By Jim Kreitler, MS, LASAC, CEO of Calvary Healing Center

Paper houses under magnifying glassThere are many factors to consider when choosing or referring to an addiction treatment program. Is it safe? Are their business practices fair and legitimate? Do they follow sound clinical guidelines in regards to therapy, documentation and confidentiality? Does the program have a track record of success?

These considerations take on added legal and ethical consideration when a licensed professional or program is referring a patient that has been under their care. If it ends tragically due to unsafe conditions or the finances become problematic, what is the liability for the referral source?

Many individuals look for treatment options on the internet. Unfortunately that has drawbacks. Treatment program websites can make the cheesiest facility look like paradise. There are also examples of programs paying unscrupulous online marketing companies to redirect searches. In those cases, a Google search might direct you to a page that provides some basic information about a rehab program, but the phone number is to a call center for a completely different company.

There are two criteria that I propose should always be considered:

  1. Is it properly licensed?
  2. Is it accredited?

While this may not be an ironclad guarantee, it speaks strongly to the professionalism and integrity of a program.

Arizona Addiction Treatment Licensing Levels

In Arizona, there are several levels of licensure for addiction treatment programs.

  • Acute behavioral health hospitals handle the most serious cases and may offer detox and an Intensive Outpatient Program (IOP) but rarely residential rehab. Operated as hospitals, they can handle higher medical and psychiatric acuity.
  • Inpatient behavioral health facilities provide primary inpatient rehab and also detox. These facilities are staffed 24/7 with RNs, offer physician and psychiatric visits (usually onsite) and meet stringent safety and anti-ligature requirements. These are the appropriate placement for those requiring 30-day inpatient treatment due to risk of relapse, post-acute withdrawal, medication management, co-occurring disorders and an intensive program of treatment. They tend to be the oldest, most established programs.
  • Recently, several levels of residential have been combined into one for licensure. It may or may not include counseling. The licensure requirements, while not onerous, reflect a level of safety, client’s rights, record-keeping, rules for medication management and reporting requirements.
  • Outpatient covers very basic safety and proper storage of records. It’s the easiest licensure but seems to be overused by programs that really provide residential.
  • Laboratory license is mainly used in addiction treatment for urine drug testing. The Clinical Laboratory Improvement Amendments (CLIA) are regulated by the federal government through the state agency, the regional office and the central office. This is not required for simple point-of-care test cups. If programs are CLIA-licensed, they are almost always billing insurance for this testing, and that practice has been ripe with reported abuse.

It’s very important to use and refer to properly licensed programs. The recent phenomenon of “Florida model” programs that license as outpatient programs but market and provide residential treatment is troubling. The Arizona Department of Health Services (ADHS) is aware but lacks jurisdiction unless the facility helps manage medications or does counseling onsite.

Referring to programs that do not license their homes carries liability. A former state behavioral health license regulator recounted a story where a family sent their son for Florida model treatment in Arizona from Michigan. The young man relapsed, overdosed and died at the house. When the mother called the state for the detailed report, she was told the facility was not licensed and had never been inspected, and there was nothing the state could do. Licensure can be checked at http://azdhs.gov/licensing/index.php#azcarecheck.

Accreditation Through CARF and JCAHO

I am a big fan of accreditation. It confirms that you’re operating at a high standard and always working to improve. If your program is not accredited, why not? Are you referring to non-accredited programs? Why, when there are plenty of properly licensed and accredited options available?

The two most widely held national and international accreditations for rehabilitation treatment centers and other behavioral health organizations are:

  • The Joint Commission (JCAHO)
  • Commission on Accreditation of Rehabilitation Facilities (CARF)

“Accreditation matters,” according to the National Association of Addiction Treatment Providers (NAATP). “While no single factor is dispositive of high quality care, accreditation is strong indicia of such. When considered in conjunction with other factors a center might include in its prospectus, such as quality of staff, comprehensive programming, and years in operation, accreditation gives a consumer valuable information with which to assess options. Our consumer base needs and deserves that. We all do.”1

“As an accreditation advocate, I advise all of our patients, inquiring families and friends, and referral sources such as therapists, hospitals and physicians who are looking for care to not only check licenses and state certifications, but also national and international accreditations, and to confirm that the facility is accredited for the level of care needed and wanted for the patient,” Rebecca Flood, Executive Director/CEO of New Directions for Women, writes in Addiction Professional magazine. “Accreditation is the determinant for whether or not I would utilize its services or send a family member there, and it should be for any family looking to place their loved one or any organization looking to refer a patient.”2

For those programs concerned that accreditation is expensive and onerous, JCAHO provides this cost example: “… an organization with six or fewer sites would pay about $1,820 in annual fees every year, plus a survey fee of around $3,020 in the year we do the on-site survey.”3 And it doesn’t have to take forever. When Foundations Recovery Network (FRN) opened Skywood Recovery, a 100-bed inpatient facility in Michigan, they achieved Joint Commission Accreditation in just less than 90 days. It would have been sooner, but you have to have closed charts from discharged patients for JCAHO to review.

Accreditation can be checked at:

Finding a Quality Treatment Center

If you’re referring a loved one or client to treatment, carefully consider the quality of a program by using the best tools at your disposal. Proper licensure gives you assurance that the program meets appropriate regulations for safety, confidentiality and clinical standards. And remember, if you are referring to a residential program, be sure it has that level of licensure.

Accreditation is another tool to determine the quality of a program and gauge their commitment to professionalism. Insurance will not contract with any unaccredited program.

If you work, run or own a program, do it right. Get in the game! Get licensed and accredited properly. You can feel pride and your clients can feel confident — a winning combination!


Sources:

1Accreditation Matters.” National Association of Addiction Treatment Providers, June 30, 2016.

2 Flood, Rebecca. “Accreditation takes on added importance.” Addiction Professional, June 29, 2016.

3FAQs Behavioral Health Accreditation.” The Joint Commission, Accessed January 19, 2018.