

1. Be legible and readable;

2. Record the individual's interaction with the staff writing the progress note, including care provided and events relevant to diagnosis and treatment or care of the individual;

3. Provide a narrative or descriptive component;

4. Include next steps related to treatment or care of the individual; and

5. Be signed and dated by the staff member who rendered the service.

C. The provider shall document whether the individual no longer needs the intensity of care provided within a residential setting.

D. Progress notes shall be entered into the individual's record at a minimum of once per shift as defined in the provider's policies and procedures.

E. Communication logs, information notes, and supervision notes shall not be considered progress notes.

A. Providers shall implement a written policy that includes:

1. Identification, qualification, training, and duties of employees responsible for discharge planning; and

2. Completion of a discharge plan prior to an individual's discharge that incorporates the following minimum provisions:

a. The discharge plan involves the individual or the individual's authorized representative and reflects the individual's preferences to the greatest extent possible consistent with the individual's needs.

b. The discharge plan involves mental health, substance abuse, developmental disability, social, educational, medical, employment, housing, legal, advocacy, transportation, and other services that the individual will need upon discharge into the community or transfer to another provider and identifies the public or private agencies or persons that have agreed to provide those services.

B. Providers of short-term intensive services typically provided for less than 30 days, such as inpatient, shall develop the required discharge plan no later than 48 hours prior to discharge. Providers of all other residential services shall develop a discharge plan within seven days prior to discharge.

C. Providers shall also comply with the criteria for discharge in 12VAC35-270-430.

A. The scope of emergency preparedness in relation to this section applies to disasters and emergencies as defined by § 44-146.16 of the Code of Virginia.

B. The provider shall develop a written emergency preparedness and response plan that includes specifics for all services and locations. The plan shall address:

1. An analysis and prioritization of vulnerability of all services and locations to various hazards that may impact the provider. Vulnerability is a combination of the likelihood and severity of hazard occurrence.

2. A base-level response plan that is applicable to all hazards and includes:

a. Documentation of preparedness activities, such as emergency planning team meetings, emergency medical drills, incident reviews, plan revisions, and other activities.

b. Maintenance of 24-hour communications capability to respond to emergencies.

c. Documented procedure for activation of the emergency plan, including a description of various triggers for activation, who may activate, overall situation assessment, response escalation, situation stabilization, and life and property preservation as first priority during any response.

d. Documented procedure to notify the department of activation of the emergency plan as soon as possible, but no later than 24 hours after incident occurrence.

e. Documented polices outlining specific responsibilities for incident command and an incident management team, including operations, logistics, planning, and finance.

f. Documented policies and procedures to ensure, to the extent possible, the life safety of individuals, employees, contractors, volunteers, and visitors.

g. Policy and procedures for building access and security, including the provision of a secure building under adverse circumstances and appropriate access to the building by emergency responders.

h. Documented policies and procedures for the resumption of normal activities following service disruption from an emergency, including any necessary site inspections required before repatriation can take place.

i. Documented identification, consideration, and mitigation activities related to high-priority vulnerabilities as identified by a vulnerability analysis.

3. An evacuation plan that includes:

a. Documented, current consideration of local or regional sites that could function as evacuation locations or stop-over points, including documentation of any arrangements the provider has made with such local or regional sites.

b. Policy and procedures for executing an evacuation or relocation of individuals receiving services to include ensuring individuals who use wheelchairs, or other mechanical devices for assistance in walking are provided with means of effective egress, individual and staff location tracking, and preservation of all critical services (e.g., pharmacy, feeding).

c. Policy and procedures for ensuring handling protected health information (PHI) during an evacuation or relocation to ensure the PHI is both properly secured and accessible at the new location or by new service providers to allow for proper continuity of care.

C. The provider shall develop a written communication plan detailing:

1. The process for notifying local and state authorities, including the department, of an emergency.

2. The process for notifying and communicating with staff, employees, contractors, volunteers, and community responders during emergencies.

3. The process for warning, notifying, and communicating with individuals receiving services.

4. The process for notifying and communicating with family members or authorized representatives during emergencies.

D. The provider shall develop a written Continuity of Operations Plan detailing:

1. Delegation of authority under emergency conditions.

2. Succession planning for emergency conditions, including the event of the license holder's death or incapacitation as required by subsection B 1 of 12VAC35-270-40. Community service boards are not required to have a succession plan.

3. Indication of which services are critical to the health and well-being of the individuals being served and therefore must be continued; services less critical that may be delayed; ancillary services that may be discontinued during emergency circumstances; and triggers with regard to the continuity of these services.

4. Documented plans for continuity of activities related to the provision of care, treatment, and services, including scheduling, modifying, or discontinuing services; personally identifiable information (PII) and PHI access and security; providing medication; and transportation services.

5. Contingency planning for supply chain disruptions of critical supplies such as pharmaceuticals, food, water, toiletries, linens, and any other supplies required for subsistence.

E. Providers shall ensure a three-day supply of emergency food and water for all individuals and staff. Emergency food caches should include food that is easily prepared and does not need to be cooked. One gallon of potable water per person, per day is required.

1. The emergency food cache shall include no expired food.

2. The emergency food cache shall be appropriate for meeting the dietary needs of the population served.

3. The provider shall ensure that any tools needed to prepare the emergency food supply, such as can openers or portable blenders, are stored with the emergency food cache.

4. The emergency food cache shall be separate from the provider's day-to-day food supply.

5. The emergency food cache shall be packed and ready for transport in case of emergency.

F. The provider shall maintain documentation of outreach to local emergency officials to include local emergency managers at least annually.

G. The provider shall implement annual emergency preparedness and response training for all employees, contractors, students, and volunteers pursuant to 12VAC35-270-290. This training shall also be provided during the onboarding of new employees and shall include:

1. Activation and notification for the emergency plan.

2. Evacuation procedures that include consideration of individuals with medical, functional, and access needs.

3. Use, maintenance, and operation of any emergency equipment.

4. Medical record stewardship during emergencies.

5. Utilization of community support services in emergencies.

H. The provider shall document review of the emergency preparedness plan and continuity of operations annually and make necessary revisions. Such revisions shall be (i) communicated to employees, contractors, students, volunteers, and individuals receiving services and (ii) incorporated into training for employees, contractors, students, and volunteers and into the orientation of individuals to services.

I. The provider shall schedule for testing the implementation of the emergency preparedness plan and conducting emergency preparedness drills. A fire, evacuation, or emergency medical drill shall be conducted at least once a month on a schedule that ensures that a fire, evacuation, and emergency medical drill shall be conducted at least quarterly.

A. Providers shall provide or arrange for the provision of appropriate medical and dental care.

B. The provider shall implement a policy that addresses provision of adequate and appropriate medical and dental care. This policy shall describe how and to what extent:

1. Medical and dental care needs will be assessed and the circumstances that will prompt the decision to obtain a medical assessment.

2. ISPs will address any medical and dental care needs appropriate to the scope and level of service.

3. The provider will provide or arrange for the provision of medical and dental care needs identified at admission.

4. The provider will provide or arrange for the provision of routine ongoing and follow-up medical and dental care services after admission.

5. The provider will communicate the results of physical examinations, medical assessments, and diagnostic tests, treatments, or examinations conducted by the provider to the individual and the individual's authorized representative, as appropriate.

6. The provider will keep accessible to employees and contractors on duty the names, addresses, and phone numbers of the individual's medical and dental providers.

7. The provider will ensure a means for facilitating and arranging, as appropriate, transportation to medical and dental appointments and medical tests when services cannot be provided on site.

8. The provider will ensure the provision of emergency medical services for each individual.

C. The provider shall identify any individuals who are at risk for falls and develop and implement a fall prevention and management plan and program for each at-risk individual.

D. The provider shall implement written infection control measures including the use of universal precautions.

E. The provider shall report outbreaks of infectious diseases to the Department of Health pursuant to § 32.1-37 of the Code of Virginia.

F. All employees, contractors, students, and volunteers in residential treatment services shall complete tuberculosis education as part of initial orientation and thereafter on an annual basis. The education shall focus on self-presentation in the event of exposure to active tuberculosis or the development of symptoms of active tuberculosis disease.

A. The provider shall implement written policies, as approved by the department, for prompt intervention in the event of a crisis or behavioral, medical, or psychiatric emergency that may occur during screening and referral, at admission, or during the period of service provision. For the purposes of this section, a crisis or behavioral, medical, or psychiatric emergency is a situation that poses an imminent risk to the individual or others and cannot be addressed within the scope of the provider's services, but does not include events that require the use of restrictive behavior intervention and supports as referenced in 12VAC35-270-500.

B. The policies and procedures shall include:

1. Procedures for immediately accessing appropriate internal and external resources, including a provision for obtaining physician and mental health clinical services if the provider's or service's on-call or back-up physician or mental health clinical services are not available at the time of the crisis or emergency;

2. Employee or contractor responsibilities; and

3. Location of the face sheets with emergency medical information as required by 12VAC35-270-460.

A. The provider shall have a designated staff member who is responsible for ensuring supervision of the site and ensuring compliance with this chapter and 12VAC35-270. The designated staff member shall be on the premises during regular business hours. In the event the designated staff member cannot be on the premises during regular business hours, the provider shall have a contact number posted in a method accessible to individuals, parents, and legal guardians and within the Office of Licensing's official licensing and communication system (CONNECT). The designated staff shall return to the premises within one hour of a call to the contact number.

B. Clinically managed high-intensity residential services shall meet the following staffing requirements. The program shall:

1. Offer telephone or in-person consultation with a physician, a licensed nurse practitioner, or a licensed physician assistant in case of emergency related to an individual's substance use disorder 24 hours a day, seven days a week;

2. Offer onsite 24-hour clinical staffing by credentialed addiction treatment professionals and other allied health professionals, such as peer recovery specialists, who work in an interdisciplinary team;

3. Have clinical staff knowledgeable about the biological and psychosocial dimensions of substance use and mental health disorders and the treatment of such disorders. Staff shall be able to identify the signs and symptoms of acute psychiatric conditions. Staff shall have specialized training in behavior management techniques; and

4. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.

C. Clinically managed low-intensity residential services shall meet the following staffing requirements. The program shall:

1. Offer telephone or in-person consultation with a physician in case of emergency related to an individual's substance use disorder, available 24 hours a day, seven days a week. The program shall also provide allied health professional staff on site 24 hours a day;

2. Have clinical staff who are knowledgeable about the biological and psychosocial dimensions of substance use disorder and the treatment of substance use disorder and are able to identify the signs and symptoms of acute psychiatric conditions;

3. Have a team comprised of appropriately trained and credentialed medical, addiction, and mental health professionals; and

4. Ensure all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.

D. Clinically managed population-specific high-intensity residential services shall meet the following staffing requirements. The program shall:

1. Offer telephone or in-person consultation with a physician, a licensed nurse practitioner, or a physician assistant in case of emergency related to an individual's substance use disorder 24 hours a day, seven days a week;

2. Have allied health professional staff on site 24 hours a day. At least one clinician with competence in the treatment of substance use disorder shall be available on site or by telephone 24 hours a day;

3. Have clinical staff knowledgeable about the biological and psychosocial dimensions of substance use and mental health disorders and their treatment and able to identify the signs and symptoms of acute psychiatric conditions. Staff shall have specialized training in behavior management techniques; and

4. Ensure all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.

E. Group homes shall maintain staffing ratios sufficient to meet the needs of individuals admitted to the service as described within each individual's ISP.

F. ICF/IIDs shall meet the following staffing requirements. The program shall:

1. Have qualified direct care staff, sufficient to meet the 24 hour scheduled and unscheduled needs of each individual;

2. Have available enough qualified professional staff to carry out and monitor the various professional interventions in accordance with the stated goals and objectives of every ISP;

3. Have professional staff who work with individuals on a periodic basis and who shall not be included in direct care staff ratios;

4. Have supervisors of direct care professionals who shall be counted in direct care staff ratios only if they share in the actual work of direct care of individuals;

5. Have direct care supervisors whose principal assigned function is to supervise direct care staff and who shall not be included in direct care staff ratios although they may occasionally provide direct care services to individuals;

6. Have non-direct care staff supervisors whose principal assigned function is to supervise non-direct care staff and who shall not be included in direct care staff ratios; and

7. Have professional program staff who shall participate as members of the interdisciplinary team in relevant aspects of the active treatment process.

G. Inpatient services shall meet the following staffing requirements. The program shall:

1. Have a licensed psychiatrist who has experience working with the population;

2. Have a sufficient number of qualified attending psychiatrists to provide basic treatment functions including evaluations, admissions, diagnoses, prescribing of treatment, discharging patients, and clinical treatment team supervision;

3. Have at least one full-time social worker. A program shall maintain a social worker staff ratio equivalent to one full-time position to 10 individuals served. The amount of social worker staff may need to increase if extensive supplementary functions are included;

4. Have a registered psychiatric nurse. A program shall maintain a staff ratio of one psychiatric nurse per shift for every 12 individuals served. This number shall be adjusted according to the acuity, medical treatment, medication, and extensive functions;

5. Have a licensed practical nurse; and

6. Have a sufficient number of psychiatric technicians to maintain a staff ratio that meets the supervision needs of individuals receiving services.

H. Medically managed intensive inpatient services shall meet the following staffing requirements. The program shall:

1. Have a team of appropriately trained and credentialed professionals who provide medical management by physicians 24 hours a day, primary nursing care and observation 24 hours a day, and professional counseling services 16 hours a day;

2. Have an interdisciplinary team of appropriately credentialed clinical staff, including addiction-credentialed physicians, nurse practitioners, physician assistants, nurses, counselors, psychologists, and social workers, who assess and treat individuals with severe substance use disorders or addicted individuals with concomitant acute biomedical, emotional, or behavioral disorders;

3. Have staff who are knowledgeable about the biopsychosocial dimensions of addiction as well as biomedical, emotional, behavioral, and cognitive disorders;

4. Have facility-approved addiction counselors or licensed, certified, or registered addiction clinicians who administer planned interventions according to the assessed needs of the individual; and

5. Ensure all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.

I. Medically monitored intensive inpatient services shall meet the following staffing requirements. The program shall:

1. Have a licensed physician to oversee the treatment process and ensure quality of care. A physician, a licensed nurse practitioner, or a licensed physician assistant shall be available 24 hours a day in person or by telephone. A physician shall assess the individual in person within 24 hours of admission;

2. Offer 24-hour nursing care and conduct a nursing assessment on admission. The level of nursing care must be appropriate to the severity of needs of individuals admitted to the service;

3. Have interdisciplinary staff, including physicians, nurses, addiction counselors, and behavioral health specialists, who are able to assess and treat the individual and obtain and interpret information regarding the individual's psychiatric and substance use or addictive disorders;

4. Offer daily onsite counseling and clinical services. Clinical staff shall be knowledgeable about the biological and psychosocial dimensions of addiction and other behavioral health disorders with specialized training in behavior management techniques and evidence-based practices;

5. Have staff able to provide a planned regimen of 24-hour professionally directed evaluation, care, and treatment services;

6. Make MAT available for all individuals. MAT may be provided by facility staff or coordinated through alternative resources; and

7. Ensure all clinical staff are qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.

J. Respite residential shall maintain staffing ratios sufficient to meet the needs of individuals admitted to the service as described within each individual's ISP.

K. Sponsored residential homes shall meet the following staffing requirements. The program shall:

1. Have qualified direct care staff sufficient in number to meet the 24-hour scheduled and unscheduled needs of each individual;

2. Ensure that if an individual requires awake overnight staff that adequate staffing is provided; and

3. Have at least one on-call staff member or substitute care arrangement per location. Substitute care arrangements shall not serve as substitute care for more than two locations at a time.

L. Supervised living shall have qualified direct care staff readily available and sufficient in number to meet the 24-hour scheduled and unscheduled needs of each individual.

M. Providers of residential services to children shall meet the following staffing requirements. The program shall:

1. Have a program director, who shall submit the following to demonstrate compliance with the qualifications required by this regulation for the program director:

a. Official transcripts from the accredited college or university of attendance within 30 days of hire; and

b. Documentation of prior relevant experience.

2. Have a case manager responsible for coordination of all services offered to individuals receiving services. The case manager shall have:

a. A master's degree in social work, psychology, or counseling;

b. A baccalaureate degree in social work or psychology with documented field work experience. An applicant who qualifies under this subdivision shall be supervised by the program director or other equally qualified designee; or

c. A baccalaureate degree and three years of professional experience working with children.

3. Have child care supervisors who are responsible for the (i) development of the daily living program within each child care unit and (ii) orientation, training, and supervision of direct care workers. Child care supervisors shall have the following qualifications:

a. A baccalaureate degree in social work or psychology and two years of professional experience working with children, one year of which must have been in a residential facility providing services for children and adolescents;

b. A high school diploma or a General Education Development (GED) certificate and a minimum of five years of professional experience working with children with at least two years in a residential facility providing services to children and adolescents; or

c. A combination of education and experience working with children as approved by the department.

4. Have child care staff who are responsible for guidance and supervision of the children to whom they are assigned. A person serving in a child care worker's position shall be at least 19 years of age, except as provided in subdivision 7 of this subsection.

5. Child care staff and relief child care staff shall furnish evidence of having obtained one of the following experience or education standards:

a. A baccalaureate degree in human services;

b. An associate’s degree and three months of experience working with children; or

c. A high school diploma or GED and six months of experience working with children.

6. A person with a high school diploma or GED and less than six months of experience working with children may be hired as child care staff, provided that the person does not work independently. Provisional child care staff shall at all times work directly with the program director, case manager, child care supervisor, or an experienced child care worker who has at least one year of professional experience working with children.

7. In lieu of the minimum position qualification contained in subdivision 4 of this subsection, providers subject to (i) the rules and regulations of the Virginia Department of Human Resource Management or (ii) the rules and regulations of a local government personnel office may develop written minimum entry-level qualifications in accordance with the rules and regulations of the supervising personnel authority.

A. In addition to the provisions of 12VAC35-270-300, providers of residential services shall incorporate the following service-specific requirements into the provider’s written staffing plan.

B. The provider shall meet the following staffing requirements related to supervision.

1. Supervision of mental health, substance abuse, or co-occurring services that are of an acute or clinical nature, such as inpatient, shall be provided by a licensed mental health professional or a mental health professional who is license-eligible and registered with a board of the Department of Health Professions.

2. Supervision of mental health, substance abuse, or co-occurring services that are of a supportive or maintenance nature, such as supervised living, shall be provided by a QMHP, a licensed mental health professional, or a mental health professional who is license-eligible and registered with a board of the Department of Health Professions. An individual who is a QMHP-T may not provide this type of supervision.

C. The provider shall employ or contract with persons with appropriate training, as necessary, to meet the specialized needs of and to ensure the safety of individuals receiving services with medical or nursing needs; speech, language, or hearing problems; or other needs where specialized training is necessary.

D. In addition to the provisions of 12VAC35-270-300, providers of residential services to children shall incorporate the following service-specific requirements into the provider staffing plan:

1. No member of the child care staff shall be on duty more than six consecutive days without a rest day, except in an emergency or as approved by the department for live-in staff.

2. Child care staff shall have an average of at least two rest days per week in any four-week period. Rest days shall be in addition to vacation time and holidays.

3. No child care staff, other than live-in staff, shall be on duty more than 16 consecutive hours, except in an emergency.

4. There shall be at least one trained child care worker on duty and actively supervising individuals at all times that one or more individuals are present.

E. Providers of residential services to children shall develop and implement staff supervision contingency plans to accommodate for illnesses among the population served or staff, emergencies, off-campus activities, and personal preferences of the individual receiving services. Contingency plans shall be based on the:

1. Needs of the population served;

2. Types of services offered;

3. Qualifications of staff on duty; and

4. Number of individuals served.

F. In addition to the provisions of 12VAC35-270-300, providers of residential services to children shall incorporate the following service-specific minimum staffing ratios into the provider staffing plan. At all times, during hours individuals are awake, the ratios of staff to children shall be:

1. For children from birth to 16 months of age: one staff member for every three children;

2. For children 16 months to two years of age: one staff member for every four children;

3. For children two to three years of age: one staff member for every six children; and

4. For children three years of age and older: one staff member for every eight children.

G. Providers of residential services to children shall obtain prior written approval by the department to allow a higher number of children to be supervised by one staff member.

H. Upon request, providers of residential services to children shall provide a copy of the staffing plan or a summary of its supervision policies to the placing agency or legal guardian prior to placement.

A. Nothing in this section shall be construed to limit the individual's right to make personal dietary choices.

B. The provider shall implement a service protocol for the provision of food services, which ensures access to nourishing, well-balanced, varied, and healthy meals that shall, at a minimum:

1. Ensure that each individual's dietary needs reflected within the individual's ISP are fulfilled;

2. Provide methods for the provider to (i) learn the cultural background, personal preferences, religious requirements, and food habits of the individuals receiving services and (ii) ensure meals are prepared in a manner that considers these preferences; and

3. List steps staff shall take to assist individuals who require assistance feeding themselves in a manner that effectively addresses any deficits while maintaining the dignity of individuals.

C. The provider shall have menus or documentation of meal planning that:

1. Meet the nutritional needs of each individual as indicated within the individual's ISP;

2. Are prepared in advance;

3. Are followed;

4. Reflect the religious, cultural, and ethnic needs of individuals receiving services based on the provider's reasonable efforts; and

5. Are updated on a quarterly basis.

D. The provider shall implement protocols to monitor each individual's food consumption and nutrition for:

1. Warning signs of changes in physical or mental status related to nutrition; and

2. Compliance with any needs determined by the ISP or prescribed by a physician, nutritionist, or health care professional.

E. Each individual shall be provided a daily diet that consists of at least three nutritionally balanced meals that include an adequate variety and quantity of food for the age of the individual and meet minimum nutritional requirements and the U.S. Department of Health and Human Services and U.S. Department of Agriculture Dietary Guidelines for Americans. Providers of residential services to children shall also provide an evening snack to each individual.

A. Any location where the provider is responsible for preparing or serving food shall request inspection and obtain approval by state or local health authorities regarding food service and general sanitation at the time of the original application and annually thereafter in accordance with Food Regulations (12VAC5-421).

B. Documentation of the most recent inspection and approval shall be kept on file. This section does not apply to sponsored residential services or to group homes or community residential homes.

A. Individuals shall be afforded opportunities to participate in community activities and utilize community resources that are based on personal interests and preferences. The provider shall:

1. Document efforts to learn each individual's preferred community activities;

2. Document opportunities for participation in community activities made available to each individual;

3. Ensure that individuals are afforded opportunities for community participation on an individual basis, except those programs in which individuals do not leave the provider's premises as outlined within the provider's policies and procedures, such as short-term substance use treatment programs; and

4. Ensure that the frequency of opportunities afforded to each individual is consistent with the ISP.

B. The provider shall implement a written policy regarding opportunities for individuals to participate in each individual's preferred religious activities. The provider's policies on religious participation shall be available to individuals and authorized representatives, if applicable. The policy shall also be available to any individual considering admission to a residential service and that individual's authorized representative, if applicable, and any agency considering placement of a child into a children's residential service.

C. No individual shall be coerced to participate in religious activities.

D. Providers of residential services to children shall develop and implement written policies and procedures for evaluating persons or organizations in the community who wish to associate with individuals on the premises or take individuals off the premises. The procedures shall cover how the facility will determine if participation in such community activities or programs would be in the individual's best interest and document permission by the parent or legal guardian authorizing the community participation and absence from the premises.

E. Each facility providing residential services to children shall have a staff community liaison responsible for facilitating cooperative relationships with neighbors, the local school system, local law enforcement, local government officials, and the community at large.

F. This section does not apply to respite residential services.

F. Each provider of residential services to children shall develop and implement written policies and procedures, approved by the department, for promoting positive relationships with neighbors.

In the event of a medication error or adverse drug reaction:

1. First aid shall be administered if indicated.

2. An employee or contractor shall promptly contact a poison control center, pharmacist, nurse, or physician and shall take actions as directed.

3. The individual's physician shall be notified as soon as possible, unless the situation is addressed in standing orders.

4. All actions taken by employees or contractors shall be documented, such as in incident reports or progress notes.

5. The provider shall review medication errors at least quarterly as part of the quality assurance in 12VAC35-270-570.

6. Medication errors and adverse drug reactions shall be recorded in the individual's medication log.

A. Within 30 days of an individual's admission, providers of residential services to adults shall either administer a physical exam or obtain results of a physical exam conducted within the preceding 12 months. Providers of inpatient services shall administer physical exams within 24 hours of an individual's admission. Providers of residential services to children shall have a physical examination conducted by or under the direction of a licensed physician no earlier than 90 days prior to admission to the facility or no later than seven days following admission, except that (i) the report of an examination within the preceding 12 months shall be acceptable if a child transfers from one residential facility licensed or certified by a state agency to another and (ii) a physical examination shall be conducted within 30 days following an emergency admission if a report of physical examination is not available.

B. Within seven days of admission, each individual shall undergo a screening assessment for tuberculosis as evidenced by the completion of a screening form containing, at a minimum, the elements found on the Report of Tuberculosis Screening form published by the Virginia Department of Health. The screening assessment may be no older than 30 days. No screening assessment shall be required for an individual who is (i) transferred from another department-licensed provider or (ii) separated from a service with another licensed provider with a break in service of six months or less.

C. A physical examination shall include the date of examination and signature of a qualified practitioner.

D. The provider shall review and follow up with the results of the physical examination and of any follow-up diagnostic tests, treatments, or examinations in the individual's record.

E. Each individual's health record shall include notations of health and dental complaints mentioned by the individual and injuries and shall summarize symptoms and treatment given.

F. Each individual's health record shall include or document the facility's efforts to obtain treatment summaries of ongoing psychiatric or other mental health treatment and reports.

G. The provider shall develop and implement written policies and procedures that include use of standard health precautions and address communicable and contagious medical conditions.

H. In addition to the provisions of subsection C of this section, a physical examination of an individual served by a provider of residential services to children shall include:

1. Immunizations administered at the time of the exam;

2. A vision screening; and

3. A hearing screening.

I. Providers of residential services to children shall ensure that each individual's health record includes written documentation of (i) the initial physical examination and (ii) an annual physical examination by or under the direction of a licensed physician, including any follow-up care recommended by the physician or as indicated by the needs of the individual.

J. Providers of residential services to children shall include in each individual's record written documentation of (i) an annual examination by a licensed dentist and (ii) follow-up dental care recommended by the dentist or as indicated by the needs of the individual. This requirement does not apply to respite care facilities or short-term intensive services that are typically provided for less than 30 days.

A. The use of seclusion, restraint, and time out shall comply with applicable federal and state laws and regulations and be consistent with the provider's written policies and procedures implemented pursuant to 12VAC35-270-500.

B. Restraints for behavioral purposes shall be designed specifically for emergency behavior management of human beings in clinical or therapeutic programs. An individual under mechanical restraint shall be continuously observed face-to-face by a staff member who shall conduct a status check every 15 minutes. During status checks, the staff member will assess and, if necessary, respond to the individual's needs for hygiene, elimination, and hydration. Providers of residential services to children are prohibited from utilizing mechanical restraints, except as permitted by other applicable state regulations or as ordered by a court of competent jurisdiction.

C. Application of time out, seclusion, or restraint shall be documented in the individual's record and include the following:

1. Physician's order for seclusion or mechanical restraint or pharmacological restraint;

2. Date and time;

3. Employees or contractors involved;

4. Circumstances and reasons for use, including other behavior management techniques attempted;

5. Duration;

6. Type of technique used; and

7. Outcomes, including documentation of debriefing of the individual and staff involved following the incident.

D. Providers of residential services to children are prohibited from use of pharmacological restraints.

A. Seclusion may only be used in facilities providing residential services to children, inpatient hospitals, crisis receiving centers, and crisis stabilization units and only in case of an emergency. Seclusion shall comply with the provisions of 12VAC35-115-110.

B. The room used for seclusion shall meet the design requirements for buildings used for detention or seclusion of individuals.

C. The seclusion room shall be at least six feet wide and six feet long with a minimum ceiling height of eight feet.

D. The seclusion room shall be free of all protrusions, sharp corners, hardware, fixtures, or other devices that may cause injury to the individual.

E. Windows in the seclusion room shall be so constructed as to minimize breakage and otherwise prevent the individual from self-harm.

F. Light fixtures and other electrical receptacles in the seclusion room shall be recessed or so constructed as to prevent the individual from self-harm. Light controls shall be located outside the seclusion room.

G. Doors to the seclusion room shall be at least 32 inches wide, shall open outward, and shall contain observation view panels of transparent wire glass or its approved equivalent, not exceeding 120 square inches, but of sufficient size for someone outside the door to see into all corners of the room.

H. The seclusion room shall contain only a mattress with a washable mattress covering designed to avoid damage by tearing.

I. The seclusion room shall maintain temperatures appropriate for the season.

J. All space in the seclusion room shall be visible through the locked door, either directly or by mirrors so constructed or installed as to minimize breakage and otherwise reduce the risk of self-harm.

All providers of medication-assisted treatment shall comply with Part II (12VAC35-276-210 et seq.) of 12VAC35-276, Regulations for Center-Based Services.

A. The provider shall secure opioid agonist medication supplies by:

1. Restricting access to medication areas to medical or pharmacy personnel;

2. Reconciling the medication inventory monthly;

3. Keeping inventory records, including the monthly reconciliation, for three years; and

4. Maintaining a current plan to control the diversion of medication to unprescribed or illegal uses.

B. The provider shall secure all hazards and toxic substances by:

1. Ensuring all hazardous materials, including products for cleaning, vehicle maintenance, gardening, and landscaping, are kept in labeled containers and stored according to package instructions or material safety data sheets; and

2. Keeping hazardous materials stored in a manner consistent with package instructions and the needs of individuals served, which may require storage out of sight or in a secure area.

A. For the purposes of this section, "clean" means freshly laundered, sanitized, and not soiled or stained.

B. The provider shall arrange for each individual to have a bed.

C. No provider shall operate more beds than the number for which the service location is licensed.

D. Pursuant to § 32.1-102.1:3 of the Code of Virginia, no ICF/IID may have more than 12 beds at any one location. This applies to new applications for services and not to existing services or locations licensed prior to December 7, 2011.

E. Beds and bed linens shall be clean, comfortable, and well-maintained.

F. Beds shall be equipped with a clean mattress, clean pillow, clean blankets, and clean bed linens. When a bed is soiled, providers shall assist individuals with bathing as needed and provide clean clothing and bed linens. Providers of residential services to children shall provide a clean, waterproof mattress cover, if needed.

G. Providers of residential services to children shall change used bed linens at least every seven days and more often if needed.

H. Providers of residential services to children shall provide mattresses that are fire retardant as evidenced by documentation from the manufacturer, except in buildings equipped throughout with an automatic sprinkler system in accordance with the Virginia Uniform Statewide Building Code (13VAC5-63).

I. Providers of residential services to children shall provide cribs for individuals under two years of age. Cribs shall be placed where no objects outside the crib, such as cords from blinds or curtains, are within reach of infants or toddlers. No pillows or filled comforters shall be used by children younger than two years of age.

J. Providers of sponsored residential home services shall certify that each sponsored residential home complies with this section.

A. Bedrooms shall meet the following square footage requirements:

1. Single occupancy bedrooms shall have no less than 80 square feet of floor space.

2. Multiple occupancy bedrooms shall have no less than 60 square feet of floor space per individual.

B. No more than four individuals shall share a bedroom, except in group homes, where no more than two individuals shall share a room. This subsection does not apply to group home locations licensed prior to December 7, 2011.

C. Each individual shall have adequate private storage space accessible to the bedroom for clothing and personal belongings, except in secure custody facilities.

D. Each sleeping area shall have a door that can be (i) closed for privacy or quiet and (ii) readily opened in case of fire or other emergency.

E. Providers of residential services to children shall provide separate sleeping areas for boys and girls when such individuals are four years of age or older.

F. Providers of residential services to children shall ensure beds are at least three feet apart at the head, foot, and sides and double-decker beds shall be at least five feet apart at the head, foot, and sides.

G. This section does not apply to correctional facilities and jails. Providers of sponsored residential home services shall certify that each sponsored residential home complies with this section.

A. Appropriate space and equipment in good repair shall be provided if laundry is done at the location.

B. For all services in which it is appropriate:

1. An adequate quantity of clean linens shall be available at all times to provide for proper care and comfort of individuals receiving services.

2. Linens and other laundry must be handled, stored, and processed to control the spread of infection.

3. Clean linens shall be stored in a clean and dry area accessible to staff.

4. Soiled linens shall be stored in covered containers in separate, well-ventilated areas and shall not accumulate.

5. Soiled linens shall not be sorted, laundered, rinsed, or stored in bathrooms, bedrooms, kitchens, or food storage areas.

6. Arrangements for laundering each individual's personal clothing shall be provided. If laundry facilities are not provided on premises, commercial laundry services shall be utilized.

All providers shall provide individuals access to appropriate technology, including computer and Internet access, at the individual's request.

A. The physical environment, design, structure, furnishings, and lighting shall be appropriate and safe for the individuals receiving services and the services provided.

B. The physical environment shall be accessible to individuals with physical or sensory disabilities, if applicable.

C. The exterior and interior physical environment and furnishings shall be kept clean and in good repair to (i) protect against dust, dirt, mold, or transmission of disease, and (ii) prevent the entrance or harboring of insects, rodents, vermin, and other pests. Exterior and interior furnishings shall be dry, free of foul odors, safe, and well-maintained.

D. Floor surfaces and floor coverings shall promote mobility in areas used by individuals and shall promote maintenance of sanitary conditions. There shall be clear pathways through the residential setting, free of tripping hazards, to ensure that all individuals can move about the setting safely. Any electrical cords, extension cords, or power strips utilized by the provider shall be properly secured and shall not be placed anywhere that the cord or strip can cause trips or falls.

E. Unless otherwise mandated by state or federal authorities, heat shall be evenly distributed in all rooms occupied by individuals such that a temperature no less than 68°F is maintained. Natural or mechanical ventilation to the outside shall be provided in all rooms used by individuals receiving services. If a provider is supplying heat throughout the residential setting by means of a wood stove or fireplace the provider shall:

1. Verify the wood burning stove or fireplace and associated chimneys, if used, are installed, maintained, and cleaned as needed by having them inspected annually by a qualified professional, and maintaining documentation of the inspection and cleaning;

2. Ensure that the wood burning stove or fireplace is operated safely, including storing fuel and disposing of ashes, and providing safety for the individual; and

3. Ensure the wood burning stove or fireplace is clean and well maintained.

F. Plumbing shall be maintained in good operational condition. Adequate hot and cold running water of a safe and appropriate temperature shall be available. Hot water accessible to individuals receiving services shall be maintained within a range of 100° to 120°F. The provider shall take precautions to protect individuals from injury due to scalding.

G. Adequate provision shall be made for the collection and legal disposal of garbage and waste materials.

H. If smoking is permitted, the provider shall make provisions for alternate smoking areas that are separate from the service environment. Smoking shall be prohibited in living areas and in areas where individuals participate in programs. This subsection does not apply to home-based services.

I. For all program areas added after September 19, 2002, minimum room height shall be 7-1/2 feet exclusive of protrusions, duct work, or dormers.

J. Bedroom, bathroom and dressing area windows and doors shall provide privacy.

K. Bathrooms intended for use by more than one individual at the same time shall provide privacy for showers and toilets.

L. No required path of travel to the bathroom shall be through another bedroom. Each individual’s bedroom shall have direct access to a corridor, living area, dining area, or other common area.

M. The provider shall ensure that a house number for the residential location can be identified clearly from the road.

N. All provider locations shall have an appropriate number of properly installed smoke detectors based on the size of the location, which shall include at a minimum:

1. At least one smoke detector on each level of multi-level buildings, including the basement;

2. At least one smoke detector in each bedroom in locations with bedrooms;

3. At least one smoke detector in any area adjacent to any bedroom in locations with bedrooms; and

4. Any additional smoke detectors necessary to comply with all applicable federal and state laws and regulations and local ordinances.

O. Smoke detectors shall be tested monthly for proper operation.

P. Providers shall comply with state and local health department rules and regulations regarding swimming pools.

Q. Providers of residential services to adults shall make available at least one toilet, one hand basin, and shower or bath for every four individuals.

R. Providers of residential services to children shall:

1. Make available at least one toilet, one hand basin, and one shower or bathtub in each living unit;

2. Make available at least one bathroom equipped with a bathtub in each facility;

3. Make available at least one toilet, one hand basin, and one shower or bathtub for every eight individuals for facilities licensed before July 1, 1981; and

4. Make available one toilet, one hand basin and one shower or bathtub for every four individuals in any building constructed or structurally modified after July 1, 1981, except secure custody facilities. Facilities licensed after December 28, 2007, shall comply with the one-to-four ratio. The maximum number of staff members on duty in the living unit shall be counted in determining the required number of toilets and hand basins when a separate bathroom is not provided for staff.

S. Providers of residential services to children shall provide privacy from routine sight supervision by staff members of the opposite gender while bathing, dressing, or conducting toileting activities. This subsection does not apply to medical personnel performing medical procedures, staff assisting infants, or staff assisting any individuals whose physical, mental, or safety needs indicate the need for assistance with these activities as justified in the individual's record.

T. This section does not apply to correctional facilities and jails. Providers of sponsored residential home services shall certify that their sponsored residential homes comply with this section.

A. All locations shall be inspected and approved as required by the appropriate building regulatory entity. Documentation of approval shall be a Certificate of Use and Occupancy indicating the building is classified for its proposed licensed purpose. The provider shall submit a copy of the Certificate of Use and Occupancy to the department for new locations.

B. This section does not apply to correctional facilities. Sponsored residential service providers shall certify that sponsored residential homes comply with this chapter.

The provider shall document at the time of the original application and annually thereafter that buildings and equipment in residential service locations serving more than eight individuals are maintained in accordance with the Virginia Statewide Fire Prevention Code (13VAC5-52).

A. The interior and exterior of all buildings shall be safe, properly maintained, clean, and in good working order. This includes required locks, mechanical devices, indoor and outdoor equipment, recreational spaces, and furnishings.

B. The provider shall implement policies for infrastructure concerns, including building and site maps, to shut off utilities when necessary.

The provider shall submit a plan to the department addressing safety and continued service delivery for any planned construction involving (i) changes in the use of existing locations or (ii) structural modifications to new or existing buildings.

A. Service locations shall be on a public water and sewage system or on a nonpublic water and sewage system. Prior to a location being licensed, the provider shall obtain the report from the building inspector pertaining to the sewage disposal system and its capacity. Nonpublic water and sewer systems shall be maintained in good working order and in compliance with local and state laws.

B. Service locations that are not on a public water system shall have a water sample tested by an accredited, independent laboratory for the absence of coliform (i) prior to being licensed and (ii) on an annual basis thereafter. The water sample shall also be tested for lead or nitrates if recommended by the local health department. Documentation of the three most recent test samples shall be kept on file.

A. Documentation of the prior approval of the administrator of the Virginia Interstate Compact on the Placement of Children (ICPC) at the Virginia Department of Social Services shall be retained in the record of each individual admitted from outside Virginia. The requirements of this section shall not apply to a facility providing documentation that the Virginia ICPC administrator determined that the facility is statutorily exempt from the compact's provisions.

B. Documentation that the provider sent copies of all serious incident reports regarding any child placed through the ICPC to the administrator of the Virginia ICPC shall be kept in the individual's record.

C. No later than five days after an individual is transferred to another facility operated by the same sponsor, the individual's record shall contain documentation that the administrator of the Virginia ICPC was notified in writing of the individual's transfer.

D. No later than 10 days after discharge, the individual's record shall contain documentation that the administrator of the Virginia ICPC was notified in writing of the discharge.

E. No provider shall discharge or send out-of-state youth in the custody of out-of-state social services agencies and courts to reside with a parent, relative, or other individual who lives in Virginia without the approval of the administrator of the Virginia ICPC.

F. This section does not apply to respite residential services for children and adolescents.

A. The facility shall have written criteria for admission that include:

1. A description of the population to be served, including the age and gender of individuals seeking services;

2. A description of the types of services offered;

3. Intake and admission procedures;

4. Exclusion criteria defining those behaviors or problems that the facility is unable to manage because it does not have the staff with appropriate experience or training; and

5. A description of how educational services will be provided to the population receiving services.

B. The facility shall accept and serve only those children whose needs are compatible with the services provided through the facility, unless a child's admission is ordered by a court of competent jurisdiction.

C. Acceptance of a child as eligible for respite care by a facility approved to provide residential respite care is considered admission to the facility. Each individual period of respite care is not considered a separate admission.

D. Each facility shall provide documentation showing proof of staff expertise or contractual agreements to provide educational services, counseling services, psychological services, medical services, or any other services needed to serve the individuals in accordance with the facility's program description as defined by the facility's criteria of admission.

A. Children shall be accepted only by court order or by written placement agreement with legal guardians.

B. Providers accepting emergency or self-admissions shall:

1. Develop and implement written policies and procedures governing such admissions that shall include procedures to obtain (i) a written placement agreement signed by the legal guardian prior to admission or (ii) the order of a court of competent jurisdiction;

2. Place in each individual's record the order of a court of competent jurisdiction, a written request for care, or documentation of an oral request for care and justification for admission on an emergency basis; and

3. Clearly document written assessment information gathered for the emergency admission that the individual meets the facility's criteria for admission

C. This section does not apply to respite residential services for children and adolescents.

A. Admission shall be based on evaluation of a screening application for admission. Nothing in this section applies to court-ordered placements or transfer of an individual between residential facilities located in Virginia and operated by the same sponsor.

B. Prior to acceptance for care, providers shall develop and fully complete an application for admission designed to compile screening information necessary to determine:

1. The educational needs of the individual;

2. The mental health, emotional, and psychological needs of the individual;

3. The physical health needs, including the immunization needs, of the individual;

4. The protection needs of the individual;

5. The behavioral support needs of the individual;

6. Current behavioral functioning and social competence;

7. Family history and relationships;

8. Social and development history;

9. History of previous treatment for mental health, developmental disability, substance abuse, brain injury, and behavior problems;

10. The suitability of the individual's admission; and

11. Medication and drug use profile, which shall include:

a. History of prescription, nonprescription, and illicit drugs taken over the six months prior to admission;

b. Drug allergies, unusual and other adverse drug reactions, and ineffective medications; and

c. Information necessary to develop an ISP and a behavioral support plan.

C. The individual's record shall contain a completed assessment based on information compiled from the screening application at the time of a routine admission or within 30 days after an emergency admission. This subsection does not apply to respite residential services for children and adolescents.

D. Each facility shall develop and implement written policies and procedures to assess each individual as part of the application process to ensure that:

1. The needs of the individual can be addressed by the facility's services;

2. The facility's staff is trained to meet the individual's needs; and

3. The admission of the individual would pose no significant risk to (i) the individual or (ii) the other individuals receiving services from the facility or facility staff.

A. The facility shall develop and execute a written agreement authorizing the individual's placement, signed by a facility representative and the parent, legal guardian, or placing agency.

B. Notwithstanding the provisions of subsection A of this section, a facility that accepts an admission upon receipt of the order of a court of competent jurisdiction shall place a copy of the court order in the individual’s record.

C. This section does not apply to respite residential services for children and adolescents.

A. Except when transfer is ordered by a court of competent jurisdiction, the provider's receiving service or facility shall document receipt of the following at the time of the individual's transfer:

1. Documentation of advance notification to the family, if appropriate, the individual, the placement agency, and the legal guardian;

2. A written summary of the individual's progress while at the transferring facility, justification for the transfer, and the individual's current strengths and needs; and

3. A copy of the individual's record.

B. The transferring service or facility shall document the date of transfer and the name of the receiving service or facility to which the individual was transferred.

Facilities approved to serve individuals over 17 years of age shall comply with these regulations for all children regardless of age, except when it is determined by the department that housing, programs, services, and supervision for children over 17 years of age are provided separately from those for the other individuals.

The provider of brain injury services shall employ or contract with a neuropsychologist or licensed clinical psychologist specializing in brain injury to assist, as appropriate, with initial assessments, development of individualized services plans, crises, staff training, and service design.

A. The provider shall develop and implement written policies and procedures for the on-site provision of a structured program of care or treatment of individuals with mental illness, developmental disability, substance abuse, or brain injury. The provision, intensity, and frequency of mental health, substance abuse, developmental disability, or brain injury interventions shall be based on the assessed needs of the individual. These interventions, applicable to the population served, shall include:

1. Individual counseling;

2. Group counseling;

3. Training in decision making, family and interpersonal skills, problem solving, self-care, and social and independent living skills;

4. Training in functional skills;

5. Assistance with activities of daily living (ADLs);

6. Social skills training in therapeutic recreational activities, such as anger management, leisure skills education and development, and community integration;

7. Providing positive behavioral supports;

8. Physical, occupational, or speech therapy;

9. Substance abuse education and counseling; and

10. Neurobehavioral services for individuals with brain injury.

B. Each provider shall have formal arrangements for the evaluation, assessment, and treatment of the mental health, developmental disability, substance abuse, or brain injury needs of the individual.

C. The provider shall develop and implement written policies and procedures that address the provision of:

1. Psychiatric care;

2. Family therapy; and

3. Staffing appropriate to the needs and behaviors of the individuals served as determined by each individual's ISP. The policies and procedures shall document how the staffing provided is appropriate to the needs and behaviors of the individuals served.

A. There shall be evidence of a structured program of care designed to:

1. Meet the individual’s physical and emotional needs as outlined in the individual's ISP;

2. Provide protection, guidance, and supervision; and

3. Meet the objectives of any required ISP.

B. Documentation of evidence of a structured daily routine designed to ensure the delivery of program services shall be readily available for individuals receiving services or authorized representatives.

C. The provider shall maintain a daily communication log to share information with staff about significant happenings or problems experienced by individuals, with the identity of the person making each entry in the log recorded.

D. Health and dental complaints and injuries shall be recorded and shall include the (i) individual's name, complaint, and affected area; and (ii) time of the complaint.

E. Routines shall be planned to ensure that each individual receives the amount of sleep and rest appropriate for the individual's age and physical condition.

F. Staff shall promote good personal hygiene of individuals by monitoring and supervising hygiene practices each day and by providing instruction when needed.

A. The provider or the department may require a report of examination by a licensed physician or mental health professional when there are indications that a staff member's physical, mental, or emotional health may jeopardize the care of the other staff or the population of individuals receiving services.

B. A staff member who is determined by a licensed physician or mental health professional to show an indication of a physical, mental, or emotional condition that may (i) jeopardize the safety of other staff or individuals receiving services or (ii) prevent the performance of duties shall be removed immediately from contact with individuals and food service. The provider shall not allow the staff member to return to the facility until the condition is cleared as evidenced by a signed statement from the physician or mental health professional.

A. In addition to the requirements of 12VAC35-270-290, written policies and procedures related to child abuse and neglect shall be distributed and reviewed as part of the training to all staff members. These shall include procedures for:

1. Handling accusations against staff; and

2. Promptly referring, consistent with requirements of the Code of Virginia, suspected cases of child abuse and neglect to the local child protective services unit and for cooperating with the unit during any investigation.

B. Any case of suspected child abuse or neglect shall be reported to the local child protective services unit as required by the Code of Virginia.

C. Any case of suspected child abuse or neglect occurring at the facility, on a facility-sponsored event or excursion, or involving facility staff shall be reported immediately to (i) the Office of Human Rights and the placing agency and (ii) the individual's parent or legal guardian, as appropriate.

D. When a case of suspected child abuse or neglect is reported to child protective services, the individual's record shall include:

1. The date and time the suspected abuse or neglect occurred;

2. A description of the suspected abuse or neglect;

3. Action taken as a result of the suspected abuse or neglect; and

4. The name of the person to whom the report was made at the local child protective services unit.

A. A separate, private bedroom shall be provided for staff and staff family members when a staff member is on duty for 24 consecutive hours or more.

B. A separate private bathroom shall be provided for staff and staff family members when there are more than four persons in the living unit and the staff person is on duty for 24 consecutive hours or more.

C. No staff or family members of staff shall share bedrooms with individuals receiving services.

A. Strip searches and body cavity searches are prohibited.

B. A provider shall develop and implement written policies and procedures governing pat downs that includes the following minimum provisions:

1. A clear written prohibition on pat downs if the provider does not allow them; or

2. If permitted, pat downs shall be:

a. Limited to instances where a pat down is necessary to prohibit contraband;

b. Conducted by personnel of the same gender as the individual being searched;

c. Conducted only by personnel who are specifically authorized to conduct searches by the written policies and procedures; and

d. Conducted in the presence of one or more witnesses and in such a way as to protect the individual's dignity in accordance with the Human Rights Regulations (12VAC35-115).

A. Within 30 days of admission, the provider shall develop and implement a written behavioral support plan that allows the individual to self-manage behaviors. Each individualized behavioral support plan shall derive from functional behavior assessment procedures and, at a minimum, include:

1. Hypothesized functions of problem behavior;

2. Definitions of problem behaviors and functionally equivalent replacement behaviors;

3. Identification and consideration of the individual's preferences or reinforcers;

4. Identification of antecedent strategies;

5. Identification of consequence strategies;

6. Identification of strategies to promote acquisition of functionally equivalent replacement behaviors or alternative adaptive behaviors; and

7. Specification of how data will be collected for both problem and desired behaviors.

B. Individualized behavioral support plans shall be developed in consultation with the following, as applicable:

1. Individual;

2. Legal guardian;

3. Individual's parents, if appropriate;

4. Program director;

5. Placing agency staff, if appropriate; and

6. Other appropriate persons.

C. Prior to working alone with any individual, each staff member shall demonstrate, through examination, knowledge and understanding of that individual's behavioral support plan. The provider shall retain documentation of the staff member's tests within the staff member's personnel file.

D. Each provider shall develop and implement written policies and procedures concerning behavioral support plans and emergency, crisis, and safety interventions that are directed toward maximizing the growth and development of the individual consistent with the requirements of 12VAC35-115-105.

E. Respite residential services for children and adolescents shall implement the behavioral support plan of the individual's primary care provider.

A. The provider shall develop and implement written policies and procedures governing the conditions under which an individual may be placed in time out. The policies and procedures shall:

1. Comply with the requirements of the Human Rights Regulations (12VAC35-115), specifically 12VAC35-115-110;

2. Specify the maximum allowable period of time out, which shall not exceed 30 minutes per episode. The conditions and duration of time out shall be based on the individual's chronological age and developmental level;

3. Require that the area in which an individual is placed for time out remains unlocked and that the door is not secured in a manner that prevents the individual from opening it. Staff shall not prevent egress in any other manner during the time out; and

4. Require that an individual in time out be able to communicate with staff.

B. The individual shall be in view at all times while time out procedures are being implemented.

C. Use of time out shall be documented.

D. Respite residential services for children and adolescents shall not use time out.

A. The facility program shall provide case management services. At the time of the admission of any individual, the provider shall identify in writing the staff member responsible for providing case management services. Case management services shall address:

1. Helping the individual and the parents or legal guardian to understand the effects on the individual of separation from the family and the effect of group living;

2. Assisting the individual and the family to maintain relationships, as appropriate, and prepare for the individual's future care;

3. Utilizing appropriate community resources to provide services and maintaining contacts with those resources;

4. Helping the individual strengthen his capacity to function productively in interpersonal relationships;

5. Conferring with the staff in direct care positions to help those staff members understand the individual's needs in order to promote adjustment to group living; and

6. Working with the individual and with the family or legal guardian or any placing agency that may be involved in planning for the individual's future and in preparing the individual for the return home or to another family for independent living or for other residential care. This shall include working with the individual on discharge in accordance with all of the requirements of 12VAC35-270-430 and 12VAC35-272-650. The case manager shall ensure that the individual's discharge team includes, at a minimum:

a. The individual receiving services;

b. The individual's legal guardian or authorized representative, if applicable;

c. Any additional family members that will assist with the individual's return home;

d. The individual's placing agency, if appropriate;

e. Appropriate treatment team members; and

f. Medical team members, if applicable.

B. The provision of case management services shall be documented in each individual's record.

C. This section does not apply to respite residential services for children and adolescents.

A. Each individual of compulsory school age shall be enrolled, as provided in the Code of Virginia, in an appropriate educational program within five school business days. Documentation of the enrollment shall be kept in the individual's record.

B. The provider shall ensure that educational guidance and counseling in selecting courses is provided for each individual.

1. The provider shall offer such guidance and counseling at the time of enrollment.

2. Additional counseling and guidance shall be provided any time the provider receives additional information about the individual's past education.

C. The provider shall ensure that education is an integral part of the individual's total program by ensuring that the individual’s education is integrated into the individual's ISP.

D. Providers operating educational programs for children with disabilities shall operate those programs in compliance with applicable state and federal statutes and regulations, including Chapter 16 (§ 22.1-319 et seq) of Title 22.1 of the Code of Virginia and 8VAC20-81, Regulations Governing Special Education Programs for Children with Disabilities in Virginia.

E. When a child with a disability is placed in a residential facility, the facility shall contact the division superintendent of the individual's home locality in writing. Documentation of the contact with the individual's home school shall be kept in the individual's record.

F. A provider with an academic or vocational program shall document that teachers meet the qualifications to teach the same subjects in the public schools.

G. Each provider shall develop and implement written policies and procedures to ensure that each individual has adequate study time.

H. This section does not apply to respite residential services for children and adolescents.

A. The provider shall have a written description of its recreation program that describes activities consistent with the facility's total program and with the ages, developmental levels, interests, and needs of the individuals, including:

1. Opportunities for individual and group activities;

2. Free time for individuals to pursue personal interests that are in addition to a formal recreation program, except that this subdivision 2 does not apply to secure custody facilities;

3. Use of available community recreational resources and facilities, except that this subdivision 3 does not apply to secure custody facilities;

4. Scheduling of activities so that the activities do not conflict with meals, religious services, educational programs, or other regular events; and

5. Regularly scheduled indoor and outdoor recreational activities that are structured to develop skills and attitudes.

B. The provider shall develop and implement written policies and procedures to ensure the safety of individuals participating in recreational activities that include how:

1. Activities will be directed and supervised by staff knowledgeable in the safeguards required for the activities; and

2. Safeguards for water-related activities are provided, including ensuring that a certified lifeguard supervises all swimming activities.

C. The provider shall document trip planning for all overnight recreational trips away from the facility. The provider shall ensure that the trip planning documents demonstrate how the same level of supervision and safety shall be provided to the individuals receiving services as when the individuals are within the residential facility.

D. All overnight out-of-state or out-of-country recreational trips require written permission from each individual's legal guardian.

E. This section does not apply to respite residential services for children and adolescents.

A. Provision shall be made for each individual to have an adequate supply of clean, comfortable, and well-fitting clothes and shoes for indoor and outdoor wear.

B. Each individual shall have the opportunity to participate in the selection of the individual's clothing, except that this requirement does not apply to secure custody facilities.

A. The provider shall develop and implement written policies for safekeeping and for recordkeeping of any money that belongs to individuals.

B. An individual's personal funds, including any allowance or earnings, shall be used for the individual's benefit.

C. This section does not apply to respite residential services for children and adolescents.

A. Assignment of chores whether paid or unpaid work assignments shall be in accordance with the age, health, ability, and service plan of the individual.

B. No chores shall interfere with school programs, study periods, meals, or sleep.

C. Work assignments or employment outside the facility, including reasonable rates of pay, shall be approved by the program director with the knowledge and consent of the parents or legal guardian.

D. The program director shall evaluate the appropriateness of the work and the fairness of the pay in both work assignments and employment.

The following actions are prohibited:

1. Deprivation of drinking water or food necessary to meet an individual's daily nutritional needs, except as ordered by a licensed physician for a legitimate medical purpose and documented in the individual's record;

2. Limitation on contacts and visits with the individual's attorney, probation officer, regulators, or placing agency representatives;

3. Bans on contacts and visits with family or legal guardians, except as permitted by other applicable state regulations or by order of a court of competent jurisdiction;

4. Delay or withholding of incoming or outgoing mail, except as permitted by other applicable state and federal regulations or by order of a court of competent jurisdiction;

5. Any action that is humiliating, degrading, or abusive;

6. Corporal punishment;

7. Subjection to unsanitary living conditions;

8. Deprivation of opportunities for bathing or access to toilet facilities, except as ordered by a licensed physician for a legitimate medical purpose and documented in the individual's record;

9. Deprivation of health care;

10. Deprivation of appropriate services and treatment;

11. Application of aversive stimuli, except as permitted pursuant to other applicable state regulations;

12. Administration of laxatives, enemas, or emetics, except as ordered by a licensed physician or poison control center for a legitimate medical purpose, administered by appropriate medical personnel, and documented in the individual's record;

13. Deprivation of opportunities for sleep or rest, except as ordered by a licensed physician for a legitimate medical purpose and documented in the individual's record; and

14. Limitation on contacts or visits with advocates employed by the department or the disAbility Law Center of Virginia, the designated protection and advocacy services entity for the Commonwealth of Virginia established pursuant to § 51.5-39.13 of the Code of Virginia.

A. In addition to complying with the discharge provisions within 12VAC35-270-430, providers of residential services to children shall have written criteria for discharge that shall include:

1. Criteria for an individual's completion of the program that are consistent with the facility's programs and services;

2. Conditions under which an individual may be discharged before completing the program; and

3. Procedures for assisting placing agencies in placing the individuals if the facility ceases operation.

B. The provider's criteria for discharge shall be accessible to individuals, parents and legal guardians, and placing agencies.

C. The record of each individual discharged upon receipt of the order of a court of competent jurisdiction shall contain a copy of the court order. The copy of the court order maintained in the individual's record shall satisfy the discharge summary requirement of 12VAC35-270-430 E.

D. Individuals shall be discharged only to the legal guardian or legally authorized representative.

E. Information concerning current medications, need for continuing therapeutic interventions, educational status, and other items important to the individual's continuing care shall be provided to the legal guardian or legally authorized representative, as appropriate.

No individual shall be placed outside the facility prior to the facility obtaining a license from the Department of Social Services as a child-placing agency, except as permitted by statute or by order of a court of competent jurisdiction.

A. Smoking shall be prohibited in living areas and in areas where individuals participate in programs.

B. Each living unit shall have a living room or other area for informal use, relaxation, and entertainment. The furnishings shall provide a comfortable, homelike environment that is appropriate to the ages of the individuals.

C. All facilities shall have indoor recreation space that contains indoor recreation materials appropriate to the ages and interests of the individuals.

D. Facilities licensed to care for 13 or more individuals shall have indoor recreation space distant from the living room. Recreation space is not required in every living unit.

E. Facilities serving a school-age population shall provide study space. Study space may be assigned in areas used interchangeably for other purposes.

F. Study space shall be well-lighted, quiet, and equipped with tables or desks and chairs that are size-appropriate and age-appropriate for the individuals receiving services.

G. Meals shall be served in areas equipped with sturdy tables and benches or chairs that are size-appropriate and age-appropriate for the individuals receiving services.

H. Adequate kitchen facilities, equipment, and dining space shall be provided for preparation and serving of meals.

I. Walk-in refrigerators, freezers, and other enclosures shall be equipped to permit emergency exits.

J. Space shall be provided for administrative activities including, as appropriate to the program, confidential conversations and the storage of records and materials.

K. Outdoor recreation space shall be available and appropriately equipped for use by the individuals receiving services.

A. The provider shall have formal and informal methods of resolving procedural and programmatic issues arising between the clinical and security employees or contractors. These methods shall ensure individual care.

B. The provider shall demonstrate ongoing communication between clinical and security employees to ensure individual care.

C. The provider shall provide cross-training for the clinical and security employees or contractors that includes:

1. Mental health, substance abuse, and developmental disability education;

2. Use of clinical and security restraints; and

3. Channels of communication.

D. Employees or contractors shall receive periodic in-service training and have knowledge of and be able to demonstrate the appropriate use of clinical and security restraint.

E. Security and behavioral assessments shall be completed at the time of admission to determine service eligibility and at least weekly for the safety of individuals, other persons, employees, and visitors.

F. Personal grooming and care services for individuals shall be a cooperative effort between the clinical and security employees or contractors.

G. Clinical needs and security level shall be considered when arrangements are made regarding privacy for individual contact with family or attorneys.

H. Living quarters shall be assigned on the basis of the individual's security level and clinical needs.

I. An assessment of the individual's clinical condition and needs shall be made when disciplinary action or restrictions are required for infractions of security measures.

J. Clinical services consistent with the individual's condition and plan of treatment shall be provided when security detention or isolation is imposed.

A. The use of audio equipment, such as televisions, radios, and record players, shall not interfere with therapeutic activities.

B. Aftercare planning for individuals nearing the end of incarceration shall include a provision for continuing medication and follow-up services with area community services to facilitate successful reintegration into the community, including a specific appointment provided to the inmate no later than the day of release.

Providers of sponsored residential home services shall maintain the following information:

1. Names and ages of residential sponsors;

2. Date of sponsored residential home agreement;

3. The maximum number of individuals that can be placed in the home at a given time;

4. Names and ages of all other individuals who are not receiving services, but are residing in a sponsored residential home;

5. Address and telephone number of the sponsored residential home; and

6. Names of all staff employed in the home, including on-call and substitute staff.

A. The provider shall maintain a written agreement with residential home sponsors. Sponsors are persons who provide the home where the service is located and are directly responsible for the provision of services. The agreement shall include the:

1. Provider's responsibilities;

2. Sponsor's responsibilities;

3. Scope of services;

4. Supervision;

5. Compensation;

6. Training;

7. Reporting requirements and procedures; and

8. A provision stating that the sponsored residential home shall not operate as a group home or Virginia Department of Social Services-approved home or foster home, and shall comply with all applicable local, state, and federal laws and regulations.

B. The agreement shall be available for inspection by the department's licensing specialist and shall include a provision granting the right of entry to state licensing specialists or human rights advocates to conduct inspections.

A. The provider shall evaluate and certify each sponsored residential home other than his own through face-to-face interviews, inspections, and other information documenting compliance with this section. Before individuals are placed in the home, and annually thereafter, the provider shall submit the certification form to the department.

B. The provider shall certify and document that each sponsored residential home meets the criteria for physical environment and residential services in this chapter.

C. The provider shall document the ability of the sponsored residential home staff to meet the needs of the individuals placed in the home by assessing and documenting:

1. The ability of the sponsor and all staff to communicate and understand individuals receiving services;

2. The ability of the sponsor and all staff to provide the care, treatment, training, or habilitation for individuals receiving services in the home;

3. The abilities of all members of the sponsored household to accept individuals with disabilities and their disability-related characteristics, especially the ability of children in the household to adjust to nonfamily members living with them;

4. The financial capacity of the sponsor to meet the sponsor's own expenses for up to 90 days, independent of payments received for individuals living in the home; and

5. The education, qualifications, and experience of the sponsor and staff in working with the population receiving services including driving record, tuberculosis screening, first-aid and CPR certification, and completion of medication administration and behavior interventions training required by 12VAC35-270-280.

D. The provider shall comply with all elements of 12VAC35-270-250 for the sponsor and all staff.

E. The provider shall implement a written policy for obtaining references, criminal background checks, and registry checks for all adults in the home who are neither staff nor individuals receiving services.

1. The policy shall indicate what actions the provider will take if the results returned indicate that any adults in the home have a finding of child abuse or neglect, prior criminal background, has been convicted of a barrier crime or otherwise fails to meet the requirements of this regulation.

2. The actions shall be appropriate for the health and safety of the population served by the provider and the expected duties of the staff.

F. The sponsored residential home shall submit to the provider the results of a physical and mental health examination of family members when requested by the provider based on indications of a physical or mental health issue.

G. No sponsored residential home shall also operate as a group home, Department of Social Services-approved home, or foster home.

H. The provider shall submit a modification application as required by 12VAC35-270-80 prior to adding a sponsored residential home. The provider shall submit the name and address of the sponsored residential home to the department prior to closing a home.

A. The provider shall have one supervisor for every 15 sponsored residential homes where individuals reside.

B. A responsible adult shall be available to provide supervision to the individual receiving services as specified in the ISP.

C. Any member of the sponsor family household who transports individuals receiving services must have a valid driver's license and be covered by automobile liability insurance. The vehicle used to transport individuals receiving services shall have a valid registration and inspection sticker.

D. The sponsor shall inform the provider (i) in advance of any anticipated additions or changes in the sponsored residential home or (ii) as soon as possible after an unexpected change occurs.

E. In addition to all other current reporting requirements, the sponsor shall report all hospitalizations of individuals receiving services to the provider and the individual's case manager within 24 hours.

Providers of sponsored residential home services shall maintain the following records on each sponsored residential home:

1. Documentation of all elements required within the sponsor qualification and approval process in 12VAC35-272-720;

2. Orientation and training provided to the sponsor and employees;

3. The log of provider inspections of the sponsored residential home including the date, the employee conducting the inspection, the purpose of the inspection, and a description of any significant events or findings; and

4. The daily log maintained by the sponsor of significant events related to individuals receiving services.

Providers shall certify and document compliance of sponsors with all provisions pertaining to staff in this part and in 12VAC35-270.

A. The provider shall implement written policies to provide orientation and supportive services to the sponsored residential home staff specific to the needs of the individuals receiving services.

B. The provider shall implement a training plan for the sponsor staff consistent with the needs of the individuals receiving services.

C. The provider shall specify and ensure adequate staffing arrangements in all sponsored residential homes, including on-call and substitute care coverage.

D. The provider shall implement a written policy on managing, monitoring, and supervising sponsored residential homes. This policy shall address changes in supervision arrangements as the number of homes increase.

E. At least once every quarter, the provider shall conduct inspections of each sponsored residential home other than his own. A minimum of two quarterly inspections each year shall be unannounced inspections.

F. On an ongoing basis and at least annually, the provider shall review and document regulatory compliance by each sponsored residential home and sponsor.

G. The provider shall develop written policies for terminating a sponsored residential home.

H. The individual’s support coordinator or case manager shall provide and document that the individual or the authorized representative is provided informed choice to choose a new placement when the current placement ends. Prior to moving an individual to another placement, the support coordinator or case manager shall conduct and document a meeting to include the individual and his authorized representative or legal guardian, if applicable; the current sponsor; and a receiving placement staff, if possible.

The maximum number of individuals in a sponsored residential home is two. The maximum number of occupants in a sponsored residential home is seven.

In addition to all other regulations applicable to sponsored residential homes, the following requirements shall be met for homes serving children:

1. The provider shall develop a service description based upon evidence-based practices or an accepted therapeutic model of mental health, substance abuse, or developmental services, or brain injury care for children.

2. The provider shall use a treatment team model consisting of staff who provide intensive support and consultation to the sponsor.

3. Weekly team meetings and supervision shall be held with the sponsor and the individual's authorized representative or legal guardian to review progress on each case, review the daily behavioral information collected, and adjust the child's ISP.

4. The sponsor shall keep a daily log of behavioral and other child-specific information and be available for daily Monday through Friday contact from the provider.

5. The sponsor shall receive 25 hours per year of in-service training pertaining to providing services for the child they serve, in addition to the training otherwise required in this chapter and 12VAC35-270. The sponsor shall also participate in ongoing training at least once a quarter.

6. The provider is not considered a child placing agency. Children are placed with the provider by licensed child placing agencies, local departments of social services, or parents or legal guardians.

7. The sponsor shall be at least 25 years of age.

8. The sponsor shall be able to provide care and supervision during nonschool hours or when the child is not attending during school hours due to illness or other excused absence.

9. The provider shall have access, either by direct provision or developing agreements, to 24-hour emergency mental health care for children served with serious emotional disturbances.

A medically managed intensive inpatient program shall meet the following programmatic requirements. The program shall:

1. Deliver services in a 24-hour medically managed, acute care setting and shall be available to all individuals within that setting;

2. Provide cognitive, behavioral, motivational, pharmacologic, and other therapies provided on an individual or group basis, depending on the individual's needs;

3. For an individual who has a severe biomedical disorder, provide physical health interventions to supplement addiction treatment;

4. For an individual who has stable psychiatric symptoms, provide individualized treatment activities designed to monitor the individual's mental health;

5. Provide planned clinical interventions that are designed to enhance the individual's understanding and acceptance of addiction illness;

6. Provide family and caregiver treatment services as deemed appropriate by a licensed professional and included in an assessment and treatment plan;

7. Provide health education services;

8. Make MAT available for all individuals admitted to the service. MAT may be provided by facility staff or coordinated through alternative resources; and

9. If the provider is providing MAT within the facility, the provider shall comply with 12VAC35-276-300, 12VAC35-276-340, and 12VAC35-276-360.

Before a medically managed intensive inpatient program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:

1. Meet diagnostic criteria for a substance use disorder or addictive disorder of moderate to high severity as defined by the DSM; and

2. Meet the admission criteria of Level 4.0 of ASAM, including the specific criteria for adult and adolescent populations.

Before a medically managed intensive inpatient program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:

1. Achieved the goals of the treatment services and no longer require ASAM 4.0 level of care;

2. Been unable to achieve the goals of the individual's treatment but could achieve the individual's goals with a different type of treatment; or

3. Achieved the individual's original treatment goals but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.

A. Medically managed intensive inpatient co-occurring enhanced programs shall be staffed by appropriately credentialed mental health professionals who assess and treat the individual's co-occurring mental disorders. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.

B. Medically managed intensive inpatient co-occurring enhanced programs shall offer individualized treatment activities designed to stabilize the individual's active psychiatric symptoms, including medication evaluation and management.

A medically monitored intensive inpatient treatment program shall meet the following programmatic requirements. The program shall:

1. Be made available to all individuals within the inpatient setting;

2. Provide a combination of individual and group therapy as deemed appropriate by a licensed mental health professional and included in an assessment and treatment plan. Such therapy shall be adapted to the individual's level of comprehension;

3. Make medical and nursing services available on site to provide ongoing assessment and care of addiction needs;

4. Provide direct affiliations with other easily accessible levels of care or close coordination through referral to more or less intensive levels of care and other services;

5. Provide family and caregiver treatment services as deemed appropriate by a licensed mental health professional and included in an assessment and treatment plan;

6. Provide educational and informational programming adapted to individual needs. The educational and informational programming shall include materials designed to enhance the individual's understanding of addiction and may include peer recovery support services as appropriate;

7. Utilize random drug screening to monitor drug use and reinforce treatment gains;

8. Regularly monitor the individual's adherence in taking any prescribed medications; and

9. If the provider is providing MAT within the facility, the provider shall comply with 12VAC35-276-300, 12VAC35-276-340, and 12VAC35-276-360.

Before a medically monitored intensive inpatient program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:

1. Meet diagnostic criteria for a substance use disorder of the DSM or addictive disorder of moderate to high severity; and

2. Meet the admission criteria of Level 3.7 of ASAM, including the specific criteria for adult and adolescent populations.

A. Before a medically monitored intensive inpatient program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:

1. Achieved the goals of the treatment services and no longer require ASAM 3.7 level of care;

2. Been unable to achieve the goals of the individual's treatment but could achieve the individual's goals with a different type of treatment; or

3. Achieved the individual's original treatment goals but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.

B. Discharge planning shall occur for individuals and include realistic plans for the continuity of MAT services as indicated.

A. Medically monitored intensive inpatient co-occurring enhanced programs shall offer psychiatric services, medication evaluation, and laboratory services as indicated by the needs of individuals admitted to the service. A psychiatrist shall assess the individual by telephone within four hours of admission and in person with 24 hours following admission. An LMHP shall conduct a behavioral health-focused assessment at the time of admission. A registered nurse shall monitor the individual's progress and administer or monitor the individual's self-administration of psychotropic medications.

B. Medically monitored intensive inpatient co-occurring enhanced programs shall be staffed by addiction psychiatrists and appropriately credentialed behavioral health professionals who are able to assess and treat co-occurring psychiatric disorders and who have specialized training in behavior management techniques and evidence-based practices. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.

C. Medically monitored intensive inpatient co-occurring enhanced programs shall offer planned clinical activities designed to promote stabilization of the individual's behavioral health needs and psychiatric symptoms and to promote such stabilization, including medication education and management and motivational and engagement strategies.

A clinically managed high-intensity residential care program shall meet the following programmatic requirements. The program shall:

1. Provide daily clinical services, including a range of cognitive, behavioral, and other therapies in individual or group therapy; programming; and psychoeducation as deemed appropriate by a licensed professional and included in an assessment and treatment plan;

2. Provide counseling and clinical interventions to teach an individual the skills needed for daily productive activity, prosocial behavior, and reintegration into family and community;

3. Provide motivational enhancement and engagement strategies appropriate to an individual's stage of readiness to change and level of comprehension;

4. Have direct affiliations with other easily accessible levels of care or provide coordination through referral to more or less intensive levels of care and other services;

5. Provide family and caregiver treatment services as deemed appropriate by a licensed professional and included in an assessment and treatment plan;

6. Provide educational, vocational, and informational programming adaptive to individual needs;

7. Utilize random drug screening to monitor progress and reinforce treatment gains as appropriate to an individual treatment plan;

8. Ensure and document that the length of an individual's stay shall be determined by the individual's condition and functioning;

9. Make a substance use treatment program available for all individuals;

10. Make MAT available for all individuals. Medication-assisted treatment may be provided by facility staff or coordinated through alternative resources; and

11. If the provider is providing MAT within the facility, the provider shall comply with 12VAC35-276-300, 2VAC35-276-340, and 2VAC35-276-360.

A. The individuals receiving clinically managed high-intensity residential care are individuals who are not sufficiently stable to benefit from outpatient treatment regardless of intensity of service.

B. Before a clinically managed high-intensity residential service program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:

1. Meet diagnostic criteria for a substance use disorder or addictive disorder of moderate to high severity as defined by the DSM; and

2. Meet the admission criteria of Level 3.5 of ASAM.

Before a clinically managed high-intensity residential service program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:

1. Achieved the goals of the treatment services and no longer require ASAM 3.5 level of care;

2. Been unable to achieve the goals of the individual's treatment, but could achieve the individual's goals with a different type of treatment; or

3. Achieved the individual's original treatment goals, but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.

A. Clinically managed high-intensity residential services co-occurring enhanced programs shall offer psychiatric services, medication evaluation, and laboratory services. Such services shall be available by telephone within eight hours and onsite or closely coordinated offsite within 24 hours.

B. Clinically managed high-intensity residential services co-occurring enhanced programs shall be staffed by appropriately credentialed mental health professionals, including addiction psychiatrists who are able to assess and treat co-occurring mental disorders and who have specialized training in behavior management techniques. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.

C. Clinically managed high-intensity residential services co-occurring enhanced programs shall offer planned clinical activities designed to stabilize the individual's mental health problems and psychiatric symptoms and to maintain such stabilization, including medication education and management and motivational and engagement strategies. Goals of therapy shall apply to both the individual's substance use disorder and any co-occurring mental disorder.

A clinically managed, population-specific high-intensity residential services program shall meet the following programmatic requirements. The program shall:

1. Provide daily clinical services that shall include a range of cognitive, behavioral, and other therapies administered on an individual and group basis, medication education and management, educational groups, and occupational or recreation activities as deemed appropriate by a licensed professional and included in an assessment and treatment plan;

2. Provide daily professional addiction and mental health treatment services that may include relapse prevention, exploring interpersonal choices, peer recovery support, and development of a social network;

3. Provide services to improve the individual's ability to structure and organize the tasks of daily living and recovery. Such services shall accommodate the cognitive limitations within this population;

4. Make available medical, psychiatric, psychological, and laboratory and toxicology services through consultation or referral as indicated by the individual's condition;

5. Provide case management, including ongoing transition and continuing care planning;

6. Provide motivational interventions appropriate to the individual's stage of readiness to change and designed to address the individual's functional limitations;

7. Have direct affiliations with other easily accessible levels of care or coordinate through referral to more or less intensive levels of care and other services;

8. Provide family and caregiver treatment services as deemed appropriate by an assessment and treatment plan;

9. Utilize random drug screening to monitor progress and reinforce treatment gains;

10. Regularly monitor the individual's adherence to taking prescribed medications;

11. Make the substance use treatment program available to all individuals receiving the residential care service;

12. Make MAT available for all individuals. Medication-assisted treatment may be provided by facility staff or coordinated through alternative resources; and

13. If the provider is providing MAT within the facility, the provider shall comply with 12VAC35-276-300, 12VAC35-276-340, and 12VAC35-276-360.

Before a clinically managed, population-specific, high-intensity residential service program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:

1. Meet diagnostic criteria for a substance use disorder or addictive disorder of moderate to high severity as defined by the DSM; and

2. Meet the admission criteria of Level 3.3 of ASAM.

A. Before a clinically managed, population-specific, high-intensity residential service program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:

1. Achieved the goals of the treatment services and no longer require ASAM 3.3 level of care;

2. Been unable to achieve the goals of the individual's treatment, but could achieve the individual's goals with a different type of treatment; or

3. Achieved the individual's original treatment goals, but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.

B. Discharge planning shall occur for individuals and include realistic plans for the continuity of MAT services as indicated.

A. Clinically managed population-specific high-intensity residential services co-occurring enhanced programs shall offer psychiatric services, medication evaluation, and laboratory services. Such services shall be available by telephone within eight hours and onsite or closely coordinated off site within 24 hours, as appropriate to the severity and urgency of the individual's mental condition.

B. Clinically managed population-specific high-intensity residential services co-occurring enhanced programs shall be staffed by appropriately credentialed psychiatrists and licensed mental health professionals who are able to assess and treat co-occurring mental disorders and who have specialized training in behavior management techniques. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.

C. Clinically managed population-specific high-intensity residential services co-occurring enhanced programs shall offer planned clinical activities designed to stabilize the individual's mental health problems and psychiatric symptoms and to maintain such stabilization, including medication education and management and motivational and engagement strategies. Goals of therapy shall apply to both the substance use disorder and any co-occurring mental health disorder.

A clinically managed low-intensity residential services program shall meet the following programmatic requirements. The program shall:

1. Offer a minimum of five hours a week of professionally directed treatment in addition to other treatment services offered to individuals, such as partial hospitalization or intensive outpatient treatment the focus of which is stabilizing the individual's substance use disorder. Services shall be designed to improve the individual's ability to structure and organize the tasks of daily living and recovery;

2. Ensure collaboration with care providers to develop an individual treatment plan for each individual with time-specific goals and objectives;

3. Provide counseling and clinical monitoring to support successful initial involvement in regular, productive daily activity;

4. Provide case management services;

5. Provide motivational interventions appropriate to the individual's stage of readiness to change and level of comprehension;

6. Have direct affiliations with other easily accessible levels of care or coordinate through referral to more or less intensive levels of care and other services;

7. Include the ability to arrange for needed procedures as appropriate to the severity and urgency of the individual's condition;

8. Provide family and caregiver treatment and peer recovery support services as deemed appropriate by a licensed professional and included in an assessment and treatment plan;

9. Provide addiction pharmacotherapy and the ability to arrange for pharmacotherapy for psychiatric medications;

10. Utilize random drug screening to monitor progress and reinforce treatment gains;

11. Make a substance abuse treatment program available to all individuals;

12. Make MAT available for all individuals. Medication-assisted treatment may be provided by facility staff or coordinated through alternative resources; and

13. If the provider is providing MAT within the facility, the provider shall comply with 12VAC35-276-300, 12VAC35-276-340, and 12VAC35-276-360.

Before a clinically managed low-intensity residential service program may admit an individual, the individual shall meet the criteria for admission as defined by the provider's policies. The provider's policy regarding admission shall at a minimum require the individual to:

1. Meet diagnostic criteria for a substance use disorder or addictive disorder of moderate to high severity as defined by the DSM; and

2. Meet the admission criteria of Level 3.1 of ASAM.

Before a clinically managed low-intensity residential service program may discharge or transfer an individual, the individual shall meet the criteria for discharge or transfer as defined by the provider's policies, which shall include provisions for the discharge or transfer of individuals who have:

1. Achieved the goals of the treatment services and no longer require ASAM 3.1 level of care;

2. Been unable to achieve the goals of the individual's treatment, but could achieve the individual's goals with a different type of treatment; or

3. Achieved the individual's original treatment goals, but have developed new treatment challenges that can only be adequately addressed in a different type of treatment.

A. Clinically managed low-intensity residential services co-occurring enhanced programs shall offer psychiatric services, including medication evaluation and laboratory services. Such services shall be provided on site or closely coordinated offsite, as appropriate to the severity and urgency of the individual's mental condition.

B. Clinically managed low-intensity residential services co-occurring enhanced programs shall be staffed by appropriately credentialed licensed mental health professionals who are able to assess and treat co-occurring disorders with the capacity to involve addiction-trained psychiatrists. All clinical staff shall be qualified by training and experience and appropriately licensed, certified, or registered by the appropriate health regulatory board to serve individuals admitted to the service.

C. Clinically managed low-intensity residential services co-occurring enhanced programs shall offer planned clinical activities that are designed to stabilize the individual's mental health problems and psychiatric symptoms and to maintain such stabilization, including medication education and management and motivational and engagement strategies. Goals of therapy shall apply to both the substance use disorder and any co-occurring mental disorder.