This Louisiana regulation establishes operating standards for behavioral health service providers offering residential levels of care under the ASAM framework, including ASAM 3.1 (low-intensity residential), ASAM 3.5 (medium- and high-intensity residential), ASAM 3.7 (medically managed residential treatment and withdrawal management), as well as opioid treatment programs (OTPs). Providers must meet specific staffing ratios, treatment planning timelines, clinical service minimums, dietary and transportation requirements, and house management standards. Additional requirements apply to residential substance use programs regarding onsite access to medications for opioid use disorder, and OTPs must comply with methadone registry reporting, drug screening, and structured treatment phase protocols. Pregnant and postpartum women (PPW) programs operating within ASAM 3.1 and 3.5 residential settings must also meet detailed child supervision, clinical care, and safety standards.
View official source§5701.Clinically Managed Low-Intensity Residential Treatment (ASAM Level 3.1) A.The BHS provider shall: 1.only admit clients clinically appropriate for ASAM level 3.1 into its program; 2.offer a combination of low-intensity clinical and recovery focused services, including: a.individual therapy; b.group and family therapy; c.medication management; and d.medication education; 3.for adolescents, offer at least five hours of services per week; 4.for adults, offer nine to 19 hours of services seven days per week; 5.review the treatment plan in collaboration with the client a minimum of every 30 days or more frequently as needed, and document accordingly; and 6.provide case management that is: a.provided by a care coordinator who is on duty as needed; or b.assumed by the clinical staff. B.Staffing 1.The provider shall have a clinical supervisor available for clinical supervision and by telephone for consultation. 2.There shall be at least one LMHP or UP on duty at least 40 hours a week. 3.Adult Staffing Patterns a.The LMHP/UP caseload shall not exceed 1:25 active clients. b.There shall be at least one direct care aide on duty during each shift. 4.Children/Adolescent Staffing Patterns a.The UP caseload shall not exceed 1:8 active clients. b.The provider shall have at least two direct care aides on duty during each shift. c.There shall be a ratio of 1:8 direct care aides during all shifts and a ratio of 1:5 direct care aides on therapy outings. C.The BHS provider may operate a PPW program. 1.A provider’s PPW program shall: a.meet the requirements of ASAM level 3.1; b.provide weekly parenting classes where attendance is required; c.address the specialized needs of the parent; d.provide education, counseling, and rehabilitation services for the parent that further addresses: i.the effects of chemical dependency on a woman's health and pregnancy; ii.parenting skills; and iii.health and nutrition; e.regularly assess parent-child interactions and address any identified needs in treatment; and f.provide access to family planning services. 2.Child Supervision a.When the mother is not available, the provider shall provide age-appropriate child supervision. b.The provider shall ensure that its child supervision is provided by either: i.the provider’s on-site program with all staff members who: (a).are at least 18 years old; (b).have infant cardiopulmonary resuscitation (CPR) certification; and (c).have at least eight hours of training in the following areas prior to supervising children independently: (i).chemical dependency and its impact on the family; (ii).child development and age-appropriate activities; (iii).child health and safety; (iv).universal precautions; (v).appropriate child supervision techniques; and (vi).signs of child abuse; or ii.a licensed day care provider pursuant to a written agreement with the provider. c.The provider shall maintain a staff-to-child ratio that does not exceed: i.1:3 for infants (18 months and younger); and ii.1:6 for toddlers and children. d.Child Specialist. The provider shall have a child specialist who: i.is available to: (a).provide staff training; (b).evaluate effectiveness of direct care staff; and (c).plan activities for at least one hour per week per child; ii.has 90 clock hours of education and training in child development and/or early childhood education; and iii.has one year of documented experience providing services to children. e.Clients shall not supervise another parent's child or children without written consent from the legal guardian and staff approval. f.Staff shall check all diapers frequently and change as needed. Staff shall dispose of the diapers in a sealed container and sanitize the changing area. 3.Clinical Care for Children. The provider shall: a.address the specialized and therapeutic needs and care for the dependent children; b.develop an individualized treatment plan to include goals, objectives, and target dates; c.provide age-appropriate education, counseling, and rehabilitation services for children that address or include: i.the emotional and social effects of living with a chemically dependent care-giver; ii.early screening and intervention of high risk behavior and referrals for appropriate services when indicated; iii.screening for developmental delays; and iv.health and nutrition; d.ensure that all children have access to medical care when needed; e.ensure that children are administered medication according to the label by the parent or licensed staff qualified to administer medications; f.ensure that if licensed staff administer medications, the provider: i.obtains written consent from the parent to administer the prescribed and over the counter medications; (a).written consent shall include information relative to dosage, route, etc.; ii.assumes full responsibility for the proper administration and documentation of the medications; and iii.ensures original labeled medication containers with name, dosage, route, etc. are obtained prior to medication administration; g.maintain current immunization records and allergy records for each child at the program site; and h.obtain consent for emergency medical care for each child at admission. 4.Child Services a.The children’s daily activity schedule shall include a variety of structured and unstructured age-appropriate activities. b.School age children shall have access to school. c.The health, safety, and welfare of the children shall be protected at all times. d.Behavior management shall be fair, reasonable, consistent, and related to the child's behavior. Physical discipline is prohibited. e.The children shall be well-groomed and dressed weather-appropriate. f.An adequate diet for childhood growth and development, including two snacks per day, shall be provided to each child. 5.The program shall develop, implement, and comply with written policies and procedures that: a.address abuse and/or neglect of a child; b.prohibit children under the age of 18 months from sleeping in bed with their mothers; c.require a current schedule showing who is responsible for the children at all times; d.address isolating parents and children who have communicable diseases and providing them with appropriate care and supervision; and e.identify those persons authorized to remove a child from the facility other than legal guardian or parent. 6.Safety and Emergency Preparedness (SEP) a.The program shall develop and implement an SEP plan with provisions and services for the clients and children. b.All toys and equipment shall be: i.age appropriate; ii.in good order and safe condition; and iii.operated in accordance with manufacturer’s recommendations. c.Staff, volunteers, and parents shall use universal precautions at all times. d.The provider shall ensure that only the legal guardian or a person authorized by the legal guardian may remove a child from the provider. e.If an individual shows documentation of legal custody, staff shall record the person's identification before releasing the child. 7.Physical Environment a.The program shall provide potty chairs for small children and sanitize them after each use. b.The program shall provide age-appropriate bathing facilities. Infants shall not be bathed in sinks. c.Each child shall be provided with his/her own bed. d.Infants up to 18 months shall sleep in either a bassinet or cribs appropriate to the size of the child. e.The provider shall provide a variety of age-appropriate equipment, toys, and learning materials for the children/adolescents. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1715 (September 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 48:1286 (May 2022), amended by the Department of Health, Health Standards Section, LR 52:49 (January 2026). §5706.Clinically Managed Medium-Intensity Residential Treatment (ASAM 3.5) (Adolescents Only) A.The provider shall: 1.admit only adolescent clients clinically appropriate for ASAM level 3.5 into its program; 2.review the treatment plan in collaboration with the client a minimum of every 30 days or more frequently as needed, and document accordingly; 3.provide case management that is: a.provided by a care coordinator who is on duty as needed; or b.assumed by the clinical staff. B.Staffing. The provider shall ensure that: 1.a physician is on call 24 hours per day, seven days per week, and reports on duty as needed for management of psychiatric and medical needs of the clients; 2.a clinical supervisor is available for clinical supervision when needed and by telephone for consultation; 3.one licensed registered nurse is on call 24/7 to perform nursing duties for the provider; 4.at least one LMHP or UP shall be on duty at least 40 hours per week; a.Each LMHP/UP’s caseload shall not exceed 1:8. 5.at least two direct care aides shall be on duty during all shifts with additional as needed; a.The ratio of aides to clients shall not exceed 1:8. On therapy outings, the ratio shall be at least 1:5; 6.a psychologist shall be available when needed; and 7.a licensed nurse shall be on duty to meet the nursing needs of the clients. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health, Health Standards Section, LR 52:50 (January 2026). §5707.Clinically Managed High-Intensity Residential Treatment (ASAM Level 3.5) (Adults Only) A.The provider shall: 1.admit only adult clients clinically appropriate for ASAM level 3.5 into its Clinically Managed High Intensity Residential Treatment; 2.review the treatment plan in collaboration with the client a minimum of every 30 days or more frequently as needed, and document accordingly; 3.provide case management that is: a.provided by a care coordinator who is on duty as needed; or b.assumed by the clinical staff. 4.provide a minimum of 20 hours per week of services. B.Staffing. The provider shall ensure that: 1.there is a physician on call 24 hours per day, seven days per week, and on duty as needed for management of psychiatric and medical needs of the clients; 2.there is a clinical supervisor available for clinical supervision when needed and by telephone for consultation; 3.the provider shall have one licensed RN on call 24/7 to perform nursing duties for the provider; and 4.there shall be at least one LMHP or UP on duty at least 40 hours per week. Each LMHP/UP’s caseload shall not exceed 1:12; 5.there shall be at least one direct care aide on duty on all shifts, with additional as needed; and 6.there shall be licensed nurses on duty to meet the needs of the clients: a.at least two licensed nurses during weekday shifts; and b. at least one and a half full-time equivalent licensed nurses during night and weekend shifts. C.The BHS provider may operate a PPW program. 1.A provider’s PPW program shall: a.meet the requirements of ASAM level 3.5; b.provide weekly parenting classes where attendance is required; c.address the specialized needs of the parent; d.provide education, counseling, and rehabilitation services for the parent that further addresses: i.the effects of chemical dependency on a woman's health and pregnancy; ii.parenting skills; and iii.health and nutrition; e.regularly assess parent-child interactions and address any identified needs in treatment; and f.provide access to family planning services. 2.Child Supervision a.When the mother is not available, the provider shall provide age appropriate child supervision. b.The provider shall ensure that its child supervision is provided by either: i.the provider’s on-site program with all staff members who: (a).are at least 18 years old; (b).have infant CPR certification; and (c).have at least eight hours of training in the following areas prior to supervising children independently: (i).chemical dependency and its impact on the family; (ii).child development and age-appropriate activities; (iii).child health and safety; (iv).universal precautions; (v).appropriate child supervision techniques; and (vi).signs of child abuse; or ii.a licensed day care provider pursuant to a written agreement with the provider. c.The provider shall maintain a staff-to-child ratio that does not exceed: i.1:3 for infants (18 months and younger); and ii.1:6 for toddlers and children. d.Child Specialist. The provider shall have a child specialist who: i.is available to: (a).provide staff training; (b).evaluate effectiveness of direct care staff; and (c).plan activities for at least one hour per week per child; ii.has 90 clock hours of education and training in child development and/or early childhood education; and iii.has one year of documented experience providing services to children. e.Clients shall not supervise another parent's child or children without written consent from the legal guardian and staff approval. f.Staff shall check all diapers frequently and change as needed. Staff shall dispose of the diapers in a sealed container and sanitize the changing area. 3.Clinical Care for Children. The provider shall: a.address the specialized and therapeutic needs and care for the dependent children; b.develop an individualized treatment plan to include goals, objectives, and target dates; c.provide age-appropriate education, counseling, and rehabilitation services for children that address or include: i.the emotional and social effects of living with a chemically dependent care-giver; ii.early screening and intervention of high risk behavior and referrals for appropriate services when indicated; iii.screening for developmental delays; and iv.health and nutrition; d.ensure that all children have access to medical care when needed; e.ensure that children are administered medication according to the label by the parent or licensed staff qualified to administer medications; f.ensure that if licensed staff administer medications, the provider: i.obtains written consent from the parent to administer the prescribed and over the counter medications; (a).Written consent shall include information relative to dosage, route, etc.; ii.assumes full responsibility for the proper administration and documentation of the medications; and iii.ensures original labeled medication containers with name, dosage, route, etc. are obtained prior to medication administration; g.maintain current immunization records and allergy records for each child at the program site; and h.obtain consent for emergency medical care for each child at admission. 4.Child Services a.The children’s daily activity schedule shall include a variety of structured and unstructured age-appropriate activities. b.School age children shall have access to school. c.The health, safety, and welfare of the children shall be protected at all times. d.Behavior management shall be fair, reasonable, consistent, and related to the child's behavior. Physical discipline is prohibited. e.The children shall be well-groomed and dressed weather-appropriate. f.An adequate diet for childhood growth and development, including two snacks per day, shall be provided to each child. 5.The program shall develop, implement, and comply with written policies and procedures that: a.address abuse and/or neglect of a child; b.prohibit children under the age of 18 months from sleeping in bed with their mothers; c.require a current schedule showing who is responsible for the children at all times; d.address isolating parents and children who have communicable diseases and providing them with appropriate care and supervision; and e.identify those persons authorized to remove a child from the facility other than legal guardian or parent. 6.Safety and Emergency Preparedness (SEP) a.The program shall develop and implement an SEP plan with provisions and services for the clients and children. b.All toys and equipment shall be: i.age appropriate; ii.in good order and safe condition; and iii.operated in accordance with manufacturer’s recommendations. c.Staff, volunteers, and parents shall use universal precautions at all times. d.The provider shall ensure that only the legal guardian or a person authorized by the legal guardian may remove a child from the provider. e.If an individual shows documentation of legal custody, staff shall record the person's identification before releasing the child. 7.Physical Environment a.The program shall provide potty chairs for small children and sanitize them after each use. b.The program shall provide age-appropriate bathing facilities. Infants shall not be bathed in sinks. c.Each child shall be provided with his/her own bed. d.Infants up to 18 months shall sleep in either a bassinet or cribs appropriate to the size of the child. e.The provider shall provide a variety of age-appropriate equipment, toys, and learning materials for the children/adolescents. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1717 (September 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 48:1287 (May 2022), amended by the Department of Health, Health Standards Section, LR 52:50 (January 2026). §5709.Medically Managed Residential Treatment (ASAM Level 3.7) (Adults Only) A.The provider shall: 1.admit only clients clinically appropriate for ASAM level 3.7 into its program; 2.ensure that: a.a physical examination is conducted by a physician, PA, or APRN within 24 hours of admission; or b.the provider’s admitting physician reviews and approves a physical examination conducted by a physician, PA, or APRN within 24 hours prior to admission; 3.review the treatment plan in collaboration with the client a minimum of every 30 days or more frequently as needed, and document accordingly; 4.provide case management that is: a.provided by a care coordinator who is on duty as needed; or b.assumed by the clinical staff. 5.provide a minimum 20 hours of clinical services per week; 6.have onsite access to perform biomedical capabilities. B.Staffing. The provider shall ensure that: 1.there is a physician on call 24 hours per day, seven days per week, and on duty as needed for management of psychiatric and medical needs; 2.there is a clinical supervisor available for clinical supervision when needed and by telephone for consultation; 3.there is at least one LMHP or UP on duty at least 40 hours/week; 4.there is at least one RN on call 24 hours per day, seven days per week to perform nursing duties and at least one licensed nurse is on duty during all shifts with additional licensed nursing staff to meet the nursing needs of the clients; 5.its on-site nursing staff is solely responsible for 3.7 program and does not provide services for other levels of care at the same time; 6.each LMHP/UP caseload shall not exceed 1:10; 7.there is at least one direct care aide on duty on all shifts with additional as needed; 8.there is an activity or recreational therapist on duty at least 15 hours per week. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1718 (September 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 48:1287 (May 2022), amended by the Department of Health, Health Standards Section, LR 52:52 (January 2026). §5711.Medically Managed Residential Withdrawal Management (ASAM Level 3.7-WM) (Adults Only) A.The provider shall: 1.admit only clients clinically appropriate for ASAM level 3.7-WM into its program; 2.ensure that: a.a physical examination is conducted by a physician, PA or APRN within 24 hours of admission; or b.the provider’s admitting physician reviews and approves a physical examination conducted by a physician, PA or APRN within 24 hours prior to admission; 3.ensure that each client’s progress is assessed at least daily; 4.ensure that each client’s physical condition, including vital signs, is assessed at least daily, or more frequently as indicated by physician’s order or change in the client’s status; 5.have a reliable, adequately sized emergency power system to provide power during an interruption of normal electrical service; 6.provide case management that is conducted: a.by a care coordinator who is on duty as needed; or b.by the clinical staff. B.Emergency Admissions 1.If a client is admitted under emergency circumstances, the admission process may be delayed until the client can be interviewed, but no longer than 24 hours unless seen by a physician. 2.The provider shall orient the direct care staff to monitor, observe and recognize early symptoms of serious illness and to access emergency services promptly. C.Staffing 1.The provider shall have a physician on call 24 hours per day, seven days per week, and on duty as needed for management of psychiatric and medical needs of the clients. 2.Nursing a.The provider shall have at least one RN on call 24 hours per day, seven days per week to perform nursing duties. b.There shall be at least one licensed nurse on duty during all shifts with additional as needed based upon the provider’s census and the clients’ acuity levels. c.There shall be a RN on-site no less than 40 hours per week who is responsible for conducting nursing assessments upon admission and delegating staffing assignments to the nursing staff based on the assessments and the acuity levels of the clients. d.The provider shall ensure that its on-site nursing staff is solely responsible for 3.7-WM program and does not provide services for other levels of care at the same time. e.The nursing staff is responsible for: i.monitoring client’s progress; and ii.administering medications in accordance with physician orders. 3.Clinical Supervisor and UPs a.The provider shall have a clinical supervisor available for clinical supervision when needed and by telephone for consultation. b.The LMHP/UP caseload shall not exceed 1:10. 4.There shall be at least one direct care aide on all shifts with additional as needed based upon the provider’s census and the clients’ acuity levels. 5.The provider shall have at least one employee on duty certified in CPR. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1718 (September 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 48:1287 (May 2022), amended by the Department of Health, Health Standards Section, LR 52:52 (January 2026). Subchapter N.Additional Requirement for Substance Use/ Addiction Residential Treatment Programs NOTE: In addition to the requirements applicable to all BHS providers, residential programs that treat substance use/addiction shall meet the applicable requirements below. §5712.Onsite Access to Medications for Opioid Use Disorder A.Each residential substance use disorder facility licensed as a BHS provider that provides treatment for opioid use disorder shall provide all of the following: 1. onsite access, as defined in the Rule, to at least one form of FDA-approved opioid antagonist treatment; and 2.onsite access, as defined in this Rule, to at least one form of FDA-approved partial opioid agonist treatment. B.A residential substance use disorder facility licensed as a BHS provider shall not be found to be in violation of this Section if prior authorization from a patient’s health insurer, a Medicaid program, is required, and the preapproval request is denied by the patient’s health insurer. C.Each residential substance use disorder facility licensed as a BHS provider which provides treatment for opioid use disorder shall submit to the department on its initial licensing application and/or its annual licensing renewal application an attestation as to whether it is complying with the requirements of §5712.A and when such compliance began. D.If the licensed facility is not fully complying with the requirements of §5712.A, then the attestation that the facility submits to the department shall include a report addressing its progress toward satisfying the requirements of this Section. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health, Bureau of Health Services Financing, LR 48:1287 (May 2022), amended by the Department of Health, Health Standards Section, LR 52:52 (January 2026). §5713.Client Funds and Assets A.If a BHS provider manages clients’ personal funds accounts, the BHS provider shall develop and implement written policies and procedures governing the maintenance and protection of the client fund accounts that include, but are not limited to: 1.the maximum amount each client may entrust with the provider; 2.the criteria by which clients can access money; 3.the disbursement procedure, including the maximum amount that may be disbursed to the client; 4.staff members who may access such funds; and 5.the method for protecting and maintaining the funds. B.The BHS provider that manages a client’s personal funds shall: 1.furnish a copy of the provider’s policy and procedures governing the maintenance and protection of client funds to the client or the client’s parents or legal guardian, if applicable; 2.obtain written authorization from the client or the client’s parent or legal guardian, if applicable, for the safekeeping and management of the funds; 3.provide each client with an account statement upon request with a receipt listing the amount of money the provider is holding in trust for the client; 4.maintain a current balance sheet containing all financial transactions to include the signatures of staff and the client for each transaction; 5.provide a list or account statement regarding personal funds upon request of the client; and 6.be prohibited from commingling the clients’ funds with the provider’s operating account. C.If the BHS provider manages funds for a client, the provider shall ensure that: 1.any remaining funds shall be refunded to the client or his/her legal guardian within five business days of notification of discharge; and 2.in the event of the death of a client, any remaining funds are refunded to the client’s legal representative within five business days of the client’s death. D.The BHS provider shall develop, implement and comply with a policies and procedures that address: 1.the maintenance and safeguard of client possessions, including money, brought to the provider by its clients; 2.maintaining an inventory of each client’s possessions from the date of admission; 3.returning all possessions to the client upon the client’s discharge; and 4.requiring the client and one staff member to sign documentation indicating that the client’s possessions have been placed with the provider and the return of possessions to the client. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1719 (September 2015). §5715.Dietary Services A.The residential BHS provider shall ensure that: 1.all dietary services are provided under the direction of a Louisiana licensed dietician; 2.menus are approved by a licensed dietician; 3.meals are of sufficient quantity and quality to meet the nutritional needs of clients, including religious and dietary restrictions; 4.meals are in accordance with FDA dietary guidelines and the orders of the authorized licensed prescriber; 5.at least three meals plus an evening snack are provided daily with no more than 14 hours between any two meals; 6.all food is stored, prepared, distributed, and served under safe and sanitary conditions in accordance with the Louisiana state Sanitary Code; 7.all equipment and utensils used in the preparation and serving of food are properly cleaned, sanitized and stored in accordance with the LAC 51, Public Health Sanitary Code; and 8.if meals are prepared on-site, they are prepared in an OPH approved kitchen. B.The BHS provider may provide meal service and preparation pursuant to a written agreement with an outside food management company. If provided pursuant to a written agreement, the provider shall: 1.maintain responsibility for ensuring compliance with this Chapter; 2.ensure that the outside food management company possesses a valid OPH retail food permit; and 3.ensure that, if the provider does not employ or directly contract with a licensed dietician, the food management company employs or contracts with a licensed dietician who serves the provider as needed to ensure that the nutritional needs of the clients are met in accordance with the authorized licensed prescriber’s orders and acceptable standards of practice. C.The licensed dietician shall: 1.approve therapeutic menus; and 2.be available for consultation when necessary. D.If the BHS provider has a program that allows menu planning and preparation by clients, the provider shall develop and implement a policy with guidelines for the participating clients that: 1.ensures that meal preparation/service, with client participation, meets all requirements listed above; and 2.defines client’s participation in writing and has written instructions posted or easily accessible to clients. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1719 (September 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 43:1388 (July 2017). §5717.Transportation A.A residential BHS provider shall assist in arranging for or provide transportation necessary for implementing the client’s treatment plan, including but not limited to, court-ordered hearings and medically necessary appointments with a health care provider. B.The BHS provider may provide transportation pursuant to a written agreement with an outside transportation service. If provided pursuant to a written agreement, the provider shall maintain responsibility for ensuring compliance with this Chapter. C.Any vehicle used to transport a BHS provider’s client shall be: 1.properly licensed and inspected in accordance with state law; 2.maintained in a safe condition; 3.operated at a climate controlled temperature that does not compromise the health, safety or needs of the client; and 4.operated in conformity with all of the applicable motor vehicle laws, including but not limited to, utilization of seat belts and vehicular child restraint systems. D.The provider shall ensure that it or its contracted transportation service: 1.has documentation of current liability insurance coverage for all owned and non-owned vehicles used to transport clients. The personal liability insurance of a provider’s employee shall not be substituted for the required coverage; 2.utilizes only drivers who are properly licensed and insured to operate that class of vehicle in accordance with state laws, rules and regulations; 3.obtains a driving history record from the state Office of Motor Vehicles for each employee upon hire and annually thereafter; 4.prohibits the number of persons in any vehicle used to transport clients to exceed the number of available seats with seatbelts in the vehicle; and 5.determines the nature of any need or problem of a client which might cause difficulties during transportation. This information shall be communicated to agency staff responsible for transporting clients. E.The provider shall comply with the following when transporting disabled non-ambulatory clients in a wheelchair: 1.a ramp to permit entry and exit of a client from the vehicle; 2.wheelchairs used in transit shall be securely fastened inside the vehicle utilizing approved wheelchair fasteners; and 3.the client is securely fastened in the wheelchair. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1719 (September 2015). §5719.Staffing A.The provider shall ensure that there are at least two staff persons on site at all times when a client is present. B.House Manager 1.A residential provider shall have a house manager. 2.The house manager shall: a.be at least 21 years old; b.have at least two years qualifying experience working for a provider that treats clients with mental illness and/or addictive disorders; c.supervise the activities of the facility when the professional staff is not on duty; d.perform clinical duties only if licensed to do so; e.report incidents of abuse, neglect and misappropriation to the medical director; f.identify and respond to and report any crisis situation to the clinical supervisor when it occurs; and g.coordinate and consult with the clinical staff as needed. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 41:1720 (September 2015), amended by the Department of Health, Health Standards Section, LR 52:53 (January 2026). §5721.Policies and Procedures A.House Rules and Regulations. A residential provider shall: 1.have a clearly written list of house rules and regulations governing client conduct and behavior management; 2.provide a copy of the house rules and regulations to all clients and, where appropriate, the client’s parent(s) or legal guardian(s) upon admission; 3.post the rules and regulations in an easily accessible location in the provider and make them available when requested; and 4.have a policy and procedure that pertains to the bedroom assignment of its clients, with consideration given to age, client’s diagnosis and severity of client’s medical condition. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1720 (September 2015). Subchapter O.Additional Requirements for Opioid Treatment Programs NOTE: In addition to the requirements applicable to all BHS providers, opioid treatment programs shall also meet the requirements of Subchapter O. §5723.General Provisions A.A provider with an opioid treatment program shall: 1.meet the requirements of the protocols established by OBH/SOTA; 2.update the Louisiana methadone central registry daily and as needed; 3.upon the death of a client: a.report the death of a client enrolled in their clinic to the SOTA within 24 hours of the discovery of the client’s death; b.report the death of a client to HSS within 24 hours of discovery if the death is related to program activity; c.submit documentation on the cause and/or circumstances to SOTA and to HSS, if applicable, within 24 hours of the provider’s receipt of the documentation; and d.adhere to all protocols established by LDH on the death of a client; and 4.conduct at least eight random monthly drug screen tests on each client per year. B.OTPs shall have established operational hours for a minimum of six days per week, including one weekend day. Operational hours shall be approved by SOTA and indicated on the license application or change notification. 1.OTP closures are permissible on Sundays and the following holidays: a.New Year’s Day; b.National Memorial Day; c.Juneteenth National Independence Day; d.Independence Day; e.Labor Day; f.Veterans Day; g.Thanksgiving Day; and h.Christmas Day. 2.Any modification to hours due to circumstances such as emergencies or Mardi Gras schedules shall be coordinated with the SOTA. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1720 (September 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 43:1388 (July 2017), LR 48:1287 (May 2022), amended by the Department of Health, Health Standards Section, LR 52:53 (January 2026). §5725.Treatment A.Client Admission Criteria. The program shall only admit clients that: 1.are at least 18 years old, unless the client has consent from a parent, or legal guardian, if applicable; 2.meet the federal requirements regarding the determination that the client is currently addicted to opiates; 3.are verified by an OTP practitioner that treatment is medically necessary; 4.have had a complete physical evaluation by the client’s or program’s OTP practitioner before admission to the opioid treatment program; and 5.have had a full medical exam, including results of serology and other tests, completed within 14 days of admission. B.Treatment Phases 1.Initial Treatment. During the initial treatment phase that lasts from three to seven days in duration, the provider shall: a.conduct client orientation; b.provide individual counseling; and c. develop the initial treatment plan including initial dose of medication and plan for treatment of critical health or social issues. 2.Early Stabilization. In the early stabilization period that begins on the third to seventh day following initial treatment through 90 days duration, the provider shall: a.conduct weekly monitoring by a nurse of the client’s response to medication; b.provide at least four individual counseling sessions; c.revise the treatment plan within 30 days to include input by all disciplines, the client and significant others; and d.conduct random monthly drug screen tests. 3.Maintenance Treatment. In the maintenance treatment phase that follows the end of early stabilization and lasts for an indefinite period of time, the provider shall provide: a.random monthly drug screen tests until the client has negative drug screen tests for 90 consecutive days as well as random testing for alcohol when indicated; b.thereafter, monthly testing to clients who are allowed six days of take-home doses, as well as random testing for alcohol when indicated; c.continuous evaluation by the nurse of the client's use of medication and treatment from the program and from other sources; d.documented reviews of the treatment plan every 90 days in the first 2 years of treatment by the treatment team; and e.documentation of response to treatment in a progress note at least every 30 days. 4.Medically Supervised Withdrawal from Synthetic Narcotic with Continuing Care. Medically supervised withdrawal is provided if and when appropriate. If provided, the provider shall: a.decrease the dose of the synthetic narcotic to accomplish gradual, but complete withdrawal, as medically tolerated by the client; b.provide counseling of the type and quantity determined by the indicators and the reason for the medically supervised withdrawal from the synthetic narcotic; and c.conduct discharge planning with continuity of care to assist client to function without support of the medication and treatment activities. 5.Required Withdrawal. The provider shall provide medically-approved and medically-supervised assistance to withdrawal from the synthetic narcotic when: a.the client requests withdrawal; b.quality indicators predict successful withdrawal; or c.client or payer source suspends payment of fees. C.Counseling. The provider shall ensure that: 1.counseling is provided when requested by the client or client’s family; 2.written criteria are used to determine when a client will receive additional counseling; 3.the type and quantity of counseling is based on the assessment and recommendations of the treatment team; 4.written documentation supports the decisions of the treatment team, including indicators such as positive drug screens, maladjustment to new situations, inappropriate behavior, criminal activity, and detoxification procedure; and 5.all counseling is provided individually or in homogenous groups, including but not limited to family member(s), spouse, child(ren) or significant other as identified by the client, not to exceed 12 clients. D.Physical Evaluations/Examinations. The provider shall ensure that each client has a documented physical evaluation and examination by an OTP practitioner as follows: 1.upon admission; 2.every other week until the client becomes physically stable; 3.as warranted by client’s response to medication during the initial stabilization period or any other subsequent stabilization period; 4.after the first year and annually thereafter; and 5.any time that the client is medically unstable. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1721 (September 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 48:1288 (May 2022), amended by the Department of Health, Health Standards Section, LR 51:535 (April 2025). §5727.Additional Staffing Requirements A.The provider’s opioid treatment program shall have the following staff in addition to the general staffing requirements. 1.Pharmacist or Dispensing Physician a.An opioid treatment program that dispenses prescription medication on-site shall employ or contract with a pharmacist or dispensing physician to assure that any prescription medication dispensed on-site meets the requirements of applicable state statutes and regulations. b.The pharmacist or dispensing physician shall have a current, valid unrestricted license to practice in the state of Louisiana. c.The provider’s pharmacist or dispensing physician shall: i.provide on-site services; ii.dispense all medications; iii.consult with the provider as needed; iv.evaluate medication policy and procedure of provider to dispense medications; v.reconcile inventories of medications that were dispensed and/or administered at least every 30 days; vi.maintain medication records for at least three years in accordance with state laws, rules and regulations; vii.approve all transport devices for take-home medications in accordance with the program’s diversion control policy; viii.work collaboratively with the medical director to decrease the dose to accomplish gradual, but complete withdrawal, only when requested by the member; ix.contribute to the development of the initial treatment plan; x.contribute to the documentation for the treatment plan review every 90 days in the first two years of treatment; and xi.document response to treatment in progress notes at least every 30 days. 2.Nursing a.The provider shall maintain a nursing staff sufficient to meet the needs of the clients. b.Each nurse shall have a current unrestricted license to practice nursing in the state of Louisiana. c.The responsibilities of the nurse(s) include but are not limited to: i.administering medications; ii.monitoring the client’s response to medications; iii.evaluating the client’s use of medications and treatment from the program and other sources; iv.documenting responses to treatment in progress notes at least every 30 days; v.contributing to documentation for the treatment plan review every 90 days in the first two years of treatment; vi.conducting drug screens; and vii.participating in discharge planning. 3.Licensed Mental Health Professionals a.The provider shall maintain a sufficient number of LMHPs to meet the needs of its clients and there is at least one LMHP or UP on site when clinical services are being provided. b.licensed mental health professionals shall have a current, valid and unrestricted license in the state of Louisiana, and must comply with current, applicable scope of practice and supervisory requirements identified by their respective licensing boards. c.the LMHP providing substance use treatment services shall have documented credentials, experience and/or training in working with members who have substance use disorders, which shall be maintained in the individual’s personnel record. d.the provider shall ensure that: i.the caseload of the LMHP shall not exceed 75 active clients; and ii.there is an LMHP on site at least five hours/week. e.licensed mental health professionals shall provide the following services: i.conduct orientation; ii.develop the initial plan for treatment; iii.revise treatment to include input by all disciplines, members and significant others; iv.provide individual counseling; v.contribute to the development as well as document the initial treatment plan; vi.document response to treatment in progress notes at least every 30 days; vii.contribute to the development as well as document reviews of treatment plan every 90 days in the first two years of treatment by the treatment team; and viii.conduct in discharge planning as appropriate. 4.Unlicensed Professionals a.The provider shall have UPs sufficient to meet the needs of the clients. b.The caseload of the UP shall not exceed 75 active clients. c.unlicensed professionals of substance use services must be registered with the addictive disorders regulatory authority (ADRA) and meet regulations and requirements in accordance with RS 37:3387 et seq. i.written verification of ADRA registration and documentation of supervision when applicable shall be maintained in the individual’s personnel record. ii.unlicensed staff who fall under a professional scope of behavioral health practice with formal board approved clinical supervision and whose scope includes the provision of substance use services will not need to register with ADRA. d.unlicensed substance use providers must meet at least one of the following qualifications: i.be a master’s prepared behavioral health professional that has not obtained full licensure privileges and is participating in ongoing professional supervision. When working in substance use treatment settings, the master’s-prepared UP must be supervised by an LMHP, who meets the requirements of this Section; ii.be a registered addiction counselor; iii.be a certified addiction counselor; or iv.be a CIT that is registered with ADRA and is currently participating in a supervision required by the addictive disorders practice act. e.unlicensed professionals perform the following services under the supervision of a physician or LMHP: i.participate in conducting orientation; ii.participate in discharge planning as appropriate; and iii.provide support to the treatment team where applicable, while only providing assistance allowable under the auspices of and pursuant to the scope of the individual’s license. 5.OTP Practitioner. There shall be an OTP practitioner who is on-site as needed or on-call as needed during hours of operation. a.the OTP practitioner shall have a current, valid unrestricted license to practice in the state of Louisiana. The OTP practitioner shall be on-site or on-call as needed during the hours of operation to provide the following services: i.examine member for admission ; ii.prescribe medications; iii.monitor the member’s response to medications; iv.evaluate the member’s use of medication and treatment from the program and other sources; v.contribute to the development of the initial treatment plan; vi.contribute to the documentation regarding the response to treatment for treatment plan reviews; vii.contribute to the documentation for the treatment plan review every 90 days in the first two years of treatment; viii.conduct drug screens; and ix.participate in discharge planning. 6.Medical Director a.the provider shall ensure that its medical director is a licensed physician with a current, valid unrestricted license to practice in the state of Louisiana with two years of qualifying experience in treating psychiatric disorders. b.the medical director shall provide the following services: i.decrease the dose to accomplish gradual, but complete withdrawal, only when requested by the member; ii.provide medically approved and medically supervised assistance for withdrawal, only when requested by the member; iii.participate in the documentation of reviews of treatment plan every 90 days in the first two years of treatment; and iv.participate in discharge planning. 7.Clinical Supervisor (CS) a.state regulations require supervision of unlicensed professionals by a CS, who: i.is an LMHP that maintains a current and unrestricted license with its respective professional board or licensing authority in the state of Louisiana; ii.shall be on duty and on call as needed; and iii.has two years of qualifying clinical experience as an LMHP in the provision of services provided by the provider; b.the CS shall have the following responsibilities: i.provide supervision utilizing evidenced-based techniques related to the practice of behavioral health counseling; ii.serve as resource person for other professionals counseling persons with behavioral health disorders; iii.attend and participate in care conferences, treatment planning activities, and discharge planning; iv.provide oversight and supervision of such activities as recreation, art/music, or vocational education; v.function as member advocate in treatment decisions; vi.ensure the provider adheres to rules and regulations regarding all behavioral health treatment, such ad group size, caseload, and referrals; vii.provide only those services that are within the person’s scope of practice; and viii.assist the clinical director and/or medical director and governing body with the development and implementation of policies and procedures. B.Training. All direct care employees shall receive orientation and training for and demonstrate knowledge of the following, including, but not limited to: 1.symptoms of opiate withdrawal; 2.drug screen testing and collections; 3.current standards of practice regarding opiate addiction treatment; 4.poly-drug addiction; 5.information necessary to ensure care is provided within accepted standards of practice; and 6.non-licensed direct care staff are required to complete a basic clinical competency training program approved by OBH prior to providing the service. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1721 (September 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 48:1288 (May 2022), amended by the Department of Health, Health Standards Section, LR 51:535 (April 2025), amended by the Department of Health, Health Standards Section, LR 52:53 (January 2026). §5729.Medications A.The provider shall ensure that all medications are administered by a nurse, pharmacist or other practitioner licensed under state law and authorized by federal and state law to administer or dispense opioid drugs. B.Take-Home Dose(s) 1.The provider shall ensure that: a.determinations for take-home dose(s), the factors considered, and the rationale to provide unsupervised doses of methadone are made by the client’s OTP practitioner, and are documented in the client’s record when each take-home dose is authorized; b.date and recommended dosage are documented in the client’s record and the methadone central registry; and c.take-home dose(s) are ordered by the OTP practitioner operating within the scope of his/her license. 2.In determining which clients may receive unsupervised doses, the OTP practitioner shall consider, among other pertinent factors that indicate whether the therapeutic benefits of unsupervised doses outweigh the risks, the following criteria: a.absence of active substance use disorders, other physical or behavioral health conditions that increase the risk of client harm as it relates to the potential for overdose, or the ability to function safely; b.regularity of attendance for supervised medication administration; c.absence of serious behavioral problems that endanger the client, the public, or others; d.absence of known recent diversion activity; e.whether take-home medication can be safely transported and stored; and; f.any other criteria that the OTP practitioner considers relevant to the client’s safety and the public’s health. 3.If it is determined that a client is safely able to manage unsupervised doses of methadone, the OTP practitioner operating within the scope of his/her license shall determine the number of take-home doses authorized within the following dispensing restrictions. a.During the first 14 days of treatment, the take-home supply shall be limited to 7 days of take home doses. b.From 15 days of treatment, the take-home supply shall be limited to 14 days of take home doses. c.From 31 days of treatment, the take-home supply provided to a client shall not exceed 28 days of take home doses at a time. 4.Loss of Privilege. Positive drug screens at any time for any drug other than those prescribed shall require a new determination to be made by the OTP practitioner regarding take-home doses. Operating within the scope of his/her license, the OTP practitioner shall determine the actual number of take-home doses and whether the client is allowed to maintain take-home medication. 5.Exceptions. The provider shall request and obtain approval for a federally identified exception to the take-home dispensing restrictions from the State Opioid Treatment Authority (SOTA). Any exception shall be for an emergency or severe travel hardship. C.Temporary Transfers or Guest Dosing. The providers involved in a temporary transfer or guest dosing shall ensure the following: 1.the receiving provider shall verify dosage prior to dispensing and administering medication; 2.the sending provider shall verify dosage and obtain approval and acceptance from receiving provider prior to client's transfer; and 3.that documentation to support all temporary transfers and guest dosing is maintained. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1722 (September 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 43:1388 (July 2017), LR 48:1289 (May 2022), amended by the Department of Health, Health Standards Section, LR 51:535 (April 2025). §5731.Client Records A.In addition to the general requirements for client records, each client record shall contain: 1.recording of medication administration and dispensing in accordance with federal and state requirements; 2.results of five most recent drug screen tests with action taken for positive results; 3.physical status and use of additional prescription medication; 4.monthly or more frequently, as indicated by needs of client, contact notes and progress notes which include employment/vocational needs, legal and social status, and overall individual stability; 5.documentation and confirmation of the factors to be considered in determining whether a take-home dose is appropriate; 6.documentation of approval of any exception to the dispensing restrictions of take-home doses and the OTP practitioner’s justification for such exception; and 7.any other pertinent information. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:1723 (September 2015), amended by the Department of Health, Health Standards Section, LR 51:536 (April 2025). §5733.Treatment to Pregnant Women A.Each substance use disorder facility licensed as an OTP provider that provides treatment for opioid use disorder to pregnant women shall provide onsite access to at least one form of FDA-approved opioid agonist treatment. 1.An OTP shall not be found to be in violation of this Section if prior authorization from a patient's health insurer, including the Medicaid program, is required and the preapproval request is denied by the patient's health insurer. B.Each OTP that provides treatment for opioid use disorder to pregnant women shall submit to the department, on its initial licensing application or its annual licensing renewal application, an attestation as to whether it is complying with the requirements of Subsection A of this Section. The requirement for submission of the attestation shall commence on January 1, 2023. 1.If the OTP is not fully complying with the requirements of Subsection A of this Section, then the attestation that the OTP submits shall include a report addressing its progress toward satisfying those requirements. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health, Bureau of Health Services Financing, LR 48:2758 (November 2022). §5735.Mobile Dosing Unit (MDU) Services A.Prior to providing MDU services, an OTP shall apply to HSS to add MDU services to an existing BHSP license. B.OTPs with a current, valid license in accordance with Subchapter O, a current, valid certification by the Substance Abuse and Mental Health Services Administration in accordance with 42 CFR §8.11, and SOTA approval may establish a MDU that shall be authorized to dispense Federal Drug Administration-approved medications for opioid use disorder (MOUD), and to collect samples for drug testing or analysis for the purpose of treatment. 1.SOTA approval shall be required for the following criteria: a.floor plan; b.policies and procedures; c.location; d.schedule; e.staffing; and f.training. 2.HSS shall receive directly from SOTA: a.evidence of approval to establish a MDU; and b.a copy of a SOTA-approved MDU location schedule. C.The MDU shall be established as part of, but geographically separate from, the OTP’s parent facility, and the MDU shall maintain all state and federal confidentiality requirements. D.Location 1.MDUs shall dispense MOUD from a location within the same LDH region as the OTP’s parent facility. 2.The MDU location shall be limited to one location each day that shall be approved by the SOTA. 3.The MDU shall be returned and secured at the OTP’s parent facility upon completion of all MDU services each day. E.Storage and Maintenance 1.All medication shall be transported and removed directly from the MDU upon completion of all MDU services each day, and stored at the OTP’s parent facility. 2.OTPs shall notify the SOTA in advance of any scheduled maintenance of the MDU, and within 24 hours of any incidents. F.OTPs shall have a Drug Enforcement Administration (DEA) and SOTA-approved contingency plan for MDUs as follows: 1.safeguarding MDU controlled substances in the event the MDU breaks down or is disabled for any reason (e.g., mechanical failure, accident, fire); and 2.ensuring that the controlled substances are removed, secured, and accounted for at the OTP’s parent facility. G.OTPs shall maintain all DEA-mandated reports and records at the parent facility, and shall provide copies to the SOTA upon request. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2151-2161. HISTORICAL NOTE:Promulgated by the Department of Health, Bureau of Health Services Financing, LR 48:2758 (November 2022), amended by the Department of Health, Health Standards Section, LR 51:536 (April 2025).