This Georgia regulation establishes licensing requirements for Drug Abuse Treatment and Education Programs (DATEPs), covering residential and non-residential substance use treatment settings including residential sub-acute detoxification, ambulatory detoxification, residential intensive treatment, residential transitional treatment, specialized day treatment, outpatient drug treatment, and special programs. Operators must obtain a license or provisional license from the Department of Behavioral Health and Developmental Disabilities before operating, and must comply with requirements for administration, staffing, physical plant, client records, incident reporting, and corrective action plans. Narcotic Treatment Programs, licensed hospitals, crisis stabilization units, and ERET facilities are explicitly excluded from this rule's scope.
View official sourceSubject 82-10-1 Drug Abuse Treatment and Education Programs Rule 82-10-1-.01 Legal Authority These rules are adopted and published pursuant to the Official Code of Georgia Annotated (O.C.G.A.) § 26-5-1 et seq. Rule 82-10-1-.02 Title and Purpose (1) These rules shall be known as the Rules and Regulations for Drug Abuse Treatment and Education Programs. (2) The purpose of these rules is to provide minimal requirements for the licensing and survey of drug abuse treatment and education programs. (3) These rules do not apply to the following: (a) Licensed hospitals; (b) Any crisis stabilization unit certified by the Department of Behavioral Health and Developmental Disabilities; (c) Approved Emergency, Receiving, Evaluation and/or Treatment (ERET) facilities as defined in Chapter 82-8-1, "Emergency Receiving, Evaluating and Treatment Facilities"; and (d) Licensed Narcotic Treatment Programs monitored by the State Opioid Treatment Authority. Rule 82-10-1-.03 Definitions In these rules, unless the context otherwise requires, the words and phrases set forth herein shall mean the following: (1) "Ambulatory detoxification program" means a program for the medical management and other support for processes associated with the physical process of withdrawal from drugs in a non-residential setting. Persons treated in this setting are without unusual or significant medical risks or behavioral problems. Specific requirements for this program type are set forth in Rule 82-10-1-.20. (2) "Behavior management" means those principles and techniques used by a facility to assist a client in facilitating self-control, addressing inappropriate behavior, and achieving positive outcomes in a constructive and safe manner. Behavior management principles and techniques shall be used in accordance with the client's treatment plan, written policies and procedures governing service expectations, treatment goals, safety, security, and these rules and regulations. (3) "Branch" means a part-time (operating less than five days per week) substance abuse program at a site or location different from the location of the licensed program, yet which is operated as a part of the licensed program and is not separately licensed. Residential and ambulatory detoxification programs are excluded from operating as a branch program. Effective July 1, 2026, new branch programs are required to be separately licensed from the parent program. (4) "Corrective Action Plan" or "CAP" means a plan developed by the facility in response to a violation identified on a written report of survey or investigation that contains the steps or actions that have been taken, or are planned, to address or correct the violation and the anticipated date of the correction. (5) "Department" means the Department of Behavioral Health and Developmental Disabilities, or its successor. (6) "Drug abuse treatment and education program" or "program" or "DATEP" means any system of treatment or therapeutic advice, or counsel provided for the rehabilitation of drug dependent persons and shall include programs offered in residential and/or nonresidential settings. Specific requirements for these program types are set forth in Rules 82-10-1-.19 through 82-10-1-.25. (7) "Drug dependent person" means a person who is in imminent danger of becoming dependent upon or addicted to the use of drugs or who habitually lacks self-control as to the use of drugs or who uses drugs to the extent that their health is substantially impaired or endangered, or their social or economic function is substantially disrupted. (8) "Drug" means any substance defined as a drug by federal or Georgia law or any other chemical substance which may be used in lieu of a drug to obtain similar effects, with the exception of alcohol and its derivative. (9) "Emergency safety interventions" means those behavioral intervention techniques that are authorized under an approved emergency safety intervention plan and are utilized by properly trained staff in an urgent situation to prevent a client from doing immediate harm to self or others. (10) "Emergency safety intervention plan" means the plan developed by the facility utilizing a nationally recognized, Department-approved, evidence-based, training program for emergency safety intervention. The plan shall clearly identify the emergency safety interventions staff may utilize and those that may never be used. (11) "Final adverse finding" means the finding(s) set forth in or upheld by a report of the Department, order or decision of the Commissioner, agreement between a facility and the Department, or formal order as of the date of: (a) The issuance of a ruling by the Superior Court or Commissioner of the Department of Behavioral Health and Developmental Disabilities on any appeal from a decision of a state administrative law judge, a hearing officer, or a hearing examiner pursuant to a contested case involving the imposition of a sanction; (b) The finalization by operation of law of a decision of a state administrative law judge, a hearing officer, or a hearing examiner when no appeal is made; (c) The disposition of a contested case by settlement between the parties; or (d) The expiration of the time allotted for a facility to contest a sanction imposed by the Department, if the facility does not properly contest the sanction within that time period. (12) "Governing body" means the county board of health, the partnership, the corporation, the association, or the person or group of persons who maintains and controls the facility and who is legally responsible for the operation. (13) "Investigation" means any examination by the Department of Behavioral Health and Developmental Disabilities, or its representatives, of a facility, including but not necessarily limited to the premises, staff, persons in care, and documents pertinent to an allegation(s) of non-compliance or a reportable incident. Investigations may be initiated at any time and may be announced or unannounced at the discretion of the Department. (14) "License" means the official permit issued by the Department of Behavioral Health and Developmental Disabilities which authorizes the holder to operate a drug abuse treatment and education program for the term provided therein. (15) "Manual hold" means the application of physical force, without the use of any device, for the purpose of restricting the free movement of a client's body. A manual hold does not include briefly holding the client without undue force to calm or comfort the client, holding the client by the hand or by the shoulders or back to walk the client safely from one area to another where the client is not forcefully resisting the assistance, or assisting the client in voluntarily participating in activities of daily living. (16) "Mechanical restraint" means a device attached or adjacent to the client's body that is not a prescribed and approved medical protection device, and that he or she cannot easily remove, that restricts freedom of movement or normal access to his or her body. (17) "Medical protection device" means a device used to aid in the healing process or prevent exacerbation of an injury or wound by restricting the normal access of the resident to his or her body or parts. A medical protective device is not used for behavioral restraint. The intended use for medical protective devices is for medical reasons such as promoting healing in a wound or preventing exacerbation of an injury that may lead to complications. A device used for management of behavioral issues is not a medical protective device. (18) "Narcotic Treatment Program" means any system of treatment provided for chronic heroin or opiate-like drug-dependent persons that administers narcotic drugs under physicians' orders either for detoxification purposes or for maintenance treatment in a rehabilitative context offered by any county board of health, partnership, corporation, association, or person or groups of persons engaged in such administration. (19) "Outpatient Drug Treatment Program" means a non-residential program staffed by professional and paraprofessional persons that provides structured drug treatment or therapeutic services, primarily counseling and other supportive services for drug dependent persons and is not classified as an ambulatory detoxification program or Specialized Day Treatment Program. Specific requirements for this program type are set forth in Rule 82-10-1-.24. (20) "Parent program" means the licensed program that develops and maintains administrative controls of Subunits and Branches of the program. (21) "Physician extender" means a licensed Physician Assistant (PA) or Advanced Practice Registered Nurse (APRN), qualified by training and experience as determined by the supervising physician, who conduct assessments, develop treatment plans, manage documentation and communicate with other healthcare providers under a designated supervising physician through an approved job description (for PAs) or nurse protocol agreement (for APRNs). (22) "Reportable incident" means any event that involves an immediate threat to the care, health or safety of a facility's client which either happens at the facility or is connected with the care the client received from the facility. (23) "Residential intensive treatment program" means a residential program staffed by professional and paraprofessional persons which provide highly structured treatment and therapeutic activities that focus on stabilization, abstinence, and skills required for recovery; are not classified as a residential sub-acute detoxification program. Specific requirements for this program type are set forth in Rule 82-10-1-.21. (24) "Residential sub-acute detoxification program" means a residential program for drug dependent persons which includes the medical management and other support for processes associated with the physical withdrawal from drugs in a residential setting, staffed by professional and paraprofessional persons, which is not in a licensed hospital or designated emergency receiving, evaluating and/or treatment facility. Specific requirements for this program type are set forth in Rule 82-10-1-.19. (25) "Residential transitional treatment program" means a residential program which provides therapeutic services to drug dependent persons, who are transitioning to the community or to other treatment modalities, and who, typically, lack a stable living situation and require variable levels of therapeutic services. Specific requirements for this program type are set forth in Rule 82-10-1-.22. (26) "Seclusion" means the involuntary confinement of a client alone in a room or in any area of a room from which the client is prevented from leaving, regardless of the purpose of the confinement. The practice of "restrictive time-out" (RTO) is seclusion and may not be utilized except in compliance with the requirements related to seclusion. The phrase "prevented from leaving" includes not only the use of a locked door, but also the use of physical or verbal control to prevent the client from leaving. (27) "Specialized day treatment program" means a non-residential program specifically for drug dependent persons staffed by professional and paraprofessional persons that provides structured treatment or therapeutic services, utilizing activity schedules as part of its operational method; it is not classified as an ambulatory detoxification or outpatient drug treatment program. Specific requirements for this program type are set forth in Rule 82-10-1-.23. (28) "Special program" means a program specifically for drug dependent persons that provides a system of therapeutic services which does not fit into existing DATEP program classifications. Specific requirements for this program type are set forth in Rule 82-10-1-.25. (29) "Subunit" means a full-time program for drug dependent persons operating semi-autonomously in a different location from the Parent program, which may provide different modalities of services, and must independently meet the licensing requirements and shall be separately licensed. (30) "Survey" means any monitoring visit or other inquiry by the Department of Behavioral Health and Developmental Disabilities, or its representatives, of a facility, including but not necessarily limited to the premises, staff, persons in care, and documents pertinent to initial and continued licensing so that the Department may determine whether a facility is operating in compliance with licensing requirements or has violated any licensing requirements. Surveys may be announced or unannounced at the discretion of the Department. Rule 82-10-1-.04 Governing Body Each licensed facility shall have a clearly identified governing body. The chairperson or chief executive officer of the governing body shall complete a statement of responsibility on behalf of the governing body acknowledging the governing body's responsibility for the operation of the facility in accordance with these rules in connection with any application for a license on a form provided by the Department. If a facility is individually owned, then the owner(s) will complete the statement of responsibility. Rule 82-10-1-.05 Licenses (1) No governing body shall operate a drug abuse treatment and education program in the state without first obtaining a license or provisional license. A licensed facility may offer one or more of the program services described in these rules. (2) Effective July 1, 2026, new branch programs, as defined in Rule 82-10-1-.03, are required to operate with a separate license from the parent program. Those that are in existence prior to July 1, 2026, may continue to have a shared licensure structure until such time any change is made to the functioning of the program (additional services, changes in the number of people served, changes in ownership/governing body, etc.). (3) License. A license will be issued, upon presentation of evidence satisfactory to the Department, that the facility is in compliance with these rules and all applicable federal and state laws for the handling and dispensing of drugs, and all state and local health, safety, (including fire, sanitation, building) and zoning requirements. A license shall remain in force and effect for a period determined by the Department unless sooner suspended or revoked by the Department. Such license shall describe each type of service and program that the licensee is authorized to provide. Any changes in authorized services and programs shall be reported to the Department. The Department will determine whether a new license is required. (4) Provisional license. A provisional license may be issued for a period not to exceed ninety (90) days to a facility that has substantially complied with all requirements for a regular license. Provisional licenses shall be renewed at the discretion of the Department only in cases of extreme hardship and in no case for longer than ninety (90) days. The obligations and conditions of a provisional license shall be the same as those of a license unless otherwise provided for by the Department. Such provisional license shall describe each type of service and program that the licensee is authorized to provide. Any changes in authorized services and programs shall be reported to the Department. The Department will determine whether a new license is required. (5) Qualifications requirement. To obtain or retain a license or provisional license, the administrator of the facility and its employees must be qualified, as defined in these rules, to administer or work in a program. However, the Department may require additional reasonable verification of the qualifications of the administrator and employees either at the time of application for a license or provisional license or at any time during the license period. (6) License is non-transferable . A license or provisional license to operate a facility is nontransferable for a change of location or governing body. Each license or provisional license shall be returned to the Department in the following cases: changes in location, governing body, facility closure or the license is suspended or revoked. (7) Exclusions. The following types of entities are not subject to these specific rules: (a) Narcotic Treatment Programs which are licensed/monitored by the State Opioid Treatment Authority; (b) Licensed hospitals not operating separate and distinct drug abuse treatment programs as classified by the Department; (c) Designated Emergency Receiving, Evaluation and/or Treatment (ERET) facilities that are not operating drug abuse treatment programs as defined herewithin; (d) Licensed individual professionals operating in compliance with their state practice acts but do not offer or purport to offer "Drug Abuse Treatment and Education Programs"; (e) Organizations or persons that provide supportive services (i.e., residence, transportation, etc.) to drug dependent persons but do not offer or purport to offer "Drug Abuse Treatment and Educational Programs." Support services under the direct control of licensed programs must be a part of the licensed program; and (f) Organizations or persons that provide treatment, therapeutic advice, or counsel for the rehabilitation of drug dependent persons that do not fall under one of the program types defined herewithin these Rules (specifically, Residential Sub-acute Detoxification Programs, Ambulatory Detoxification Programs, Residential Intensive Treatment Programs, Specialized Day Treatment Programs, Outpatient Drug Treatment Programs, or Special Programs, all as defined in Rule 82-10-1-.03). Examples of organizations or person that meet this exception include primary care clinicians and mental health therapy providers who are not providing services under one of the program types defined herein. Rule 82-10-1-.06 Accreditation The Department may, in its discretion, issue a license to a facility that provides proof of accreditation by an accreditation agency approved by the Department, if the accreditation agency's requirements are substantially equivalent or more stringent than the requirements of these rules. The license may be issued without an on-site visit by the Department, however, the Department reserves the right to perform an on-site survey of accredited facilities. Any denial, suspension, or revocation of such accreditation shall result in similar licensure actions, and the governing body shall be required to apply for a new license. For the purpose of this rule, proof of accreditation shall include a copy of the facility's most recent accreditation report together with any supplemental recommendations or reports. Such reports shall be submitted to the Department whenever received by a facility and whenever requested by the Department. Rule 82-10-1-.07 Applications (1) An application for a license to operate a drug abuse treatment and education program shall be submitted to the Department on forms provided by the Department, as well as requested updating information, and shall include assurances satisfactory to the Department that the facility is in compliance with all applicable federal and state laws for the handling and dispensing of drugs, with professional practice acts, and all state and local health, safety, sanitation, building, and zoning requirements. (2) False or misleading information. An application for a license must be truthfully and fully completed. In the event that the Department has reason to believe that an application has not been completed truthfully, the Department may require additional verification of the facts alleged. The Department may refuse to issue a license where false statements have been made in connection with an application or any other documents required by the Department. (3) The Department may deny the application of any governing body with a DATEP license that has been suspended, restricted, or revoked within the past twelve (12) months. Rule 82-10-1-.08 Reporting Incidents to the Department (1) The facility shall report all reportable incidents to the Department within twenty-four (24) hours; provided, however, legal action involving the juvenile justice system is not required to be reported. (2) Reportable incidents include the following incidents involving a facility's clients: (a) Death; (b) Serious injury requiring medical attention beyond first aid; (c) Rape; (d) Assault; (e) Battery; (f) Abuse; (g) Neglect; (h) Exploitation; (i) External disaster or emergency effecting operation of the facility; (j) Injury beyond first aid from an emergency safety intervention; and (k) Any incident which results in federal, state, or private legal action by or against the facility which affects any child or the conduct of the facility. (3) Reports of reportable incidents shall be made in a form acceptable to the Department, and the Department may specify a methodology and/or an online platform or system through which such reports must be electronically submitted. (4) The Department may request the facility to conduct an investigation of any reportable incident. If so requested, the facility shall provide the Department with a detailed investigative report within seven (7) days of the Department's request. At the request of the facility, and for good cause shown, the Department may in its discretion allow the facility additional time to complete and submit such investigative report. (5) Where required by O.C.G.A. § 30-5-4 , the facility shall also report incidents to an appropriate law enforcement agency or prosecuting attorney. (6) Child abuse reports. Whenever the facility has reason to believe that a client who is a minor in care has been subjected to child abuse it shall cause a report of such abuse to be made to the child welfare agency providing protective services as designated by the Department of Human Services (Division of Family and Children Services) or in the absence of such an agency to an appropriate police authority or district attorney in accordance with the requirements of O.C.G.A. § 19-7-5 . A copy of such report shall also be filed with the Department. Rule 82-10-1-.09 Surveys, Investigations and Corrective Action Plans (1) Survey. The Department is authorized to conduct a survey to determine whether a facility is operating in compliance with licensing requirements or has violated any licensing requirements. Such surveys may be initiated at any time, in the discretion of the Department, and may continue during the pendency of any action initiated by the Department. After initial licensure, the Department shall conduct on-site surveys of each facility on a regular basis. The Department may authorize third party audits or surveys of facilities for the purpose of determining whether a facility is in compliance with these rules. (2) Investigation. Where the Department determines that a rule violation related to a complaint or a reportable incident may have occurred, the Department may initiate an investigation. Such investigations may be initiated at any time, in the discretion of the Department, and may continue during the pendency of any action initiated by the Department. (3) Cooperation with survey and investigation. The facility shall cooperate with any survey or investigation conducted by the Department and shall provide, without delay, reasonable and meaningful access to the facility's premises, and information pertinent to licensure including staff and persons in care. The Department shall have the authority to require the production of any documents related to the initial and continued licensing of any facility. (4) Violations report. If violations of any licensing rules are identified, the facility will be given a written report of the violation that identifies the rule violated; provided however, that the names and identifying information regarding the complainants are classified as confidential. Nothing in this rule shall be construed to require the Department to release the name or identifying information regarding a complainant without first obtaining proper authorization from such complainant. Nor shall this rule be construed to require the Department to release any other confidential or privileged information without first obtaining proper authorization. (5) Violations dispute. The facility may offer an explanation for or dispute the Department's findings of violation(s) of licensing rules within ten (10) days of a survey or investigation report showing such finding(s). When the Department transmits the survey or investigation report to the facility, the Department shall include instructions for how such an explanation or dispute can be made, and the facility must make such explanation or dispute as directed in those instructions. At a minimum, the instructions must include directions on how the facility can initiate an administrative action, as provided for in the Rules and Regulations for Licensure Enforcement and Sanctions, Chapter 82-14-1. However, the Department may (but is not required to) provide for a prior process of administrative review by the Department before the matter is ripe for administrative action before agencies or courts outside the Department. (6) Corrective action plan. The facility shall develop a corrective action plan within fifteen (15) days of a written report of violations. (a) If the initial corrective action plan is unacceptable to the Department, the facility will be provided with at least one (1) opportunity to revise the unacceptable corrective action plan. (b) The facility shall comply with the corrective action plan accepted by the Department. (c) Where the Department determines that the facility either has not filed an acceptable corrective action plan or has not complied with the accepted corrective action plan, the Department may initiate one or more sanctions as described in the Rules and Regulations for Licensure Enforcement and Sanctions, Chapter 82-14-1. (d) The Department may require the facility to develop an "internal corrective action plan" which does not need to be submitted to the Department, except at the request of the Department. The "internal corrective action plan" must meet all other requirements of a corrective action plan. Rule 82-10-1-.10 Administration (1) Program purpose . A licensed facility shall develop and implement written policies and procedures that specify its philosophy, purpose, and program orientation. Such policies and procedures shall identify the target population served including the ages of the clients, how the needs of the target population are met, and substances used. (2) Program operations. A licensed facility shall develop and implement written policies and procedures for operations to include: (a) A description of the range of treatment and services provided by the program to be reviewed annually and updated as needed, specifying which American Society of Addiction Medicine (ASAM) levels of care will be offered, what services will be provided directly by the program, and what services are provided in cooperation with available community or contract resources; (b) The process for intake, assessment, admission, treatment planning, and evaluation of treatment; (c) Discharge summaries and aftercare plans; (d) The protection of client's rights (including but not limited to those rights set forth in Rule 82-10-1-.26) and confidentiality of client records; (e) The appropriate use of behavior management and emergency safety interventions; and (f) When the facility administers medications, policies and procedures related to medication administration. (3) Administrator. The governing body of the facility shall designate an administrator who shall be authorized to manage the facility. The clinical director may serve as the administrator. (4) Clinical director. The governing body of the facility shall designate a clinical director who is responsible for all treatment services provided. (5) Finances. The governing body shall provide for the preparation of an annual budget and approve such budget. Copies of the current year's budget and expenditure records shall be maintained for examination and review by the Department. (a) The administrator and all persons authorized to receive and disburse operating funds shall be authorized by the governing body to do so. (b) The facility shall develop and implement a written schedule of client fees. The schedule shall identify all fees which are chargeable to clients and a copy of the schedule shall be provided to the client, or parent, or guardian, or responsible party upon request, during the admission process and subsequently upon request. (c) A financial audit shall be completed annually by a certified public accountant or other external qualified audit approved by the governing body. (6) Client records . A written record of each client assessed, and each client admitted to the program must be maintained by the program. (a) Contents. Each client record shall include all information necessary to monitor the client's condition and contain at least the following information: 1. Basic identifying information including name, address, telephone number, date of birth, sex, and race; 2. If applicable, the names, addresses, and telephone numbers of parents, or guardians, or responsible parties; 3. Persons to notify in case of an emergency if different from above; 4. The name of the client's attending physician, if any; 5. All records of screening and assessment, including a comprehensive psychosocial history; 6. If applicable, documentation of why the client was not admitted for treatment and suggested referrals given to client; 7. Written consent as required in rule 82-10-1-.13; 8. Documentation of orientation as required in rule 82-10-1-.13; 9. Rights of the client (state and federal, including but not limited to those client's rights set for the in Rule 82-10-1-.26) including confidentiality and signed by the client; 10. Treatment plan and treatment notes (including drug administration records if applicable); 11. Results of laboratory tests, as appropriate; 12. Discharge summary and aftercare plan; 13. Any other records relating to the client's treatment and stay in the program such as written grievances, reports about discipline to include any use of emergency safety interventions if an incident resulting in injury occurs while the patient is at the facility location, observations, etc. 14. A statement of confidentiality, including to whom records may be released, how they may be released, etc.; and 15. Releases of information, as applicable. (b) Confidentiality and retention of client records. Written policies and procedures shall be established and implemented for the maintenance and security of client records specifying who shall supervise the maintenance of such records, who shall have custody of such records, and to whom records may be released, how they may be released and for what purposes they may be released. Confidentiality, release, and retention of client records must comply with 42 CFR, Part 2 Confidentiality of Alcohol and Drug Abuse Patient Records. (c) The Department shall have access to all client clinical records for the purpose of determining compliance with licensure requirements. (7) Personnel records. A facility shall maintain written records for each employee and the administrator. Each individual file shall include: (a) Identifying information such as name, address, telephone number, emergency contact person(s); (b) A ten (10) year employment history or a complete employment history if the person has not worked ten (10) years; (c) Records of applicable licenses and educational qualifications as required by these rules; (d) Record of tuberculosis testing upon hire, with additional evaluation to exclude disease as clinically indicated; (e) Record of annual tuberculosis risk assessment and symptom evaluation, with testing as clinically indicated; (f) Record of random drug screening; (g) Date of employment; (h) The person's job description or statements of the person's duties and responsibilities; (i) Documentation of training and orientation required by these rules; (j) Any records relevant to the employee's performance including at least annual performance evaluations; and (k) The results of employment and criminal background checks conducted by the facility prior to employment indicating that the employee has no history of violence or abuse which would pose a risk to clients receiving services through the treatment program. If a criminal background check by the Department is required by law, this documentation requirement may be met by the presence of an official notice of an eligible determination by the Department, or an order of a court of competent jurisdiction finding the employee eligible for employment by the program under applicable law. (8) Emergency services. During non-operating hours, the facility must make provisions for twenty-four (24) hour emergency services or a telephone "hot line" to assist a client in a crisis situation. This information must be provided to the client upon admission. (9) HIV/AIDS . A licensed facility shall provide HIV/AIDS education, risk assessment and the provision of HIV counseling and testing, either directly or by referral. (10) Priority access. Written policies and procedures must be developed for providing priority in access to services and admissions to programs for drug dependent pregnant females. (11) Drug-free workplace. Written policies and procedures shall be established and implemented to provide for a drug-free workplace. Pre-employment and ongoing random urine drug screens shall be utilized for all facility employees. Each sample collected shall be screened for opiates, methadone, amphetamines, cocaine, benzodiazepines, THC and other drugs either as indicated by the Department or the employer. (12) Referral to other programs. Each program shall have a formal plan of cooperation with other programs in the state for referral of clients to allow for continuity of care for drug dependent persons or for emergency hospitalization. The licensed programs must have identified resources that would be available to continue the drug dependent person's care and to have worked out referral/transfer arrangements where appropriate. Rule 82-10-1-.11 Staffing (1) The facility shall have sufficient types and numbers of staff as required by these rules to provide the treatment and services offered to clients and outlined in its program description. (2) Staff subject to professional practice acts must be in compliance with the state practice acts. (3) Counseling services are provided by individuals qualified by education, and experience to provide substance abuse counseling and who are licensed/certified if required by state practice acts. (4) The medical responsibility for each client will be vested in a licensed physician who oversees all medical services provided by the program. Physician extenders may be utilized to the extent allowed by state practice acts. (5) Each facility shall have available professional mental health consultation to review selected cases and to provide assistance to the staff in client management or for referral for psychiatric services. (6) The clinical director must be either a Doctor of Medicine licensed to practice in this state, or an independently licensed practitioner who is licensed to provide treatment, therapeutic advice or counsel for the rehabilitation of drug dependent persons in compliance with state practice acts, or a certified addiction counselor under the supervision of the medical director. (7) Employment and criminal background checks shall be conducted prior to employment, and no person may be employed by the facility who has a history of violence, exploitation, or abuse which would pose a risk to the clients being treated by the facility, or who is otherwise prohibited by law from being employed by the facility. If a criminal background check by the Department is required by law, the criminal background check requirement may be met by an eligible determination by the Department, or an order of a court of competent jurisdiction finding the employee eligible for employment by the program under applicable law. (8) Staff training and orientation. Prior to working with clients, all staff who provide treatment and services shall be oriented in accordance with these rules and shall thereafter receive additional training in accordance with these rules. (a) Orientation shall include instructions in: 1. The facility's written policies and procedures regarding its program purpose and description; client rights, responsibilities, and complaints (including but not limited to those client's rights set forth in Rule 82-10-1-.26); confidentiality; and other policies and procedures that are relevant to the employee's range of duties and responsibilities, including the use of standard precautions for infection control, use of behavior management and emergency safety interventions, and information about HIV/AIDS; 2. The employee's assigned duties and responsibilities; and 3. Reporting client progress and problems to supervisory personnel and procedures for handling medical emergencies or other incidents that affect the delivery of treatment or services. (b) Additional training consisting of a minimum of thirty (30) clock hours of training or instruction shall be provided annually for each staff member who provides treatment services to clients. Such training shall be in subjects that relate to the employee's assigned duties and responsibilities. Rule 82-10-1-.12 Physical Plant and Safety (1) Required approvals. (a) A facility shall be in compliance with all applicable local health, sanitation, building, and zoning requirements. (b) A facility shall be in compliance with all applicable laws and rules issued by the state fire Marshall, the proper local fire marshal or state inspector, and shall have a certificate of occupancy if required. (2) All buildings and grounds shall be constructed and maintained in a safe manner and in accordance with these rules. (3) A facility shall have appropriate and sufficient space to meet the programmatic needs of its clients and carry out the facility's array of services. Such space shall include areas conducive to privacy for counseling and group activities, reception/waiting areas, and bathrooms which assure privacy for collection of urine specimens. (4) Residential sleeping areas. (a) For residential programs initially licensed or expanded after September 29, 2013, sleeping areas shall contain not less than sixty (60) square feet of usable floor space per resident in multiple use bedrooms and not less than one hundred (100) square feet of usable space in single bedrooms. (b) Each resident shall be provided with his or her own personal space and furnishings for storage of clothes and personal belongings. (c) Each resident shall be provided with his or her own personal bed and mattress. Clean sheets, pillows, and pillowcases, blankets or bed covering shall be provided and sheets and pillowcases shall be changed as needed, but at least weekly. (d) Bedrooms shall be provided with outside ventilation by means of windows, air conditioners, or mechanical ventilation. All rooms that have windows that can be opened without special devices shall have window screens inserted and the windows and screens must be in good repair. (5) Residential lavatory and bathing facilities. (a) For residential programs initially licensed or expanded after September 29, 2013, there shall be at least one (1) lavatory (water basin and toilet) with hot and cold water for every six (6) residents or fraction thereof. Lavatories that contain more than one (1) toilet shall contain stalls for individual privacy. All lavatories shall be properly ventilated. (b) For residential programs initially licensed or expanded after September 29, 2013, there shall be at least one (1) shower or bathtub with hot and cold water for every ten (10) residents or fraction thereof. Bathtubs and shower stalls shall be equipped with non-slip surfaces. (6) Residential dining areas. There shall be a separate furnished dining area for serving meals that contains not less than ten (10) square feet of usable floor space for each resident being served. (7) Residential climate control and pest control . A facility shall be maintained at a temperature range of sixty-five (65) degrees Fahrenheit (seventy-two (72) degrees if serving pregnant women, infants or small children) to eighty-two (82) degrees Fahrenheit, depending on the season of the year. An effective pest control system shall be implemented and documentation on file as to actions taken. (8) Off-site residences. Facilities which provide off-site residences as a part of their programs must ensure that the residences also meet the above requirements. (9) Premises. All grounds, space, and facilities, both those within the program and those regularly used by residents as an integral part of the program, shall be kept clean and free from hazards to health and safety and from litter. Rule 82-10-1-.13 Food Service (1) A residential facility which provides food service shall provide each resident with meals and snacks of food groups and serving sizes which meet the nutritional guidelines of the United States Department of Agriculture. Meals and snacks shall be varied daily. Modified diets based on medical or religious reasons shall be served as needed. (2) If required by the local county board of health, a residential facility shall obtain a valid food service permit from the local county board of health. All residential facilities providing food services shall meet the following requirements: (a) Food shall be stored, prepared, and maintained in a safe and sanitary manner commensurate with generally accepted and recognized food service standards. (b) There shall be designated and separate space for food preparation and storage. (c) All perishable and potentially hazardous foods shall be refrigerated at a temperature of forty (40) degrees Fahrenheit or below unless frozen. Freezer temperatures shall be maintained at zero (0) degrees Fahrenheit or below. (d) Food shall be in sound condition, free from spoilage and contamination and shall be safe for human consumption when served to residents. (e) Food service equipment and preparation areas shall be kept clean and free of accumulation of dust, dirt, food particles, and grease deposits. (f) When non-disposable dishes, glasses, and flatware are used, they shall be properly cleaned by pre-rinsing and scraping, washing, sanitizing, and drying. (3) Where a residential facility provides food services through contract or arranges for food services, the residential facility shall require that food served be safe for human consumption and that the meals/snacks provided meet the nutritional guidelines of the United States Department of Agriculture. Rule 82-10-1-.14 Client Referral, Intake, Assessment, and Admission (1) A program shall only accept referrals and shall only admit and retain clients whose known needs can be met by the program in accordance with the program's purpose and description. Written policies and procedures for client referral, intake, assessment, and admission shall be established and implemented and shall include the following: (a) Screening. All persons referred to the program or who present themselves for services shall be initially screened to determine if the prospective client appears to meet the program's admission criteria. Such screenings shall be done by a staff person who has been determined to be qualified by education, training, experience, and who are licensed/certified if required by state practice acts to perform such screenings. Screening shall constitute an initial appraisal of the clients' dysfunctions and the types of services that appear needed. Persons whose needs cannot be met by the program shall not be admitted and should be referred to other programs that provide appropriate services. A record (log) will be kept of persons not admitted and reason(s) for not admitting. The program has the discretion to use information on clinical evaluations done within thirty (30) days. (b) Assessment. All clients admitted to the program shall be evaluated by a staff person who has been determined to be qualified by education, training, and experience and who are licensed/certified if required by state practice acts to perform or coordinate the provision of such assessments. Such evaluations shall include a comprehensive assessment of the client's physical, emotional, behavioral, social, recreational, and educational status and needs. The program has the discretion to use current clinical information concerning a client transitioning from another licensed program, licensed hospital, or a state or federal agency, if there has not been a discontinuance in treatment. 1. Medical Screening and Assessment. The Medical Director shall document protocols for admission screening and assessment to include, at a minimum: (i) Documentation of vital signs; (ii) Laboratory tests ordered as clinically indicated, but at minimum, CBC, infectious disease screening (e.g., HIV, Hepatitis B, Hepatitis C), urinalysis (routine and microscopic), tuberculosis screening, urine drug screen (SAMHSA Panel), and pregnancy test for all females with childbearing potential between the ages of 12 and 55 years of age; and (iii) Nursing Assessment. Determination by a registered nurse or physician/physician extender whether the client requires a physical and/or psychiatric examination by a physician/physician extender; 2. History and Physical . If an examination by a physician/physician extender is indicated, arrangements shall be made for such an examination as appropriate. The assessment shall also include circumstances leading to admission, mental status, support system, psychiatric and medical history, risk assessment for HIV, history of use of drugs, including the age of onset, duration, patterns, and consequences of use, family history of drug use, route of administration and previous treatment. 3. If a client has been referred for treatment from another facility, the results of a physical examination and laboratory tests from the other facility may be documented and used to assess physical status, provided that such physical examination was done within six (6) months of admission, and there has been no significant change in the physical status of the client. Further assessments or laboratory tests may be required depending upon the modality of treatment needed or the client's changing condition. 4. Biopsychosocial assessment. At the time of admission or as soon as clinically appropriate (but no longer than ten (10) working days), a comprehensive biopsychosocial assessment shall be done and shall document personal and social history, including current relationships, educational status, living arrangements, social habits, employment status, legal status and related areas. (c) Admission. 1. Informed consent. Except as otherwise authorized by law, no person shall be admitted for treatment without written authorization from the client and parent, guardian, or responsible party, if applicable. The following information must be explained by a trained staff person to the client and other consenters and documented in the client's file: (i) The program's services and treatment; (ii) The specific condition that will be treated; (iii) The expected charges for services including any charges that might be billed separately; (iv) The client's rights and responsibilities (including but not limited to those rights and responsibilities set forth in Rule 82-10-1-.26); (v) The rights of consenters to obtain information about the client's treatment, etc.; and (vi) The procedures for complaint and question resolution. 2. Orientation. The program shall provide orientation to clients admitted for treatment within 24 hours of admission or at such time that the client appears able to hear and respond to requests, but in no event later than seventy-two (72) hours after admission. Clients must be reoriented as needed to ensure an understanding of the program. Orientation shall be done by a staff person who has been determined to be qualified by education, training, and experience to perform the task. The following information must be explained to the client and documented in the client's file: (i) The expected benefits of the treatment that the client is expected to receive; (ii) An explanation of comprehensive, individualized treatment planning; (iii) The client's responsibilities for adhering to the treatment plan and the consequences of non-adherence; (iv) The identification of the staff person(s) expected to provide treatment or coordinate the treatment; (v) Program rules including requirements for conduct and the consequences of infractions; (vi) Client's rights, responsibilities, and complaints (including but not limited to those rights and responsibilities set forth in Rule 82-10-1-.26); (vii) The program's policies for use of behavior management and emergency safety interventions when necessary; and (viii) Policies and procedures for visiting hours and communications with persons outside the program, if a residential program. (d) Drug dependent pregnant females shall be given priority for admission and services when a program has a waiting list for admissions. Rule 82-10-1-.15 Treatment Plan (1) A program must develop and implement a comprehensive, individualized treatment plan for each client. Such treatment plans shall be modified and updated as necessary, depending upon the clients' needs. (2) Initial treatment plan. An initial treatment plan will be formulated at the time of admission after assessment (within a minimum of ten (10) working days) and will include the initial treatment recommendation for the client. The initial treatment plan may be documented in the program notes. (3) Comprehensive treatment plan. The treatment plan must be comprehensive, individualized, formulated by a multi-disciplinary team with the input of the client, approved by an independently licensed practitioner or certified addiction counselor, completed within thirty (30) days of admission, and shall contain sufficient information about the client's expected treatment including: (a) Descriptions of the client's problems and needs; (b) Measurable goals and desired outcomes that are to be attained by the client, which include both long-term goals and short-term objectives leading to these goals; (c) The interventions and services that the program will provide to help the client achieve the goals and desired outcomes; (d) The expected course of treatment; and (e) Identification of the staff person(s) who will provide treatment or coordinate the treatment. (4) Progress notes. A program shall document the services received by the client and document chronological observations of the client's clinical course of treatment which includes the client's response to treatment and progress towards achieving goals and desired outcomes. Progress notes shall be documented by the staff member assigned the primary responsibility for the client's care and shall be legible and recorded in the client's plan. Progress notes shall be recorded as applicable: (a) At the end of each shift in the client's medical record for residential detoxification programs; (b) Following any contact with a client undergoing ambulatory detoxification or narcotic treatment; (c) At least weekly for substance abuse treatment residences; (d) Daily for day treatment programs; (e) Whenever there are face-to-face contacts with the client for outpatient drug treatment programs; (f) Whenever the client is observed to engage in a behavior which may affect a change in the treatment plan; and (g) Immediately following the use of any emergency safety intervention with the client. (5) Random urine drug screens are required for each client, the frequency of which is determined by the program to determine its effectiveness. Clinical directors may elect to rely upon presumptive urine screening results for client management. The program must demonstrate the ability to access confirmatory qualitative laboratory analysis. (6) Plan reviews. Plans shall be reviewed and updated, as needed, by the staff member who has primary responsibility for coordinating or providing for the care of the client. Reviews shall be done whenever necessary as indicated by the client's needs or at least every thirty (30) days for residential and sixty (60) days for outpatient. Rule 82-10-1-.16 Medications (1) If a program administers medications, written policies and procedures for prescription, administration and security of medications shall be established and implemented. Such policies and procedures shall include the following: (a) Medications are prescribed by a physician/physician extender, and/or other practitioners as allowed by state law, and the risks and benefits of the prescribed medication are explained to the client (and parent, guardian, or responsible party if applicable) by the physician/physician extender or a staff person who has been delegated responsibility in writing by the physician to explain the risks and benefits. Documentation of such explanations of risks and benefits must be maintained by the program. (b) The program may have written pre-medication screening protocols which are completed and approved by the physician. Such protocols shall include an assessment as required in Rule 82-10-1-.14. (c) Unless self-administered, all medications are administered by a physician/physician extender, registered nurse, or licensed practical nurse. (d) Any medications prescribed, administered or self-administered under supervision are documented on a medication administration record that is filed with the treatment plan, unless maintained as a clinical record at the client's bedside or in the medication room in a residential detoxification setting. The record must include: 1. Name of medication; 2. Date prescribed; 3. Dosage; 4. Frequency; 5. Route of administration; 6. Date and time administered; and 7. Documentation of staff administering medication or supervising self-administration. (e) Adverse drug reactions and errors are reported to a physician/physician extender immediately and corrective action is initiated. Adverse drug reactions and error are recorded in the drug administration record and the treatment plan, and all persons who are authorized to administer medication or supervise self-medication are alerted. (f) All medications shall be stored under lock and key when not being administered or self-administered. (g) Program staff shall adhere to all federal and state laws and rules regarding controlled substances. Rule 82-10-1-.17 Quality Assurance Written policies and procedures for an ongoing quality assurance process shall be established and implemented. Such processes shall identify areas of treatment or treatment problems to be addressed; establish and monitor criteria by which the quality and appropriateness of the treatment are to be measured; analyze the outcomes; make recommendations for change, as needed; and monitor changes to ensure problem resolution. Responsibility for administering and coordinating the quality assurance process shall be delegated to a staff person who has been determined to be qualified by education, training, and experience to perform such tasks. If the program provides medical services, the medical director shall be actively involved in the process. Rule 82-10-1-.18 Discharge Summary and Aftercare Plan (1) A program must complete an individualized discharge summary for all discharged clients and also an aftercare plan for continuing services and support for those clients who complete their course of treatment. (2) Discharge summary. A discharge summary shall be completed for all clients within seven (7) working days of discharge. A summary shall be completed by the person who has primary responsibility for coordinating or providing for the care of the client, and it shall include a final assessment of the client's status at the time of discharge, summary of progress towards treatment goals, and the reasons the client was discharged prior to completing treatment, if applicable. (3) Aftercare Plan. Aftercare plans for continuing services and support shall be developed and completed prior to discharge for clients who complete treatment. The plan shall be completed by the person who has primary responsibility for coordinating or providing for the care of the client, and it shall include a final assessment of the client's status at the time of discharge, summary of progress towards treatment goals, a description of what services and supports the client is expected to need following discharge, and a description of potential barriers to overcome to maintain a drug free lifestyle. Crisis service options must be included in the aftercare plan. The client must participate in aftercare planning, and if applicable, parents, or guardians, or responsible persons must participate whenever feasible. Clients who do not complete treatment should be offered crisis service options when possible. Rule 82-10-1-.19 Residential Sub-Acute Detoxification Program (1) Programs offering residential sub-acute detoxification must meet Rules 82-10-1-.01 through 82-10-1-.18 and Rules 82-10-1-.26 through 82+-10-1-.27, in addition to the rules set forth in this Rule (82-10-1-.19). (2) The program shall establish and implement written policies and procedures that address how the program manages the medical and detoxification services that it provides. The program shall operate twenty-four (24) hours a day. (3) Staffing. Treatment is provided by qualified medical staff and other professionals who are qualified by education, training, experience, and who are licensed/certified if required by state practice acts to perform detoxification services that meet the needs of clients. (a) Medical staff. The medical staff is headed by a medical director who is licensed to practice medicine in Georgia, and all other medical staff are licensed to practice in Georgia. The medical director must approve all medical policies and procedures, including assessment tools, treatment protocols, and emergency procedures. Such policies and procedures shall include provisions for an effective infection control program. (b) Director of nursing. A licensed registered nurse determined qualified by education, training, and experience to supervise nursing services for detoxification shall be designated as the director of nursing. (c) Physician/physician extender coverage shall be provided in accordance with the treatment protocol. At a minimum, there shall be on call physician/physician extender coverage 24 hours a day, and a physician/physician extender must be on site daily as medically indicated. (d) Nursing coverage shall be provided in accordance with clients' needs as determined by the number and condition of client population. At a minimum, there shall be one registered or licensed practical nurse, working within their scope of practice, awake and on duty on premises 24 hours per day to respond to client needs. (e) Other medical services. 1. Diagnostic services. Clinical laboratory services and x-ray services shall be provided in accordance with the Department of Community Health's Rules for Licensure of Clinical Laboratories, Chapter 111-8-10, and Rules for X-Ray, Chapter 290-5-22. 2. Emergency medical services. The program's medical policies and procedures include provisions for the delivery of emergency medical services, which services are either provided directly or through an established procedure specifying how emergency services will be accessed. 3. Pharmaceutical services. Pharmaceutical services are offered through a licensed pharmacy service in the community or by the program's own licensed pharmacist. (4) Admission. (a) Clients are admitted to treatment by the order of a physician/physician extender only after assessment and determination that the medical, emotional, and behavioral status of the client justifies admission. The initial detoxification care plan must be documented in the record and may be initiated by the order of the physician/physician extender following admission. (b) An admission assessment of clients shall be performed by a physician/physician extender or registered nurse. If an assessment is done by other than a physician/physician extender, then the assessment must be communicated to physician/physician extender by telephone prior to the client's admission. The assessment must include: 1. Drug history including past detoxification episodes, and current use of drugs and medications; 2. Causes that triggered the present need for services; 3. Descriptions of medical risks and any behavioral or emotional problems; 4. Taking and documentation of vital signs; 5. Determination of whether a physical and/or psychiatric examination by a physician/physician extender is needed immediately and arrangements for such examination, if the assessment was done by a registered nurse. If the assessment is done by a physician/physician extender, it will include a physical examination; and 6. Laboratory tests will be ordered as clinically indicated, but at a minimum will include CBC, infectious disease screening (e.g., HIV, Hepatitis B, Hepatitis C), urinalysis (routine and microscopic), tuberculosis screening, urine drug screen (SAMHSA Panel), and pregnancy test for all females with childbearing potential between the ages of 12 and 55 years of age. (5) Treatment. (a) Within twenty-four (24) hours of admission, or the next normal business day if admission occurred on a weekend or holiday, the client must be seen by a physician/physician extender if the admission assessment was done by a registered nurse. If a physical examination is needed, such examination shall be done at that time. (b) Within forty-eight (48) hours of admission, a complete detoxification care plan shall be developed by a registered nurse, or physician/physician extender. If not done by a physician/physician extender, the development of the plan shall be supervised and signed by a physician/physician extender. Any changes to the plan must be documented in the plan and reviewed and signed by the physician/physician extender. The plan shall address the nursing and medical procedures needed to stabilize the client and to manage the withdrawal. (c) In addition to medical management, the program shall provide the client substance abuse counseling and support by staff who are determined qualified by training, education, experience, and who are licensed/certified if required by state practice acts to provide such services. Such services shall be provided to clients as soon as it is determined that they can benefit from such services but no later than within three working days of admission. (d) A discharge summary and aftercare plan, if applicable, shall be completed in accordance with Rule 82-10-1-.18. Rule 82-10-1-.20 Ambulatory Detoxification Programs (1) Programs offering ambulatory detoxification must meet Rules 82-10-1-.01 through 82-10-1-.18 and Rules 82-10-1-.26 through 82-10-1-.27, in addition to the rules set forth in this Rule (82-10-1-.20). (2) The program shall establish and implement written policies and procedures that address how the program manages the medical and detoxification services that it provides. The program shall be open and operate five (5) days a week with on-call physician/physician extender coverage as outlined below. (3) Staffing. Treatment is provided by qualified medical staff and other professionals who are qualified by education, training, experience, and who are licensed/certified if required by state practice acts to perform detoxification services that meet the needs of clients. (a) Medical staff. The medical staff is headed by a medical director who is licensed to practice medicine in Georgia, and all other medical staff are licensed to practice in Georgia. The medical director must approve all medical policies and procedures, including assessment tools, treatment protocols, and emergency procedures. (b) Medical coverage. There shall be a physician/physician extender or registered nurse on duty and on premises during all hours of operation to provide oversight of other medical staff and to supervise client treatment and assess clients as needed. Each physician/physician extender employed by the program is determined qualified by training, education, and experience to manage detoxification treatment and assumes responsibility for the medical services provided by the staff. (c) On-call coverage. A staff physician/physician extender shall provide twenty-four (24) hour, on-call coverage when the program is closed or a physician/physician extender is not present on the premises. (d) On premises nursing coverage shall be provided in accordance with clients' needs as determined by the number and condition of the client population. (4) Other Medical Services. (a) Diagnostic services. Clinical laboratory services and x-ray services shall be provided in accordance with the Department of Community Health's' Rules for Licensure of Clinical Laboratories, Chapter 111-8-10, and Rules for X-Ray, Chapter 290-5-22. (b) Emergency medical services. The program's medical policies and procedures include arrangements for the delivery of emergency medical services. (c) Pharmacy services. Pharmaceutical services are provided through a licensed pharmacy in the community or the program's own licensed pharmacist. (5) Admission. (a) Clients are admitted to treatment by the order of a physician/physician extender only following assessment and determination that the medical, emotional, and behavioral status of the client and his or her support systems are adequate to justify admission to an ambulatory program. Persons treated in ambulatory detoxification settings are without unusual or significant medical or behavioral problems that would pose a significant risk to the safe completion of an ambulatory detoxification program. The initial detoxification care plan must be documented in the record and may be initiated by the order of the physician/physician extender following admission. (b) An admission assessment of the client shall be performed by a physician/physician extender or registered nurse. If an assessment is done by other than a physician/physician extender, then the assessment must be communicated to a physician/physician extender by telephone prior to the client's admission. The assessment must include: 1. Drug history including past detoxification episodes, and current use of drugs and medications; 2. Causes that triggered the present need for services; 3. Descriptions of medical risks and any behavioral or emotional problems; 4. Taking and documentation of vital signs; 5. Determination of whether a physical and/or psychiatric examination by a physician/physician extender is needed immediately, and arrangements for such examinations, if indicated, if the assessment was done by a registered nurse; 6. Determination that the prospective client appears to have the support and supervision needed from family members and others to benefit from ambulatory treatment; and 7. Laboratory tests will be ordered clinically as indicated, but at a minimum will include: CBC, infectious disease screening (e.g., HIV, Hepatitis B, Hepatitis C), urinalysis (routine and microscopic), tuberculosis screening. urine drug screen (SAMHSA Panel), and pregnancy test for females with childbearing potential between the ages of 12 and 55 years of age. (6) Treatment. (a) Within twenty-four (24) hours of admission, or the next normal business day if admission occurred on a weekend or holiday, the client must be seen by the physician/physician extender if the admission assessment was done by a registered nurse. If a physical examination is needed, such examination shall be done at that time. (b) Within forty-eight (48) hours of admission, a detoxification care plan shall be developed by a registered nurse, or physician/physician extender. If not done by a physician/physician extender, the development of the plan shall be supervised and signed by a physician/physician extender. Any changes to the plan must be documented in the plan and reviewed and signed by the physician/physician extender. The plan shall address the nursing and medical procedures and monitoring activity needed to stabilize the client and to manage the withdrawal. (c) For the length of the detoxification care plan and while on medication, the client shall be required to visit the program at least once a business day for a check of vital signs and monitoring of medication by one of the medical staff. (d) In addition to medical management services, the program shall provide the client counseling and support by staff who are determined qualified by training, education, experience, and who are licensed/certified if required by state practice acts to provide such services. Such services shall be provided to clients as soon as it is determined that they can benefit from such services but no later than within three (3) working days of admission. (e) A discharge summary and an aftercare plan, if applicable, shall be completed in accordance with Rule 82-10-1-.18. Rule 82-10-1-.21 Residential Intensive Treatment Programs (1) Programs offering residential intensive treatment programs must meet Rules 82-10-1-.01 through 82-10-1-.18 and Rules 82-10-1-.26 through 82-10-1-.27, in addition to the rules set forth in this Rule (82-10-1-.21). (2) Residential intensive treatment programs provide services for clients with significant substance abuse impairment, and who, typically, have not progressed in a less intensive setting, or lack support and require a highly structured and specialized environment, or are transitioning from detoxification. (3) Client intake, assessment, and admission; treatment planning; and discharge and aftercare, if applicable, shall be done in accordance with Rules 82-10-1-.14, 82-10-1-.15, and 82-10-1.18. Additional admission requirements, including laboratory tests, may be required by facility policy and/or determination of the medical/clinical director. (4) A program shall provide a minimum of eight (8) hours per day of various therapeutic services designed to enable the client to function without substance abuse. Such services shall be provided by persons who have been determined qualified by education, training, experience, and who are licensed/certified if required by state practice acts to render such services that meet the needs of clients. (5) There shall be sufficient types and numbers of staff members on duty in the residence to provide for safe supervision of clients whenever clients are present. (6) Provisions shall be made for mandatory education of children in care in accordance with O.C.G.A. § 20-2-690 et seq . or its successor statute. (7) A program shall have a written agreement with a physician/physician extender for the provision of medical care. Rule 82-10-1-.22 Residential Transitional Treatment Programs (1) Programs offering residential transitional treatment programs must meet Rules 82-10-1-.01 through 82-10-1-.18 and Rules 82-10-1-.26 through 82-10-1-.27, in addition to the rules set forth in this Rule (82-10-1-.22). (2) Residential transitional treatment programs provide services on an intermediate basis for clients characterized as chronic substance abusers who are transitioning to the community or to other treatment modalities, and who, typically, lack a stable living situation and require variable levels of therapeutic services. (3) Facilities that only provide housing for persons, such as half-way houses or temporary shelters, are not subject to licensure as residential transitional treatment programs, unless the residence offers treatment services or is a supportive service owned and/or controlled by a licensed program. (4) Client intake, assessment, and admission; treatment planning; and discharge and aftercare shall be done in accordance with Rules 82-10-1-.14, 82-10-1-.15 and 82-10-1-.18. Additional admissions requirements, including laboratory tests, may be required by facility policy and/or determination of the medical/clinical director. The program has the discretion to use physical and biopsychosocial assessment information from another licensed program, licensed hospital, or a state or federal agency, if the client is transitioning directly from another program. (5) The program shall provide at least five (5) or more hours per week of therapeutic services designed to enable the client to function without substance abuse. Such services shall be rendered by persons who have been determined qualified by training, education, experience, and who are licensed/certified if required by state practice acts to render such services. (6) There shall be sufficient types and numbers of staff members on duty in the residence to provide for safe supervision of clients whenever clients are present. (7) Provisions shall be made for mandatory education of children in care in accordance with O.C.G.A. § 20-2-690 et seq. or its successor statute. (8) A program shall have a written agreement with a physician/physician extender for the provision of medical care. Rule 82-10-1-.23 Specialized Day Treatment Programs (1) Programs offering specialized day treatment programs must meet Rules 82-10-1-.01 through 82-10-1-.18 and Rules 82-10-1-.26 through 82-10-1-.27, in addition to the rules set forth in this Rule (82-10-1-.23). (2) Specialized day treatment programs emphasize continued abstinence, development of social support network and necessary lifestyle changes, educational skills, vocational skills, social and interpersonal skills, the understanding of addictive disease, and the continued commitment to a recovery program. The program provides structured treatment or therapeutic services, utilizing activity schedules as part of its operational method, i.e., plans or schedules of days or times of day for certain activities. The programs utilize methods, materials, settings, and outside resources that are appropriate to the development levels and ages of clients, and age appropriate. These programs are provided over a period of several weeks or months and often follow detoxification or residential services. They may also utilize group and/or counseling and/or therapy. Such programs shall provide: (3) Client intake, assessment, and admission; treatment planning; and discharge and aftercare shall be done in accordance with Rules 82-10-1-.14, 82-10-1-.15, and 82-10-1-.18. Additional admissions requirements, including laboratory tests, may be required by facility policy and/or determination of the medical/clinical director. (4) Treatment must be provided by persons determined to be qualified by training, education, experience, and who are licensed/certified if required by state practice acts to render such services that meet the needs of the clients. (5) Provisions shall be made for mandatory education of children in care in accordance with O.C.G.A. § 20-2-690 et seq. or its successor statute. Rule 82-10-1-.24 Outpatient Drug Treatment Programs (1) Programs offering outpatient drug treatment programs must meet Rules 82-10-1-.01 through 82-10-1-.18 and Rules 82-10-1-.26 through 82-10-1-.27, in addition to the rules set forth in this Rule (82-10-1-.24). (2) Outpatient drug treatment programs provide a variety of structured treatment and therapeutic services intended to enable clients to function drug free and to learn social and psychological skills. Typically, these include services such as biopsychosocial assessment; group, individual, and family counseling; supportive counseling; substance abuse education; and therapeutic recreational activities. Such services shall be provided in part, outside normal business hours, so that clients who work or go to school can attend. Such programs shall provide: (3) Client intake, assessment, and admission; treatment planning; and discharge and aftercare shall be done in accordance with Rules 82-10-1-.14, 82-10-1-.15, and 82-10-1-.18; (4) Treatment must be provided by persons determined to be qualified by training, education, experience, and who are licensed/certified if required by state practice acts to render such services that meet the needs of the clients; and (5) Substance abuse intensive outpatient programs (SAIOPs) shall be licensed as outpatient drug treatment programs. (6) Admission laboratory testing requirements will be conducted as clinically indicated. Rule 82-10-1-.25 Special Programs (1) Structured programs that do not fit into existing program classifications but meet the requirements of these rules will be licensed as special programs. These programs may be part of other licensed programs or may be individually licensed. (2) Programs offering special programs must meet Rules 82-10-1-.01 through 82-10-1-.18 and Rules 82-10-1-.26 through 82-10-1-.27. Rule 82-10-1-.26 Client's Rights and Complaints (1) A program shall establish and implement written policies and procedures regarding the rights of clients, and the handling and resolution of complaints. At a minimum, the program must ensure that its clients enjoy the rights and responsibilities listed herein. (2) Such policies and procedures shall include a written notice of rights which shall be provided to each client and parent, guardian, or responsible party, if applicable, when the client receives orientation. The required notice shall contain the following items: (a) Right to a humane treatment or habilitation environment that affords reasonable protection from harm, exploitation, and coercion; (b) Right to be free from physical and verbal abuse; (c) Right to be free from the use of physical restraints and seclusion unless it is determined that there are no less restrictive methods of controlling behavior to reasonably ensure the safety of the client and other persons: (d) Right to be informed about the plan of treatment and to participate in the planning, as able; (e) Right to be promptly and fully informed of any changes in the plan of treatment; (f) Right to accept or refuse treatment, unless it is determined through established authorized legal processes that the client is unable to care for themselves or is dangerous to themselves; (g) Right to be fully informed of the charges for treatment; (h) Right to confidentiality of client records; (i) Right to have and retain personal property which does not jeopardize the safety of the client or other clients or staff and have such property treated with respect; (j) Right to converse privately, have convenient and reasonable access to the telephone and mail, and to see visitors, unless denial is necessary for treatment and the reasons are documented in the client's treatment plan; (k) Right to be informed of the program's complaint policy and procedures and the right to submit complaints without fear of discrimination or retaliation and to have them investigated by the program within a reasonable period; (l) Right to have access to their own client records and to obtain necessary copies when needed; (m) Right to receive a written notice of the address and telephone number of that state licensing authority, i.e., the Department, which further explains the responsibilities of licensing the program and investigating client complaints which appear to violate licensing rules; and (n) Right to obtain a copy of the program's most recent completed report of licensing survey from the program upon written request. The program is not required to release a report until the program has had the opportunity to file a written corrective action plan for the violations as provided for in these rules. (3) Such policies and procedures shall also include provisions for clients and others to present complaints, either orally or in writing, and to have their complaints addressed and resolved as appropriate in a timely manner. Rule 82-10-1-.27 Behavior Management and Emergency Safety Interventions (1) Behavior Management. (a) The program shall develop and implement policies and procedures on behavior management. Such policies and procedures shall set forth the types of clients served in accordance with the program's purpose, the anticipated behavioral problems of the clients, and appropriate techniques of behavior management for dealing with such behaviors. (b) Behavior management policies and procedures shall incorporate the following minimum requirements: 1. Behavior management principles and techniques shall be used in accordance with the treatment plan and written policies and procedures governing service expectations, treatment goals, safety, security, and these rules and regulations. 2. Behavior management shall be limited to the least restrictive appropriate method, as described in the client's treatment plan pursuant to rule 82-10-1-.15 and in accordance with the prohibitions as specified in these rules and regulations. (c) Behavior management techniques shall be administered by trained staff and shall be appropriate for the client's known medical, behavioral, cognitive and/or physical status and needs. The following forms of behavior management shall not be used by program staff with clients receiving services through the program: 1. Assignment of excessive or unreasonable work tasks; 2. Denial of meals and hydration; 3. Denial of sleep; 4. Denial of shelter, clothing, or essential personal needs; 5. Denial of essential program services; 6. Verbal abuse, ridicule, or humiliation; 7. Manual holds, chemical restraints, mechanical restraints, or medical protection devices not used appropriately as emergency safety interventions; 8. Denial of communication and visits unless restricted in accordance with rule 82-10-1-.15; 9. Corporal punishment; 10. Seclusion or confinement of a client in a room or area which may reasonably be expected to cause physical or emotional damage to the client; or not used appropriately as an emergency safety intervention; and 11. Seclusion or confinement of a client to a room or area for periods longer than those appropriate to the client's known medical, behavioral, cognitive and/or physical status and needs, or confinement to a room or area without the supervision or monitoring necessary to ensure the client's safety and well-being. (d) Program staff shall be made aware of each client's known or apparent medical and psychological conditions to ensure that the staff have adequate knowledge to deliver safe and healthy care to the client. (e) Clients shall not be permitted to participate in the behavior management of other clients or to discipline other clients, except as part of an organized therapeutic self-governing program in accordance with accepted standards of clinical practice that is conducted in accordance with written policy and is supervised directly by designated staff. (f) All forms of behavior management used by staff shall also be documented in case records to ensure that such records reflect behavior management problems. (g) The program shall document appropriate corrective action when the program staff become aware of or observe the use of prohibited forms of behavior management. (2) Emergency Safety Interventions. (a) Emergency safety interventions may be used only by staff trained in the proper use of such interventions when it can be reasonably anticipated from a client's behavioral history, that a client may require the use of emergency safety interventions to keep either the client or others safe from immediate physical harm, and less restrictive means of dealing with the injurious behavior have not proven successful or may subject the client or others to greater risk of injury. (b) No later than March 31, 2007 and ongoing thereafter, all program staff who may be involved in the use of emergency safety interventions, shall have evidence of having satisfactorily completed a nationally recognized training program for emergency safety interventions to protect clients and others from injury, which has been approved by the department and taught by an appropriately certified trainer in such program. At a minimum, the emergency safety intervention program that is utilized shall include the following: 1. Techniques for de-escalating problem behavior including client and staff debriefings; 2. Appropriate use of emergency safety interventions; 3. Recognizing aggressive behavior that may be related to a medical condition; 4. Awareness of physiological impact of a restraint on the client; 5. Recognizing signs and symptoms of positional and compression asphyxia and restraint associated cardiac arrest; 6. Instructions on how to monitor the breathing, verbal responsiveness, and motor control of a client who is the subject of an emergency safety intervention; 7. Appropriate self-protection techniques; 8. Policies and procedures relating to using manual holds, including the prohibition of any technique that would potentially impair a client's ability to breathe; 9. Agency policies and reporting requirements; 10. Alternatives to restraint; 11. Avoiding power struggles; 12. Escape and evasion techniques; 13. Time limits for the use of restraint and seclusion; 14. Process for obtaining approval for continual restraints and seclusion; 15. Procedures to address problematic restraints; 16. Documentation; 17. Investigation of injuries and complaints; 18. Monitoring physical signs of distress and obtaining medical assistance; and 19. Legal issues. (c) Emergency safety interventions shall not include the use of any restraint or manual hold that would potentially impair the client's ability to breathe or has been determined to be inappropriate for use on a particular client due to a documented medical or psychological condition. (d) The program shall have written policies and procedures for the use of emergency safety interventions, a copy of which shall be provided to and discussed with each client (as appropriate taking into account the client's known medical, behavioral, cognitive and/or physical status and needs) and the client's parents and/or legal guardians prior to or at the time of admission. Emergency safety interventions policies and procedures shall include: 1. Provisions for the documentation of each use of an emergency safety intervention including: (i) Date and description of the precipitating incident; (ii) Description of the de-escalation techniques used prior to the emergency safety intervention; (iii) Environmental considerations; (iv) Names of staff participating in the emergency safety intervention; (v) Any witnesses to the precipitating incident and subsequent intervention; (vi) Exact emergency safety intervention used; (vii) Documentation every 15 minutes of the constant visual monitoring of a client in seclusion; (viii) Beginning and ending time of the intervention; (ix) Outcome of the intervention; (x) Detailed description of any injury arising from the incident or intervention; and (xi) Summary of any medical care provided. 2. Provisions for prohibiting manual hold use by any employee not trained in prevention and use of emergency safety interventions. (e) Emergency safety interventions may be used to prevent runaways only when the client presents an imminent threat of physical harm to self or others, or as specified in the treatment plan. (f) Program staff shall be aware of each client's medical and psychological conditions (e.g. obvious health issues, list of medications, history of physical abuse, etc.), as evidenced by written acknowledgement of such awareness, to ensure that the emergency safety intervention that is utilized does not pose any undue danger to the physical or mental health of the client. (g) Clients shall not be allowed to participate in the emergency safety intervention of other clients. (h) Immediately following the conclusion of the emergency safety intervention and hourly thereafter for a period of at least four (4) hours where the client is with a staff member, the client's behavior will be assessed, monitored, and documented to ensure that the client does not appear to be exhibiting symptoms that would be associated with an injury. (i) Emergency safety intervention training shall be in addition to the annual training required in rule 82-10-1-.11 and shall be documented in the staff member's personnel record. (j) All actions taken that involve utilizing an emergency safety intervention shall be recorded in the client's case record showing the cause for the emergency safety intervention, the emergency safety intervention used, and, if needed, approval by the clinical director, the staff member in charge of casework services, and the physician/physician extender who has responsibility for the diagnosis and treatment of the client's behavior. (k) Programs shall submit a written report to the program's clinical director on the use of any emergency safety intervention immediately after the conclusion of the intervention and, if the client is a child or has an assigned legal guardian, shall further notify the client's parents or legal guardians regarding the use of the intervention. A copy of such report shall be maintained in the client's file. (l) At least once per quarter, the program, utilizing a master agency restraint log and the client's case record, shall review the use of all emergency safety interventions for each client and staff member, including the type of intervention used and the length of time of each use, to determine whether there was a clinical basis for the intervention, whether the use of the emergency safety intervention was warranted, whether any alternatives were considered or employed, the effectiveness of the intervention or alternative, and the need for additional training. Written documentation of all such reviews shall be maintained. Where the program identifies opportunities for improvement as a result of such reviews or otherwise, the program shall implement these changes through an effective quality improvement plan. (m) All forms of emergency safety interventions used by staff shall be documented in case records. (n) Manual Holds. 1. Emergency safety interventions utilizing manual holds require all staff involved to be trained to carry out the hold. 2. Emergency safety interventions shall not include the use of prone restraint or the use of any restraint or manual hold that would potentially impair the client's ability to breathe or has been determined to be inappropriate for use on a particular client due to a documented medical or psychological condition. 3. When a manual hold is used upon any client whose primary mode of communication is sign language, the client shall be permitted to have his or her hands free from restraint for brief periods during the intervention, except when such freedom may result in physical harm to the client or others. 4. If the use of a manual hold exceeds fifteen (15) consecutive minutes, the clinical director or his or her designee, who possesses at least the qualifications of the clinical director and has been fully trained in the program's emergency safety intervention plan, shall be contacted by a two-way communications device or in person and determine that the continuation of the manual hold is appropriate under the circumstances. Documentation of any consultations and outcomes shall be maintained for each application of a manual hold that exceeds fifteen (15) minutes. Manual holds shall not be permitted to continue if the restraint is determined to pose an undue risk to the client's health given the client's physical or mental condition. 5. A manual hold may not continue for more than thirty (30) minutes at any one time without the consultation as specified in subparagraph (4) of this subparagraph, and under no circumstances may a manual hold be used for more than one (1) hour total within a twenty-four (24) hour period. 6. If the use of a manual hold on a client reaches a total of one hour within a twenty-four (24) hour period, the staff shall reconsider alternative treatment strategies, document same, and consider notifying the authorities or transporting the client to a hospital or mental health facility for evaluation. 7. The client's breathing, verbal responsiveness, and motor control shall be continuously monitored during any manual hold. Written summaries of the monitoring by a trained staff member not currently directly involved in the manual hold shall be recorded every fifteen (15) minutes during the duration of the restraint. If only one trained staff member is involved in the restraint and no other staff member is available, written summaries of the monitoring of the manual hold shall be recorded as soon as is practicable, but no later than one hour after the conclusion of the restraint. (o) Seclusion. 1. Seclusion is only used as an emergency safety intervention for the immediate physical safety of the client and others during an emergency safety situation and when other less restrictive interventions have been determined to be ineffective. Seclusion shall not be used as a means of coercion, discipline, convenience, punishment or retaliation. 2. If used, seclusion of more than thirty (30) minutes must be approved by the clinical director or designee. No client shall be placed in a seclusion room more than one (1) hour within any twenty-four (24) hour period without obtaining authorization for continuing such seclusion from the client's physician/physician extender, psychiatrist, or licensed psychologist and documenting such authorization in the client's record. 3. A seclusion room shall only be used if a client is in danger of harming himself or herself or others. Seclusion shall be ceased when the emergency safety situation ceases and the client's safety and the safety of others can be ensured, even if the seclusion order has not expired. 4. A client placed in a seclusion room shall be provided with an explanation of the criteria for release from seclusion. During seclusion, the client shall be constantly visually monitored, with documentation at least every fifteen (15) minutes. 5. A room used for the purposes of seclusion must meet the following criteria: (i) The room shall be constructed and used in such ways that the risk of harm to the client is minimized; (ii) The room shall be equipped with a viewing window on the door or wall so that staff can monitor the client; (iii) The room shall be lighted and well-ventilated; (iv) The room shall be a minimum of fifty (50) square feet in area; and (v) The room must be free of any item that may be used by the client to cause physical harm to himself/herself or others. 6. No more than one client shall be placed in the seclusion room at a time. 7. A seclusion room monitoring log shall be maintained and used to record the following information: (i) Name of the secluded client; (ii) Reason for client's seclusion; (iii) Time of client's placement in the seclusion room; (iv) Name and signature of the staff member that conducted visual monitoring; (v) Signed observation notes; and (vi) Time of the client's removal from the seclusion room. Rule 82-10-1-.28 Enforcement and Sanctions (1) The Department may refuse to grant an initial license, revoke a current license, or impose other sanctions as described in Rules and Regulations for Licensure Enforcement and Sanctions, Chapter 82-14-1. (2) The Department may suspend any requirements of these rules and the enforcement of any rules where the Governor of the State of Georgia has declared a public health emergency. Rule 82-10-1-.29 Waivers and Variances (1) The Department may, in its discretion, grant waivers and variances of specific rules upon application or petition being filed on forms provided by the Department. The Department may establish conditions which must be met by the program to operate under the waiver or variance granted. Waivers and variances may be granted in accordance with the following considerations: (2) Variance . A variance may be granted by the Department upon a showing by the applicant or petitioner that the specific rule or regulation that is the subject of the variance request should not be applied as written because strict application of the rule would cause undue hardship. The applicant or petitioner must also show that adequate standards affording protection for the health, safety and care of clients exist and will be met in lieu of the exact requirements of the rules or regulations in question. (3) Waiver. The Department may dispense entirely with the enforcement of a rule or regulation by granting a waiver upon a showing by the applicant or petitioner that the purpose of the rule or regulation is met through equivalent standards affording equivalent protection for the health, safety and care of clients. (4) Experimental Variance or Waiver. The Department may grant waivers and variances to allow experimentation and demonstration of new and innovative approaches to delivery of services upon a showing by the applicant or petitioner that the intended protections afforded by the rule or regulation which is the subject of the request are met and that the innovative approach has the potential to improve service delivery. Rule 82-10-1-.30 Severability In the event that any rule, sentence, clause or phrase of any of these rules and regulations may be construed by any court of competent jurisdiction to be invalid, illegal, unconstitutional, or otherwise unenforceable, such determination or adjudication shall in no manner affect the remaining rules or portions thereof. The remaining rules or portions thereof shall remain in full force and effect, as if such rules or portions thereof so determined, declared or adjudged invalid or unconstitutional were not originally a part of these rules. Rule 82-10-1-.01 Legal Authority Rule 82-10-1-.02 Title and Purpose Rule 82-10-1-.03 Definitions Rule 82-10-1-.04 Governing Body Rule 82-10-1-.05 Licenses Rule 82-10-1-.06 Accreditation Rule 82-10-1-.07 Applications Rule 82-10-1-.08 Reporting Incidents to the Department Rule 82-10-1-.09 Surveys, Investigations and Corrective Action Plans Rule 82-10-1-.10 Administration Rule 82-10-1-.11 Staffing Rule 82-10-1-.12 Physical Plant and Safety Rule 82-10-1-.13 Food Service Rule 82-10-1-.14 Client Referral, Intake, Assessment, and Admission Rule 82-10-1-.15 Treatment Plan Rule 82-10-1-.16 Medications Rule 82-10-1-.17 Quality Assurance Rule 82-10-1-.18 Discharge Summary and Aftercare Plan Rule 82-10-1-.19 Residential Sub-Acute Detoxification Program Rule 82-10-1-.20 Ambulatory Detoxification Programs Rule 82-10-1-.21 Residential Intensive Treatment Programs Rule 82-10-1-.22 Residential Transitional Treatment Programs Rule 82-10-1-.23 Specialized Day Treatment Programs Rule 82-10-1-.24 Outpatient Drug Treatment Programs Rule 82-10-1-.25 Special Programs Rule 82-10-1-.26 Client's Rights and Complaints Rule 82-10-1-.27 Behavior Management and Emergency Safety Interventions Rule 82-10-1-.28 Enforcement and Sanctions Rule 82-10-1-.29 Waivers and Variances Rule 82-10-1-.30 Severability