February 13, 2007
REQUIREMENTS FOR ESTABLISHING DRUG REHABILITATION CENTER
By: Saul Spigel, Chief Analyst
You asked about the requirements an organization must meet to establish a drug rehabilitation center and receive state funding.
A drug rehabilitation center must receive a certificate of need (CON) from the Office of Health Care Access (OHCA) and be licensed by the Department of Public Health (DPH) before it can begin operation. The CON is a two-step process that determines if the facility or service is needed. The applicant first files a letter of intent providing preliminary information about the proposal and then a detailed application, which may be subject to a public hearing. But a nonprofit substance abuse treatment facility that has a contract with the Department of Mental Health and Addiction Services (DMHAS) could be exempted from the CON process under two circumstances.
The facility must also receive a license from DPH as a “private, freestanding facility for the care or the treatment of substance abusive or dependent persons.” The licensing process requires the applicant to describe its organization, leadership, and the services it plans to provide. It must also (1) show that its facility meets state and local zoning, building, health, fire codes, and specific physical plant and food service requirements; (2) adhere to prescribed personnel, staffing, staff development, and service planning practices; (3) and, depending on the specific services it provides, follow certain medical and drug administration procedures.
A drug rehab clinic could receive state funds from several sources. It may be able to receive reimbursement for treating individuals from (1) the Department of Social Services' Medicaid fee-for-service and HUSKY A programs and (2) DMHAS for people receiving State Administered General Assistance (SAGA) medical benefits or who have no form of medical assistance. Each source has different provider enrollment requirements. A clinic may also be eligible to access low-cost debt financing through the Connecticut Health and Educational Facilities Authority.
CERTIFICATE OF NEED
The CON is a two-step procedure that, for an applicant proposing a new drug rehab facility, consists of a letter of intent (LOI) followed by an application. Applicants must pay a CON filing fee equal to 0.05% of any proposed capital expenditures over $3 million.
A nonprofit substance abuse treatment facility that has a contract with DMHAS could be exempted from the CON process under two circumstances. DMHAS may grant a CON exemption to a facility that it identifies as closing a gap in the statewide service delivery plan (CGS § 17a-678). Or DMHAS can recommend to OHCA that it grant an exemption if the facility is seeking to add, expand, or relocate a service or activity that DMHAS identifies as meeting a specific service need (19a-639b).
The LOI form requires applicants to provide information required by statute, including the project's nature, location, and projected cost. Within 15 days after the completed LOI is filed, OHCA publishes notice of it in a newspaper in the proposed service area and the applicant receives a CON application form. It then has between 60 and 120 days to file the completed application. The applicant can ask for one 30-day extension, extending the filing date to the 150th day after the LOI filing.
The CON application is specific to the proposal. The completed application must address the following components:
1. the proposal's financial feasibility and relationship to the applicant's long range plan;
2. the proposal's effect on the applicant's rates and financial condition and consumers' and payers' interests;
3. the proposal's contributions to the quality, accessibility, and cost effectiveness of health care delivery;
4. facility managers' competence;
5. rate sufficiency;
6. changes in the applicant's current utilization;
7. the applicant's teaching and research responsibilities;
8. the applicant's efforts in improving productivity and containing costs; and
9. any other factors OHCA deems relevant.
Once OHCA deems a filed application complete, it has 90 days to render a decision. OHCA must hold a public hearing on a proposal if three individuals or someone representing an entity with five or more people asks for one within 21 days after the application is deemed complete. OHCA may, at its discretion, hold a hearing on proposals to (1) introduce or add to an existing health care function or service; (2) use technology that is new or being introduced to the state; (3) terminate an existing health care function or service, reduce total beds, or close of health care facility; and (4) spend $20 million or more on land, buildings, and non-clinical equipment. OHCA has 90 days from the date the application and the hearing process are complete, to approve, modify, or deny the proposed project (CGS §§ 19a-638 to -643; Conn. Agency Regs. §§ 19a-643-79 to -89).
More information on CON is available on OHCA's website, http://www.ct.gov/ohca/taxonomy/ct_taxonomy.asp?DLN=42021&ohcaNav=|42021|.
A drug rehabilitation facility must also obtain a DPH license as a “private, freestanding facility for the care or the treatment of substance abusive or dependent persons.” It cannot obtain the license without a CON. The license application must contain the following:
1. evidence of compliance with local zoning ordinances and building codes;
2. local fire marshal's annual certificate of compliance;
3. statements of ownership and operation;
4. certificate of public liability insurance;
5. a current organizational chart and names and titles of staff; and
6. the service classification(s) in which it is seeking licensure and descriptions of the services it plans to provide.
A drug rehabilitation clinic can be licensed to provide nine services: (1) ambulatory chemical detoxification, (2) care and rehabilitation, (3) chemical maintenance treatment, (4) day or evening treatment, (5) intensive treatment, (6) intermediate and long-term treatment and rehabilitation, (7) medical triage, (8) outpatient treatment, and (9) residential detoxification and evaluation.
DPH regulations require each facility to, among other things:
1. have a governing board, an executive director, and fiscal manager and specify their responsibilities;
2. adopt written personnel policies and procedures covering work rules, discipline, evaluation, and medical exams;
3. meet state and local codes and specific physical plant and food service rules;
4. meet specific staffing requirements;
5. develop and implement emergency and disaster policies and procedures;
6. follow specified accident and injury reporting procedures; and
7. develop individual service plans for clients and properly maintain client records.
The regulations contain numerous other requirements about services and medical treatment for facilities that provide specific types of services.
The licensing regulations (Conn. Agency Regs. § 19a-495-570) can be found at http://www.dph.state.ct.us/phc/docs/112_Private_Freestanding_Fa.doc.
A drug rehab clinic could receive state funds from several sources for treating individuals: (1) the Department of Social Services for serving clients in the Medicaid fee-for-service and HUSKY A programs and (2) the Department of Mental Health and Addiction Services for people receiving State Administered General Assistance (SAGA) medical benefits or who have no form of medical assistance. Each program has different provider enrollment or credentialing requirements and procedures.
Electronic Data Systems is responsible for enrolling providers in the Medicaid fee-for-service program. An enrollment application can be obtained by contacting its Provider Assistance Center at (800) 842-8440 (in-state toll free) or (860) 409-4500. Further information is available on its website: http://www.ctmedicalprogram.com/index.html.
Four managed care organizations (MCOs: Anthem Blue Cross/Blue Shield, Health Net Healthy Options, Community Health Network, Preferred One) administer HUSKY A benefits. Each separately enrolls providers.
SAGA providers must be credentialed by Community Health Network, an MCO operated by a group of federally qualified health centers. Its credentialing information is available at http://www.chnct.org/Providers/pdf/Forms/Credentialing%20Application.pdf.
Finally, DMHAS contracts with providers for services to clients with no form of medical coverage (CGS §17a-676). The Purchase Service Unit of the department's Administration and Finance Division is responsible for generating funding applications and contracts for providers. Providers interested in contracting with DMHAS should contact Division Director David Crompton at (860) 418-6923.
A drug rehab clinic might be able to obtain funds from the Connecticut Health and Educational Facilities Authority (CHEFA). CHEFA provides low-cost, tax-exempt debt financing to nonprofit health institutions. But a search of CHEFA's website did not reveal any clinics that have received CHEFA funding (http://www.chefa.com/index.php).