65D-30.006. Standards for Detoxification

In addition to rule 65D-30.004, F.A.C., the following standards apply to detoxification.

(1) Detoxification is a process involving acute or subacute care that is provided on a non-hospital inpatient or an outpatient basis to assist individuals who meet the placement criteria for this component to withdraw from the physiological and psychological effects of substance use.

(2) General Requirements. Detoxification protocols shall be developed by the medical director, or in accordance with the medical protocol established in subsection 65D-30.004(6), F.A.C., and implemented upon admission according to the physiological and psychological needs of the individual.

(3) Inpatient Detoxification.

(a) Services.

1. Stabilization. Stabilization services shall be provided as an initial phase of detoxification.

2. Supportive Counseling. Each individual shall participate in supportive counseling on a daily basis unless the individual is not sufficiently stable. Supportive counseling sessions shall be of sufficient duration to enable staff to make reasonable decisions regarding the individual’s need for other services. Services shall be directed toward ensuring that the individual’s most immediate needs are addressed and encouraging the individual to remain engaged in treatment and to follow up on referrals after discharge.

3. Daily Activities. The provider shall develop a schedule of daily activities that will be provided based on the detoxification protocols as defined in subsection 65D-30.002(27), F.A.C. This shall include recreational and educational activities, and participation shall be documented in the clinical record.

4. Involuntary Assessment and Disposition. Individuals who are involuntarily admitted into a detoxification unit under protective custody, emergency admission or involuntary assessment and stabilization pursuant to section 397.6772, 397.6797, or 397.6811, F.S., shall be assessed and referred as in subsection 65D-30.005(9), F.A.C.

(b) Observation of Individuals. Individuals requiring close medical observation, as determined and documented by medical staff, shall be visible and readily accessible to nursing staff. Individuals who do not require close medical observation shall be in a bed area that allows for general nursing observation.

(c) Staff Coverage. Each facility shall have a physician on call at all times to address medical problems and to provide emergency medical services. The physician’s name, telephone number, and schedule for this arrangement shall remain current and clearly posted at the nurse’s station. An R.N. shall be the supervisor of all nursing services and shall be on-call 24 hours per day, 7 days per week. An L.P.N. or R.N. shall be on-site 24 hours per day, 7 days per week. All staff shall have immediate access to a nurse supervisor or physician for consultation.

(d) Staffing Requirement and Bed Capacity. The staffing requirement for nurses and nursing support personnel for each shift shall be as follows:

Licensed Bed Capacity	Nurses	Nursing Support
1-15	1	1
16-20	1	2
21-30	2	2

The number of nurses and nursing support staff shall increase in the same proportion as the requirement described above. In instances where an inpatient detoxification component and a licensed crisis stabilization unit are co-located, the staffing requirement for the combined components shall conform to the staffing requirement of the component with the more restrictive requirements.

(4) Outpatient Detoxification. The following standards apply to outpatient detoxification.

(a) Eligibility for Services. Eligibility for outpatient detoxification shall be determined from the following:

1. The individual’s overall medical condition;

2. The individual’s family or support system, for the purpose of observing the individual during the detoxification process, and for monitoring compliance with the medical protocol;

3. The individual’s overall stability and behavioral condition;

4. The individual’s ability to understand the importance of managing withdrawal utilizing medications and to comply with the medical protocol; and

5. An assessment of the individual’s ability to abstain from the use of substances, except for the proper use of prescribed medication.

(b) Drug Screening. A drug and alcohol screen shall be conducted at admission. Thereafter, the program shall require random drug and alcohol screening for each individual in accordance with the provider’s medical protocol.

(c) Services.

1. Supportive Counseling. Each individual shall participate in supportive counseling on a weekly basis. Counseling sessions shall be of sufficient duration to enable staff to make decisions regarding the individual’s need for other services and to determine progress.

2. Referral to Inpatient Detoxification. Providers shall refer individuals to inpatient detoxification or the appropriate level of care when there is evidence that the individual is unable to comply with the outpatient protocol.

(d) Staffing Requirement. Staffing for outpatient detoxification shall minimally consist of the following:

1. A physician, or an A.R.N.P. or a P.A. working under the supervision of a physician, available and on-call during operating hours,

2. An R.N., or an L.P.N. working under the supervision of an R.N., on-site during operating hours; and,

3. A counselor, on-site during operating hours.

(e) Training. All direct services staff working in outpatient detoxification shall be trained in the outpatient detoxification protocol prior to having contact with the individual in need of services.

(5) Additional Requirements for the Use of Methadone in Detoxification. In cases where a provider uses methadone in the detoxification protocol, the provider shall comply with the minimum standards found under subsection 65D-30.006(2), F.A.C., if methadone is provided as part of inpatient detoxification, and subsection 65D-30.006(3), F.A.C., if methadone is provided as part of outpatient detoxification. In either case, methadone may be used short-term (no more than 30 days) or long-term (no more than 180 days). Short-term detoxification is permitted on an inpatient and an outpatient basis while long-term detoxification is permitted on an outpatient basis only. A provider shall not admit an individual in more than two (2) detoxification episodes in one (1) year. The physician or other medically qualified professional designee identified in accordance with the medical protocol established in subsection 65D-30.004(7), F.A.C., shall assess the individual upon admission to determine the need for other forms of treatment. Providers shall also comply with the standards found under subsection 65D-30.014(4), F.A.C., with the exception of the following conditions:

(a) Take-home methadone is not allowed during short-term detoxification.

(b) Individuals involved in long-term detoxification shall have a drug screen initially and at least monthly thereafter.

(c) Individuals involved in short-term detoxification shall have at least one (1) initial drug screen.

(5) Hours of Operation. Providers shall post their hours of operation and this information shall be visible to the public.

Rulemaking Authority 397.321(5) FS. Law Implemented 397.311(26), 397.321, 397.4014, 397.410 FS. History–New 5-25-00, Amended 4-3-03, 8-29-19.