PART 830 ACUPUNCTURE THERAPY IN ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT FACILITIES

[Statutory Authority: Mental Hygiene Law, Section 19.09, Education Law, Article 160]

Notice: The following regulations are provided for informational purposes only. The Office of Alcoholism and Substance Abuse Services makes no assurance of reliability. For assured reliability, readers are referred to the Official Compilation of Rules and Regulations.

Sec.
830.1 Introduction
830.2 Legal base
830.3 Definitions
830.4 Acupuncture administered prior to initiation of treatment plan
830.5 Acupuncture in the treatment plan
830.6 Personnel and staffing
830.7 Informed consent
830.8 Space requirements 830.9 Use and disposal of needles
830.10 Records
830.11 Waiver

Section 830.1 Introduction.

(a) Use of acupuncture therapy in alcoholism or substance abuse facilities. An alcoholism or substance abuse facility may offer acupuncture therapy to patients who abuse or are dependent on alcohol and/or other substances as an adjunct part of an individual treatment plan, and in outpatient programs as part of an office visit which includes at least one other service, in accordance with the requirements of this Part.

(b) Purpose of service. The purpose of acupuncture therapy in alcoholism and substance abuse treatment is to reduce craving and other withdrawal symptoms and relieve anxiety, thereby assisting patients in achieving and maintaining abstinence. However, acupuncture shall be used as one part of a patient's treatment for alcoholism and/or substance abuse and shall not be the exclusive method of treatment for any patient.

830.2 Legal base.

(a) Section 19.09 of the Mental Hygiene Law authorizes the Commissioner of the Office of Alcoholism and Substance Abuse Services to adopt regulations necessary and proper to implement any matter under his or her jurisdiction.

(b) Article 160 of the Education Law provides for the licensure or certification of acupuncturists, but permits unlicensed acupuncturists to perform acupuncture in alcoholism and substance abuse facilities licensed or certified by the Office of Alcoholism and Substance Abuse Services, provided they have completed a training course approved by the Education Department and practice in accordance with regulations promulgated by the Office of Alcoholism and Substance Abuse Services.

830.3 Definitions.

(a) Acupuncture therapy means the treating, by means of the insertion of needles at a point or combination of points on the surface of the body predetermined on the basis of the theory of physiological interrelationship of body organs with an associated point or combination of points for diseases, disorders and dysfunctions of the body for the purpose of achieving a therapeutic or prophylactic effect.

(b) Alcoholism or substance abuse facility shall mean and include, for the purposes of this Part, a currently certified or licensed: alcoholism facility, alcoholism outpatient facility, residential or ambulatory drug free treatment facility, residential chemical dependency program for youth, inpatient substance abuse treatment program, a medically supervised ambulatory substance abuse treatment program, or methadone program.

(c) Licensed acupuncturist means a person licensed or certified by the State of New York pursuant to Section 8214 or 8216 of the Education Law to practice acupuncture.

(d) Acupuncture detoxification therapist means clinical persons who have documented successful completion of acupuncture training in an educational program acceptable to the Education Department under Article 160 of the Education Law and who practice acupuncture in accordance with Section 8216(4) of such Article.

(e) HIV means the human immunodeficiency virus or any other agent identified as a probable causative agent of AIDS.

(f) HBV means the hepatitis B virus.

(g) TB means tuberculosis.

830.4 Acupuncture administered prior to initiation of treatment plan.

(a) Use of acupuncture prior to initiation of treatment plan. Acupuncture may be used as one part of a patient's treatment for alcoholism or substance abuse and shall not be the exclusive method of treatment for any patient. However, acupuncture therapy may be administered to an admitted patient prior to the initiation of his or her individual treatment plan as one of the services offered to stabilize and engage the patient during that period, provided it is administered in accordance with the requirements of this Section and Sections 830.5, 830.6, 830.7, 830.8 and 830.9 of this Part.

(b) Physician protocol and approval. For each alcoholism or substance abuse facility providing acupuncture therapy pursuant to this Part, the program physician shall, in consultation with the acupuncturist, develop a protocol for decisionmaking regarding whether or not a patient requires a medical evaluation prior to the administration of acupuncture therapy to such patient. No patient requiring a medical evaluation in accordance with such protocol shall receive acupuncture therapy until a physican of the alcoholism or substance abuse facility has reviewed the patient's medical condition and has provided written authorization for the administration of acupuncture therapy upon such patient.

(c) Patient monitoring and counselling. Each patient receiving acupuncture therapy under this section shall be observed and monitored regularly during each acupuncture therapy session by a counselor or other professional staff member who will provide necessary counselling in accordance with this Title and who will attend to any symptoms exhibited by the patient.

(d) Schedule and record. A schedule and record of acupuncture therapy sessions for each patient receiving acupuncture therapy prior to initiation of an individual treatment plan must be prepared. The schedule may be expressed in conditional terms, by specifying that the patient is to attend acupuncture therapy whenever he or she craves or becomes preoccupied with alcohol and/or other substances.

(e) Durational limitation. Acupuncture therapy may be provided on demand to a patient prior to initiation of an individual treatment plan. However, in no event may acupuncture therapy be provided to a patient without the initiation of an individual treatment plan for longer than 30 days from the date of admission.

830.5 Acupuncture in the treatment plan.

(a) Acupuncture as adjunct to treatment. Acupuncture therapy is not a requisite component of a treatment plan. However, if included, acupuncture therapy shall be used as one part of a patient's treatment for alcoholism or substance abuse and shall not be the exclusive method of treatment for any patient.

(b) Treatment plan.

(1) Acupuncture therapy may be included in and shall be administered only as called for by a patient's individual treatment plan developed in accordance with this Title.

(2) The individual treatment plan must clearly state that acupuncture therapy will be used only to treat such individual's alcohol or substance abuse problem and in no event will acupuncture be used to treat any other conditions.

(3) The individual treatment plan must contain a schedule of acupuncture sessions tailored to the patient's needs.

(i) The schedule of acupuncture sessions must be expressed in terms of the frequency and duration of acupuncture therapy.

(ii) The schedule in the treatment plan may call for changes in the frequency of acupuncture therapy sessions over time, justified by clinical documentation of progress.

(iii) The schedule of acupuncture treatment sessions may be expressed in conditional terms by specifying that the patient is to attend acupuncture therapy sessions whenever he or she craves or becomes preoccupied with alcohol and/or other substances.

(iv) The program shall amend the treatment plan whenever changes in the patient's condition make a different schedule of acupuncture sessions clinically indicated.

(c) Patient monitoring and counselling. Each patient receiving acupuncture therapy shall be observed and monitored regularly during each therapy session by a counselor or other professional staff member who will provide necessary counselling and will attend to any symptoms exhibited by the patient.

(d) Provision on demand. Acupuncture therapy may be provided on demand, but in no event may occur unless, at a minimum, the patient also receives a brief counselling session while acupuncture is being administered, or the patient receives a counselling session either directly preceding or directly following each event at which acupuncture is administered. A notation shall be made in the clinical record of each such visit.

830.6 Personnel and staffing.

(a) Persons authorized to administer. Acupuncture therapy provided in alcoholism or substance abuse facilities shall only be performed by the following persons:

(1) an acupuncturist, as defined in section 830.3(c) of this Part, who has had at least one year of experience in the treatment of alcoholism and substance abuse or has had a training program in the treatment of alcoholism and substance abuse during the first six months of employment; or

(2) an acupuncture detoxification therapist, as defined in 830.3(d) of this Part who is a professional staff member and who has successfully completed a course of acupuncture training in an educational program acceptable to the Education Department under Article 160 of the Education Law and who practices acupuncture in accordance with Section 8216(4) of such Article and this Part, acting under the supervision of a licensed or certified acupuncturist who has had at least one year of experience in the treatment of alcoholism and substance abuse during the first six months of employment, and the clinical director of the program.

(b) Facility infection control responsibilities. Each facility employing acupuncturists must take steps to ensure that:

(1) all acupuncturists and acupuncture detoxification therapists have received appropriate training in infection control techniques, universal precautions, and work practices that help prevent needle-sticks or other injuries and direct contact with or splashes of blood and body fluid;

(2) all acupuncturists and acupuncture detoxification therapists are provided a safe work environment, including protective equipment, clothing, and devices, as appropriate, to reduce the risk of occupational exposure to blood and body fluid;

(3) all acupuncturists and acupuncture detoxification therapists should be offered and encouraged to receive the hepatitis B vaccine;

(4) all acupuncturists and acupuncture detoxification therapists receive information about the risks associated with HIV and HBV transmission and the merits of knowing their status if they have personal or occupational risks so they may benefit from medical management;

(5) all acupuncturists and acupuncture detoxification therapists are informed that if they have an impaired immune system due to HIV infection or other medical condition, they are at risk of acquiring potentially life-threatening infections, including TB, from patients; and

(6) information on the availability of voluntary, confidential or anonymous counseling and testing for HIV and HBV is made available to all acupuncturists and acupuncture detoxification therapists.

(1) An acupuncturist, as defined in section 830.3(c) of this Part, shall provide direct, on-site supervision of acupuncture therapy in the alcoholism or substance abuse facility. Such acupuncturist shall schedule the hours of his or her supervision consistent with the alcoholism or substance abuse facility's acupuncture schedule to assure that the acupuncturist sees the full range of facility patients. Such supervision schedule shall be varied in order to effectively accomplish this, provided it consists of at least three hours per week for any facility providing fewer than 15 hours of scheduled acupuncture clinic time. For facilities providing more than 15 hours of scheduled acupuncture clinic time, supervision shall be the sum of 10 percent of each acupuncture detoxification therapist's total work hours per week.

(2) In addition to the supervision requirements of this section, at least once every 90 days, an acupuncturist, as defined in section 8303(C) of the Part, shall perform a comprehensive review of the performance of each acupuncture detoxification therapist, be directly observing such staff member's administration of acupuncture on patients. A notation of such review shall be included in each reviewed staff member's personal file.

(d) Staff-to-patient ratio. The alcoholism or substance abuse facility must employ an adequate number of acupuncturists and/or acupuncture detoxification therapists to competently administer acupuncture to the number of patients who have a documented need for acupuncture therapy as determined by the clinical staff.

830.7 Informed consent.

(a) Requisite patient notification. The alcoholism or substance abuse facility shall explain to each patient who is offered acupuncture therapy the goals and techniques of the acupuncture procedure, potential risks including but not limited to "needle shock," precautions that can be taken against such risks, and that no conditions other than alcoholism or substance abuse will be treated through acupuncture therapy.

(b) Written informed consent. After giving each patient the information described in this Section, and before performing acupuncture therapy, the alcoholism or substance abuse facility must obtain the written informed consent of each patient to participate in acupuncture therapy.

830.8 Space requirements.

Acupuncture therapy shall be administered in a suitable separate room that meets the following minimum requirements:

(a) each patient must have ample space to sit or lie comfortably during acupuncture therapy;

(b) each patient must be visible to an acupuncturist or acupuncture detoxification therapists at all times;

(c) the space must be sufficiently physically distinct to protect patients in acupuncture therapy from distractions and interruptions during their treatment;

(d) an atmosphere conducive to private contemplation must be maintained; and

(e) each alcoholism or substance abuse facility shall prominently post a sign visible to all facility patients listing all times at which patients may receive acupuncture therapy.

830.9 Use and disposal of needles.

(a) Insertion and removal of needles.

(1) Needles shall be inserted and removed only by acupuncturist or acupuncture detoxification therapists, as defined in Section 830.2 (c) and (d) of this Part.

(2) Only sterilized, single-use, disposable needles shall be used; except that facilities licensed pursuant to Article 28 of the Public Health Law may use reusable needles consistent with general protocols for needle sterilization.

(3) Needles shall be inserted into each patient immediately after being removed from their cases and shall not be left outside their cases, unused.

(4) Acupuncture detoxification therapists shall insert needles only in the points that have been identified in a training program approved by the State Education Department as effective in treating alcoholism and substance abuse and shall not attempt to treat any other conditions or complaints or to insert needles in any other locations.

(5) Each acupuncturist and/or acupuncture detoxification therapists shall count the needles upon insertion and removal from the patient and must ensure that all needles are accounted for and are properly placed in rigid containers for disposal in accordance with subdivision (c) of this section. For each session of acupuncture therapy, a written notation of the number of needles inserted and removed from each patient shall be made in the patient's treatment record.

(b) Universal precautions. Acupuncturists and acupuncture detoxification therapists shall observe universal precautions for invasive procedures while performing acupuncture, including, but not limited to, the appropriate use of hand washing and the use of protective barriers such as surgical gloves for the insertion and removal of needles. The medical director or program physician of the alcoholism or substance abuse facility and the acupuncturist shall assure that such precautions are followed.

(1) All needles removed from patients must be placed immediately and directly for disposal in rigid, leakproof, puncture-resistant containers that are secured to preclude loss of the contents. Such containers shall be red in color or shall be conspicuously labeled with the word "infectious" or the words "regulated medical waste" and shall not be used for any other purpose.

(2) Reusable containers shall be thoroughly washed and decontaminated each time they are emptied unless the surfaces of the containers have been completely protected from contamination by disposable liners, bags, or other devices removed with the waste.

(3) All used needles shall be properly treated and disposed as medical waste in accordance with Title 15 of Article 27 of the Environmental Conservation Law.

830.10 Records.

(a) A note for the patient's record shall be completed after each session of acupuncture therapy any patient receives.

(b) Each note must include, at a minimum, a notation of whether the patient stayed for the duration of the treatment session, a statement of the patient's sobriety status, a summary of the outcome of the session, and a description and/or explanation of any unusual occurrence during the session.

(c) In addition to the acupuncturist's or acupuncture detoxification therapist's note, the record may include information personally written by the patient describing the acupuncture therapy experience.

(d) Each note must be reviewed and signed by the acupuncturist or acupuncture detoxification therapist providing the treatment.

830.11 Waiver.

(a) The commissioner may grant a waiver of a requirement not specifically required by law if the commissioner determines that:

(1) meeting the requirement would impose an unreasonable hardship;

(2) the health and safety of patients would not be diminished; and

(3) the best interests of the patients and the program would be served.

(b) (1) In considering a request for a waiver, the commissioner will consider such factors as special needs of the population to be served, geographic distances and transportation problems, staff availability, long range plans of the program, alternatives, and any other relevant information.

(2) A request for a waiver must be submitted in writing, must contain substantial documentation to support the need for the waiver and include such other information as the commissioner may require.

(c)

(1) Special limits or conditions may be established by the commissioner in granting a waiver.

(2) A waiver shall be in effect for no longer than the duration of the operating certificate or license held by the facility for which such waiver is granted.

Date of Last Change: 08/04/93