What types of chemical dependency services are offered in Washington?
Treatment services can be offered through residential and outpatient treatment facilities, which provide evaluation and either treatment or referrals for individuals with chemical dependency disorders.
What does it mean to be "licensed," "certified," or "accredited" in this industry?
Licensing means that a particular type of facility or professional may only operate with the advance and continuous authorization ("license") of a designated government agency ...
Licensing & Certification
What kind of licensure and certifications are required to operate a chemical dependency treatment program in Washington?
Facilities must be licensed to operate. Licenses from the DoH are required to operate residential treatment facilities (RTF). Initial agency licenses are required from DSHS ...
How can the licensing and credentialing agencies in Washington be reached?
Oversight is done by DoH and/or DSHS's DBHR, depending on the facility type. Licensing for residential treatment facilities is overseen by DoH while DBHR oversees the initial licensing and the program certifications ...
How does a residential treatment facility obtain a license?
A completed application for RTF licensure must be submitted to DoH 60 days or more before commencing operations on the forms provided by DoH and signed by the owner or legal designee.
How does a residential treatment facility renew or amend its license?
DoH mails the "Notice to Renew" about 45 days before the due date, which is 30 days before license expiration. At least 30 days before the expiration date of the current license, the facility must submit to DoH:
What responsibilities does a residential treatment facility have to maintain its license?
The RTF must ensure it is in compliance with all relevant state and federal rules and regulations.
Under what circumstances will the Department of Health deny, suspend, modify, or revoke licensure for a residential treatment facility?
DoH may deny, suspend, modify, or revoke an RTF license if the applicant or licensee has: ...
What is the process for obtaining certification for a chemical dependency facility?
Chemical dependency facilities must apply for an initial license from DSHS to operate as a behavioral health agency, and must apply for program certifications from DBHR
What might cause the Division of Behavioral Health and Recovery to deny, suspend, or revoke a certification for a program offered by a chemical dependency facility?
DBHR may deny a program's certification if any of the following occurs: ...
What kinds of inspections might there be for licensure and certification determination?
For residential treatment facility licensing, DoH may send an authorized representative to enter, visit, survey, and inspect an RTF licensed or applying for a license at any time ...
How can a facility prepare for inspections, on-site reviews, and audits?
Facilities must ensure that staff are well-trained and ready to answer questions which may be asked of them by DoH or DBHR, reflecting knowledge of compliance and operational requirements.
What are the requirements of an emergency plan for a residential treatment facility?
An RTF must ensure client health and safety by establishing and implementing an emergency plan designed for response to internal and external emergency safety situations.
What kind of governing body is required for residential treatment facilities?
Under Washington state regulations, RTFs must have governing bodies with responsibility for operating and maintaining the facility. The governing bodies provide organizational oversight to ensure safe and adequate resident care.
What kinds of policies and procedures must a chemical dependency program have?
Certified chemical dependency programs are required to have certain administrative, personnel and clinical policies in place.
Zoning and Land Use
What are the protections afforded to small group homes used for the purpose of residential substance abuse treatment?
The regulation of land use and zoning is traditionally reserved to state and local governments, except to the extent that it conflicts with requirements imposed by the Fair Housing Act, the protections of the ADA, or other federal laws.
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, although there are some hurdles that opiate substitution facilities must face when siting new locations as discussed below.
What are the basic physical plant requirements for treatment facilities?
Please note, these regulations concern the physical requirements for licensure and certification, and do not constitute all environmental requirements.
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.
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.
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 the intensity and frequency of services provided.
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.
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 ...
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 ...
When can a facility use restraint or seclusion techniques for behavior management?
Any RTF that utilizes restraint or seclusion must ensure that restraint or seclusion is performed in accordance with all applicable federal and state laws, regulations, and rules.
What grounds are needed in order to dismiss a client from a program?
Generally, there are four types of discharge. First, successful completion of the program means that the client has met the goals of his or her recovery plan.
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.
How must clients' privacy be protected?
Client confidentiality is an important issue covered by both federal and state laws. These laws set forth specific requirements regarding how and when patient information may be shared and the protections that must be in place ...
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 drug and alcohol rehabilitative services often face financial difficulties, whether because of the consequences of their addiction or the expense of multiple, prior failed treatment programs.
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.
What marketing practices are prohibited?
The most widespread prohibited marketing practices in addiction treatment appear to revolve around inappropriate inducements and inaccurate marketing claims.
What are the limits of gift giving to potential referral sources?
Federal and state laws prohibit the exchange of items of value to induce referrals for health-related services. As a result, the exchange of any item of value, whether it is cash or in kind, must be carefully monitored.
What kind of benefits can I offer existing or new clients?
Providers must avoid giving a patient or prospective patient anything of value or benefit. For example, facilities must avoid giving gifts to clients or referral sources because these may violate anti-kickback laws and rules against patient brokering.
Recovery Houses & Drug and Alcohol Free Housing
What is a recovery house and what is drug and alcohol free housing?
Recovery houses and other sober living facilities are transitional alcohol and drug free housing with rules, peer-led groups, activities and/or other structured operations. These housing options are directed toward the maintenance of sobriety for persons who exhibit treatment resistance, relapse potential, and/or lack of suitable recovery living environments, who recently have completed substance abuse treatment services, or who may be receiving such treatment services at another facility.
Do we need a license or certification to open a recovery house?
Recovery houses are currently not licensed by DoH as residential treatment facilities, but they require certification from the DBHR to offer treatment programs.
How can recovery houses demonstrate their commitment to meeting minimum quality standards?
Sober homes may devise their own quality standards. The National Alliance for Recovery Residences provides a Code of Ethics that is used by sober homes in many states and is available here: ...
What kinds of services can a recovery house offer?
Recovery houses provide a structured alcohol and drug free environment for congregate living that offers regularly scheduled peer-led or community gatherings (self-help groups, etc.).
Zoning and Land Use
What are the protections afforded by federal law to small group homes used for the purpose of sustained recovery?
A recovery house with six or fewer people is generally exempt from zoning and land use regulations based on federal and state law, and need not seek municipal approval to operate.
Can local governments put special restrictions on recovery houses?
This area of law is complex and evolving. It is well settled that state and federal law prohibit local governments from discriminating against or treating the residents of sober living homes differently from that of traditional families.
What other aspects should an operator consider before choosing a location for a recovery house?
In siting a recovery house, attention should be paid to potential hostility from neighbors. While federal and state law protect the right to operate sober living residences of six or fewer people in any residential community ...
Residents' Rights and Responsibilities
What would our obligations to residents be?
In general, recovery and sober living houses should agree to the following: (1) to enforce that the premises remain safe and free of intoxicant use ...
What kind of agreement must we ask our residents to sign?
Any agreement residents sign must comply with landlord and tenant laws of Washington. Legal counsel should be consulted regarding terms of leases.
Can we insist on drug tests and searches?
As a general matter, sober living facilities do not have the right to impose testing or searches without consent. However, under Washington regulations, a landlord has the right to require the tenant to take a urine analysis test ...
Can recovery houses or drug and alcohol free housing bill insurance for required and/or random drug testing?
Recovery houses or drug and alcohol free housing sometimes rely on the drug screening that takes place when the resident attends outpatient services, although they may make use of drug testing equipment that can be used on-site.
Can we make clients' obligations contractually enforceable?
Yes, as long as the obligations are enforceable under Washington law in general and the laws relating to landlord and tenants.
Governance and Staffing
What kind of ownership and staffing structures are common with these types of residential arrangements?
A recovery house may be structured as a nonprofit corporation, a for-profit corporation, limited liability company, partnership, or a sole owner arrangement. Landlords for drug and alcohol free housing may consist of ...
Are there any other organizations from which we could find more information?
The American Addiction Treatment Association (AATA) delivers reliable information and resources on compliance and best practices to enable recovery industry professionals, owners, and operators to navigate the evolving clinical and regulatory landscapes.
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