Incidental Medical Services (IMS)

A substance use disorder requires an optimum level of medical intervention to be available to those in need. To ensure care for medical necessities that often arise during detox and rehab treatment, incidental medical services are provided. This service was approved by the California Department of Health Care Services (DHCS), in 2016. Incidental Medical Services (IMS) were made available to utilize as an amendment of the Health and Safety Code. This modification is found within Chapter 744 of the Assembly Bill 848.

In order to guarantee the best possible outcomes of health regarding individuals undergoing detox and treatment, IMS is an asset. This level of superior medical care, when available during rehab, promotes a successful treatment program, and long lasting recovery goals. Addiction treatment centers that incorporate incidental medical services allow for more wide-range professional medicine to be practiced. 

These IMS essentials are able to be performed around the clock, and available every day of the week. However, incidental medical services are not able to administer the same maintenance as would be necessary for primary care qualifications. Instead, it is a derivative service, per the DHCS agreement.

The Primary Focus of IMS

Essentially, the primary focus of implementing incidental medical services into rehab for addiction is to enhance the quality of treatment. Not only does this benefit the individual by helping to maintain and achieve a healthy detox, but also reach recovery. By relying on the expertise of licensed and trained personnel, more intensive approaches can be taken to ensure wellbeing. This promotes the effectiveness of addiction treatment, as well as adding to wellness efforts, upon completion of the program. 

Six Incidental Medical Services Required to Be Provided 

incidental medical services

Having IMS available requires that specific actions be taken. In order to receive approval from the DHCS, there are six mandatory measures. These required services that have to be satisfied for each individual include: 

  1. Obtaining an accurate and up to date medical history of the participant.
  2. Monitoring of each attending individuals’ health status.
  3. Performing essential testing during detox and throughout substance abuse treatment.
  4. Providing alcoholism or drug abuse recovery, and the necessary treatment services.
  5. Overseeing a patients’ self-administered medications, whether approved within the rehab or deriving from prior diagnosis.
  6. Appropriate treatment of any substance abuse disorder, which would include the process of detox. 

To allow for further understanding of incidental medical services, a breakdown of each of the six requirements follows below. During rehab, these actions and programs are accounted for, promoting both security and health of those seeking treatment for addiction. To be best prepared for the care that can be received, you should learn more about IMS. A brief overview provides insight into the value of the program, and the superior level of care fulfilled at rehab

Obtaining an Accurate and Up-to-Date Medical History 

Upon beginning treatment at rehab, the first measure taken will be the initial assessment. In a safe and comfortable environment, a series of comprehensive questions will need to be completed. The HealthCare Questionnaire will be completed with a trained and compassionate in-house staff member. This takes place in person and in a privately assigned location. 

This inquiry will then be directed to either the resident licensed medical professional on staff or a healthcare practitioner. Typically, this takes place within a 24 hour period of submission. In order to be approved to be administered incidental medical services the evaluation must be reviewed and approved. It will be at this point that the individual and the doctor will convene. Finally, upon signature and date of an IMS Approval Certification, pre-assessment is completed. 

Why is Medical History Relevant to Rehab Treatment?

After completing your initial IMS assessment and review of prior medical history necessities detox and treatment can be determined. The initial assessment and incidental medical services approval must be granted for any program, including partial hospitalization. While partial hospitalization programs do not require an around the clock stay at the facility, treatment is still very intensive. 

Preauthorization and approval of a patient’s medical records informes technicians of individual circumstances when IMS is necessary and applicable. This is to ensure that the most superior level of care can be provided to any individual when medically necessary. 

Monitoring of Each Individuals’ Health Status

The process of rehabilitation requires that a person adjust both behaviors, habits, and mental associations with their addiction. Because of this, underlying illnesses that may require treatment may have been masked by substance abuse or misinterpreted as withdrawal. When both psychological illness and addiction present together, it is treated as a dual diagnosis

Because incidental medical services require that frequent monitoring takes place during enrollment, this information can be referred back to later. If dual diagnosis is suspected at this point, arrangements for treatment can be made to confirm and treat post-detox. 

The incidental medical services guidelines require that an individual is overseen regularly, and that all information is recorded. This is to establish a baseline for treatment, ideally from the earliest point after active addiction has halted. In order to gain approval for incidental medical services to be performed, an individual must comply with these standards. 

How Often is Health Status Monitored and Checked? 

Before treatment can begin, an individual will be monitored in the assessment stage. During this time, it will be concluded whether a person is eligible for care regarding incidental medical services. In order to be efficient, continual evaluation will consist of check-ins: 

Then, throughout the remainder, the monitoring of vitals will continue to be observed and recorded 3 times a day. 

Why Are Health Status Checks Needed?

The observation of vitals will be used to determine the state of wellness of the individual seeking treatment. The factors that will be established will include:

It will be up to the discretion of the healthcare practitioner or resident physician to determine the course of action. If an addict is medically cleared, the enrollment process can continue. 

Does Monitoring of Health Status Continue After Initial Assessment?

After the initial assessment for incidental medical services, health screenings will continue throughout detox. While preparing for detox treatment, individuals will be examined using one of two systematic rating charts. 

  1. COWS (Clinical Opiate Withdrawal Scale)
  2. CIWA (Clinical Institute Withdrawal Assessment for Alcohol)

According to the incidental medical service protocol, it may be necessary to arrange a more intensive location for detox to occur. In some cases, it’s determined that the facility and medical staff are not equipped to manage potential severity of withdrawal. In this case, alternate arrangements can be made for critical care. 

Essential Testing Performed During Detox and Addiction Treatment

Incidental medical services are responsible for performing and observing tests leading up to and during detox. This is exclusively the responsibility of the doctor, or the practicing HPC. These essential toxicology tests of incidental medical services required by law include:

The method used to collect this information is determined by the doctor or HPC assigned to each case. Testing helps to dictate whether medical detox can be performed safely, or if non-medical detox is absolutely necessary. Regardless of what is determined to be the best detox program, testing is mandatory to reinforce incidental medical service requirements. 

Providing Alcoholism or Drug Abuse Recovery or Treatment 

Essentially, it is mandatory to ensure that rehab functions as intended, by incorporating incidental medical services. This provision is to guarantee that each individual is thoroughly and professionally examined by a licensed medical doctor or HCP. While there is less potential for dangerous circumstances to arise using holistic treatment methods, not every addict responds as efficiently. 

Many times, a more intensive and proactive detox and addiction treatment will be necessary. It will be up to the doctor whether to utilize drug-assisted detox options. It is also required that rehabs offer other types of addiction therapy as alternatives, or to encourage support toward sobriety. 

Dependent on what is revealed within the mandatory exam, taking place within 24 hours of arrival, a treatment plan is formulated. Therapeutic medications may be administered for mental health treatment or addiction, based on findings in the following professional fields:

After completing evaluations from the appropriate medical classifications, treatment courses are dictated by incidental medical services. 

Overseeing Self-Administered Medications

Individuals that are attending rehab for addiction essentially have the right to take medications prescribed to them legally. This may include drugs that are intended to promote physical or psychological health, such as depression or high blood pressure.  However, there are some exceptions. 

In order to be approved by incidental medical services, these medications must NOT:

It’s up to incidental medical services to supervise when and how any previously prescribed medications are being taken. This is primarily because the incentive to self-medicate has the tendency to lead to abuse, especially while experiencing withdrawal. Some medications can have influence over relapse, or prevent a person from completing the detox program completely. 

Which Medications May Not be Permitted by Incidental Medical Services?

Often over-the-counter drugs are permitted. However, while in the facility, incidental medicine services are required to approve usage prior to individual discretion. Typically, medications that are not permitted to be self-administered on campus include those that treat:

Because of their potential for abuse, they are likely to interfere with rehab treatment. Under some extreme circumstances, IMS physicians may be able to administer these medications to an individual. However, retaining the ability to self-administer is not a likely occurrence. The permission to utilize any of these drugs will be determined by incidental medical services, case by case. 

Treatment of Substance Abuse Disorders Including Detox 

incidental medical services

Treating a substance use disorder is a very complex process that requires an assimilation of multiple therapeutic and clinical approaches. This may include a combination of care between the professionals designated within incidental medical services and an individual’s primary doctor. The determining factor would be based on any potential impact it would provide toward a successful addiction recovery

Incidental medical service physicians will evaluate an individual’s needs before, during and after treatment. They will make recommendations for care based on where the person is in their recovery process. They will also take into consideration the evaluations of other staff regarding the dedication to sobriety that is displayed. 

Working with the relevant medical information provided to them, IMS physicians and HCP’s implement treatment to promote healthy addiction recovery. 

Resource Options for Treatment of Addiction and Detox

There are many options to treat withdrawal symptoms and addiction. One valuable resource overseen by incidental medical service physicians is medication-assisted treatment (MAT). Typically, this option is utilized when an individual is participating in an inpatient treatment program level of care. 

Some of the most widely used medications used for MAT are:

The use of these medications can be an asset to an individual’s recovery and management of withdrawal. However, MAT is also somewhat controversial. Incidental medical services, working with your outside primary doctor, will determine if this will benefit addiction treatment. Although they can alleviate some of the difficulties associated with a substance use disorder, some have the potential for abuse. It will be important to allow for open communication between your GP and IMS, for your safety and sobriety. 

CNV Detox also offers non-medical detox for patients who have more mild addiction and withdrawal symptoms.

Get Sober Using Addiction Treatment Services

The first step toward a sober tomorrow is choosing to get help for your addiction. Reach out to a rehab that puts your recovery needs first. Rehab can provide you with a safe space and professional medical care to ensure a safe recovery. Don’t miss your chance to make a positive change that will impact tomorrow. You deserve the best care while working to become the best version of you. You deserve to be free from addiction and live sober. CNV Detox can help you make it happen. Book your assessment today.  

References:

https://www.ndafp.org/image/cache/27B.pdf

https://www.mdcalc.com/cows-score-opiate-withdrawal

https://pharmacy.rutgers.edu/wp-content/uploads/4.0-ClinicalOpiateWithdrawalScale2-1.pdf

https://www.dhcs.ca.gov/provgovpart/Pages/Incidental-Medical-Services.aspx

https://www.dhcs.ca.gov/formsandpubs/Documents/MHSUDS_Information_Notice_18-031_Incidental_Medical_Services%20FINAL%207.20.18.pdf