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Addiction Treatment Center Resources - Washington

Frequently Asked Questions

Overview

1.  What kinds of licensure or certification is required to operate a chemical dependency treatment program?

Persons, partnerships and corporations, or other legal entities intending to provide chemical dependency treatment services in a residential setting require a license to operate. Residential treatment facilities are physical locations from which chemical dependency treatment services are provided 24 hours a day. Read More

2.  What types of chemical dependency services are offered in Washington?

Treatment services are offered through residential and outpatient treatment facilities which provide evaluation and treatment or evaluation and referral of any individual with a chemical dependency disorder. All of the following types of service providers require certification from the Department of Social and Health Services. Read More

3.  What does it mean to be 'licensed,' 'certified' or 'accredited' in this industry?

Licensing means that the facility has been granted a written notice conveying to the public that the state regulatory agency has issued its permission to operate authorized services. These services can only be delivered with the advance and continuous authorization of a designated government agency to ensure protection of public health, safety, and welfare. Read More

Licensing

4.  Which body authorizes and oversees chemical dependency treatment facilities in the State of Washington?

Licensing for residential treatment facilities is overseen by the Washington...  Read More

5.  What responsibilities does a Residential Treatment Facility have?

The residential treatment facility (RTF) must ensure it is in compliance with all relevant state and federal rules and regulations. In particular, it should maintain and post a current RTF license and the name, address and telephone number of the Department of Health (DoH), appropriate client advocacy groups, and description of ombudsman services in a conspicuous place on the premises. The RTF should take... Read More

6.  How does a Residential Treatment Facility obtain a license?

A completed application for a Residential Treatment Facility licensure must be submitted to the Department of... Read More

7.  How Does a Residential Treatment Facility Renew its License?

The Department of Health (DoH) mails the "Notice to Renew" about 45 days before the due date (30 days before license expiration). At least thirty days before the expiration date of the current license, the facility must submit to DoH: Read More

8.  What types of changes and incidents can impact a license once granted?

The Department of Health (DoH) may deny, suspend, modify, or revoke a RTF facility license if the applicant or facilities have:

(a) Been denied a license to operate a health care, child care, group care or personal care facility in this state or elsewhere, had the license suspended or revoked, or been found civilly liable or criminally convicted of operating the facility without a license;

(b) Committed, aided or abetted an illegal act in connection with the operation of any RTF or the provision of health care or residential services; Read More

9.  What is the process for obtaining certification?

Chemical dependency facilities for certification from the Department of Social and Health Services (DSHS) Division of Behavioral Health and Recovery (DBHR)by using the forms available here: Read More

10.  What might cause the Department of Social and Health Services (DSHS) to suspend or revoke a certification?

DSHS may cancel a provider's certification if the provider:

(a) Ceases to provide services for which the provider is certified.

(b) Voluntarily cancels certification. Read More

On-Site Review

11.  What kinds of inspections might there be for licensure and certification determination?

The Department of Health (DoH) may send an authorized representative to enter, visit, survey and inspect a residential treatment facility licensed or applying for a license at any time, and especially when an application for licensure or renewal is in process. The facility must grant the authorized representative full and free access to the records of the facility and its clients. Read More

12.  How can a facility prepare for inspections, on-site reviews and audits?

While the criteria are periodically updated, key subjects of review may include:

(a) Medication management (security and storage, self-administration, logging of administration, labelling, and destruction);

(b) Policies and procedures detailing compliance with federal, state, and local laws and regulations (including confidentiality, non-discrimination, and client rights); Read More

Zoning and Land Use

13.  What are the protections afforded to small group homes used for the purpose of residential substance abuse treatment?

Facilities for those recovering from alcoholism and drug addiction are generally subject to local zoning laws and regulations. However, local zoning and land use laws that treat groups of unrelated persons with disabilities less favorably than similar groups of unrelated persons without disabilities violate federal housing statutes. Alcoholism, drug addiction, and other mental illnesses constitute “handicaps” and “disabilities” under federal law, as long as there is no current, illegal use of or addiction to a controlled substance. Read More

14.  Are there any proximity restrictions regulating how close treatment centers may be to each other? Can I open a residential treatment center right next to one that is already there?

There is no statewide rule or regulation preventing multiple facilities from operating in close proximity. However, many residential treatment facilities have faced objections and difficulties in various different locations across the state. Before investing in multiple facilities in close proximity, we recommend that the facility consider potential opposition. Read More

15.  What are the basic physical plant requirements for treatment facilities?

Please note, these regulations relate to space and do not constitute all environmental requirements. Facilities must comply with all relevant laws and rules designed to prevent fire and safety hazards and minimize the risk of client self-injury. Premises which will be used to treat members of the public must be clean, safe, secure and suitable for their intended purpose, as well as meeting all required health and safety standards. Read More

16.  What kinds of policies and procedures should a chemical dependency facility have?

Certified chemical dependency providers are required to have administrative, personnel and clinical policy manuals.

Required administrative policies include:

(a) A policy describing how services will be made sensitive to the needs of each client, including assurance that certified interpreters or other acceptable alternatives are available for persons with limited English-speaking proficiency and persons having a sensory impairment and assistance will be provided to persons with disabilities in case of an emergency. Read More

17.  What are the requirements of an Emergency Plan for a Residential Treatment Facility?

The facility must ensure client health and safety by establishing and implementing an Emergency Plan designed for response to internal and external emergency safety situations. The emergency plan must:

(a) Be specific to the Residential Treatment Facility (RTF), and each building that comprises the RTF;

(b) Be communicated to the clients and staff; Read More

Care, Treatment and Services

Admissions Agreement

18.  What information must be disclosed to the client during intake and what must we put in our admissions agreement?

Prior to admission, or in the case of an intoxicated client, as soon as stabilization occurs, basic information about treatment services must be provided, in simple, non-technical terms and in the client's primary language. This must include Read More

Placement

19.  How does a facility decide whether a client meets criteria for placement in a particular level of care?

In order to make a determination on whether the services offered by the facility are an appropriate fit to meet the treatment needs of the client, the facility carries out an assessment of the client's treatment and rehabilitation needs and goals. A program must only accept referrals and must only admit and retain clients whose known needs can be met by the program in accordance with its program purpose and description. Read More

Contact

20.  What services and staffing must be offered at each level of care?

Substance abuse treatment facilities must meet the needs of admitted clients, as identified during the admission assessment process. Each facility type has unique requirements pertaining to intensity and frequency of services provided. There must be sufficient types and numbers of staff members on duty in the residence to provide for safe supervision of clients whenever clients are present. Read More

Treatment Planning

21.  What are the requirements of a chemical dependency assessment?

Chemical dependency treatment facilities are required to conduct an assessment of each client's involvement with alcohol and other drugs through a face-to-face assessment. The assessment must be conducted by a chemical dependency professional (CDP) or a CDP trainee under a CDP's supervision. The assessment should include obtaining the following information: Read More

Medication

22.  What rules govern administration of client medications in a residential setting?

The residential treatment facility is responsible for the control and use of all medications, including ensuring policies and procedures and medication protocols are developed, approved, reviewed and implemented by licensed health care providers, administration and pharmacist (as needed). Read More

Client Rights

23.  What rights are guaranteed to clients?

Clients' rights must be respected and protected. Each facility has a responsibility to provide clients, or their representatives, with a copy of their rights, in a language they can understand during orientation, in case of disciplinary discharge, and inform them of the complaint and appeal process. Read More

24.  When Can a Facility Use Restraint or Seclusion Techniques for Behavior Management?

Any residential treatment facility (RTF) that utilizes restraint or seclusion must ensure that restraint or seclusion is performed in accordance with all applicable federal and state laws and rules. Restraint means a continuum of methods used to prevent or limit free body movement. Seclusion means the involuntary confinement of a client alone in a room or area from which the client is physically prevented from leaving. Read More

Discharge

25.  What grounds are needed in order to dismiss a client from a program?

There are four types of discharge. Successful completion of program means that the client has met the goals of their treatment/recovery plan. Unsuccessful discharge means that treatment has not been effective, or the client has decided not to complete the program. It may be appropriate to make a discharge by way of transfer or referral to another service provider, for example if the client either improves or deteriorates, an alternative care setting might be more appropriate. Read More

26.  I need to discharge a client that relapsed, but am I at risk if he or she overdoses tonight and how can I protect myself?

The discharge of a client must be handled carefully given the risks if a client suffers negative health consequences in the aftermath of discharge. It is helpful to address the discharge process in the admissions agreement, so that if the client does not engage with his/her treatment plan and leaves against advice, then he/she accepts the liability does not fall onto the program. Read More

Privacy

27.  How must I respond to clients who are unable to pay the required deductibles? Can I waive a program participant’s financial responsibility?

Clients seeking chemical dependency treatment services often face financial difficulties, whether as a result of the consequences of their addiction or as a result of the expense of multiple, prior failed treatment programs.  As a consequence, many clients (and their families or financial guarantors) claim an inability to pay deductibles, coinsurance, and/or copayments. Waiving or discounting client financial responsibility can be problematic because insurers consider the practice to be fraudulent and abusive. Read More

28.  What are the key issues insurers raise to demand recoupment of fees from chemical dependency treatment programs?

Insurers may demand recoupment of fees based on any defect in the billing claim or supporting documentation and/or based on any noncompliance with federal or state laws. The most common defects in the billing claim that insurers assert are lack of medical necessity and insufficient documentation to support the claim. Read More

Marketing

29.  What marketing practices are prohibited?

The most widespread prohibited marketing practices in addiction treatment appear to revolve around inappropriate inducements and inaccurate marketing claims.  Federal and state laws prohibit facilities from paying marketers for client referrals or based on a formula that takes account of the value or volume of client referrals.  Similarly, clients must never be financially induced in choosing a particular facility. Read More

30.  What are the limits of gift giving to potential referral sources?

Facilities must avoid giving gifts to clients or referral sources... Read More

31.  What kind of benefits can I offer existing or new clients?

State and federal regulators prohibit the exchange of items of value to induce referrals so the exchange of any item of value, whether it is cash or in kind, must be carefully monitored. The goal of these regulations is to ensure the independence of referrals for healthcare services. Read More

Recovery Residences

Licensing

32.  What is a recovery home?

Recovery Homes are transitional alcohol and drug free housing with rules, peer-led groups, activities and/or other structured operations which are directed toward maintenance of sobriety for persons who exhibit treatment resistance, relapse potential and/or lack of suitable recovery living environments or who recently have completed substance abuse treatment services or who may be receiving such treatment services at another licensed facility. Read More

33.  Which kind of residential arrangements qualify as drug and alcohol free housing?

Drug and alcohol free housing requires a rental agreement and means a dwelling in which each of the dwelling units on the premises is occupied or held for occupancy by at least one tenant who is a recovering alcoholic or drug addict and is participating in a program of recovery. Read More

34.  Do we need a license or certification to open a recovery home?

Recovery homes are currently not Licensed by the Department of Health (DoH) as a Residential Treatment Facility nor are recovery homes certified by the Department of Social and Health Services (DSHS) as a Chemical Dependency Service Provider. Read More

35.  In the absence of licensing, how can recovery homes demonstrate their commitment to meeting minimum quality standards?

Sober homes may devise their own quality standards. Read More

36.  What kinds of services can a recovery home offer?

Recovery Homes provide a structured alcohol and drug free environment for congregate living that offers regularly scheduled peer-led or community gatherings (self-help groups, etc.). Read More

Zoning and Land Use

37.  What are the protections afforded by federal law to small group homes used for the purpose of sustained recovery?

Recovery homes and other transitional living facilities for those recovering from alcoholism and drug addiction are generally subject to local zoning laws and regulations. However, local zoning and land use laws that treat groups of unrelated persons with disabilities less favorably than similar groups of unrelated persons without disabilities violate federal housing statutes. Read More

38.  Can local governments put special restrictions on recovery homes?

Recovery homes in some communities have found growing efforts to regulate them by local ordinance, including registration requirements, concentration (spacing) limits, and other requirements. Read More

39.  What other aspects must I consider before choosing a location for our recovery home?

In siting a recovery home, attention must be paid to potential hostility from neighbors. While federal and state law may protect the right to operate recovery homes of six or fewer in any residential community depending upon a variety of circumstances, operators must be prepared to deal with the stress and expense of combatting hostile neighbors and potentially hostile cities in litigation. Read More

Tenant's Rights and Responsibilities

40.  What would our obligations to tenants be?

The landlord provides a drug and alcohol free environment, covering all tenants, employees, staff, agents of the landlord, and guests. Read More

41.  What kind of agreement must we ask our clients to sign?

Any agreement residents sign must comply with landlord and tenant laws of Washington. Legal counsel should be consulted regarding terms of leases. Read More

42. Can we insist on drug tests and searches?

Rules and regulations may be imposed on residents, but legal counsel should be consulted before including specific provisions for drug tests and searches. Read More

43.  Can a recovery home bill insurance for required and/or random drug testing?

In order for a drug test to be reimbursed by insurance, it must be ordered by a physician based on examination of the resident.
Read More

44.  Can we make clients' obligations contractually enforceable?

Yes, as long as the obligations are enforceable under Washington law in general, and the law relating to landlord and tenants. Read More

Governance and Staffing

45.  What kind of ownership and staffing structures are common with these types of residential arrangements?

A recovery housing facility may be structured as a nonprofit corporation, a for-profit corporation, limited liability company, partnership, or a sole owner arrangement. There will be a landlord and a residential manager who may be on or off-site to monitor compliance with the terms of the rental agreement. Read More

46.  Are there any other organizations where we could find more information?

Substance Abuse and Mental Health Services Administration
http://www.samhsa.gov/ Read More

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