1. Licensure and Medical Authority

• Must be licensed by the state to operate as a detoxification, withdrawal management, or medically-managed program.

• Must meet ASAM Level 3.2, 3.7, or 4.0 standards (clinically managed to medically managed detox).

• Medical Director required (must be a board-certified MD — preferably in Addiction Medicine, Psychiatry, or Emergency Medicine).

2. Medical Staffing Standards

• 24/7 RN or higher medical staff onsite.

• Physician available on-call 24/7 and conducts face-to-face evaluations within:

  • 24 hours of admission for routine cases.

  • Immediately (under 2 hours) for high-risk cases (e.g., benzodiazepine, alcohol withdrawal risk).

• Medical oversight ratio:

  • 1 nurse per 8 detox clients maximum during waking hours.

3. Clinical and Psychosocial Staffing

• Licensed clinical staff must provide:

  • Daily assessments (clinical and behavioral).

  • Individual counseling or case management during stay (minimum once every 72 hours).

  • Discharge planning must begin within 48 hours of admission.

4. Facility Safety and Monitoring

• Must have:

  • Medication room with double-lock storage and chain of custody log.

  • Secure physical environment (camera monitored common areas).

  • Naloxone and emergency kits onsite, easily accessible.

• Must perform:

  • Vital signs monitoring at minimum every 4 hours during acute phase.

  • Continuous fall risk, seizure risk, and suicide risk assessments.

5. Client Admission and Discharge Protocols

• Comprehensive pre-admission screening (medical, psychiatric, SUD history).

• Written admission criteria following ASAM or DSM-5 guidelines.

• Written discharge/transfer criteria for:

  • Stepping down to residential, PHP, IOP, or outpatient care.

  • Emergency medical transfer (e.g., ER admission).

• Continuity of Care:

  • Must arrange follow-up services prior to discharge for every client.

6. Ethical and Legal Compliance

• No patient brokering or incentivized referrals.

• No refusal of medically necessary care based solely on insurance/payment status once admitted.

• Full informed consent on admission, including:

  • Risks of detox.

  • Alternatives to treatment.

  • Grievance policy.

7. Outcome Tracking and Quality Improvement

• Must track:

  • AMA/ACA (Against Medical Advice/Against Clinical Advice) discharge rates.

  • Readmission within 30 days.

  • Completion of detox protocols.

• Submit quarterly QI reports to BHSO (de-identified).

8. Emergency Preparedness

• Must conduct:

  • Quarterly mock medical emergencies (seizure, overdose, fall, suicidal crisis).

• All staff must complete:

  • CPR, AED, First Aid certifications annually.

• Emergency medical transfer agreements with local hospitals.

9. Resident Rights and Dignity Standards

• Residents must receive:

  • Written Client Bill of Rights upon admission.

  • Ability to access advocacy resources.

  • Grievance policies posted clearly.

• Staff must adhere to trauma-informed care and de-escalation protocols at all times.

10. Oversight, Inspections, and Renewal

• Subject to random unannounced inspections by BHSO.

• Annual reaccreditation review including chart audit, facility walkthrough, and policy review.

• BHSO reserves the right to suspend Commissioned status if standards are compromised.