PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Health and Rehabilitative Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 02-10-112.
Title of Rule: Chapter 388-805 WAC, Certification requirements for chemical dependency service providers.
Purpose: Establishes the level of quality and patient care standards for chemical dependency service providers seeking certification by DSHS/Division of Alcohol and Substance Abuse (DASA).
Statutory Authority for Adoption: RCW 70.96A.090.
Statute Being Implemented: Chapter 70.96A RCW.
Summary: 1. DASA is proposing amendments to chapter 388-805 WAC. The key new rules and amendments proposed will implement:
a. 42 C.F.R., Part 8, Certification of Opioid Treatment Programs, effective May 18, 2001, which include major changes to the federal requirements adopted by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration.
b. RCW 70.96A.400 - [70.96A.]420, effective July 22, 2001 (chapter 242, Laws of 2001), amended by the 2001 Washington state legislature.
In response, emergency WAC adoptions were submitted to the Code Reviser's Office on March 8, 2002, July 5, 2002, November 1, 2002, and February 28, 2003, effective for one hundred twenty days each. The emergency rules amended Washington state administrative codes to recognize CSAT certification standards and implement the changes made to RCW 70.96A.400, [70.96A.]410, and [70.96A.]420.
2. In addition, DASA stakeholders recommended using the American Society of Addiction Medicine, Patient Placement Criteria (PPC), primarily for patient placement, continued service, and discharge criteria. The proposed WAC revision reduces regulatory use of PPC for treatment planning activities. Other revisions include:
a. A new WAC section is proposed to require agencies to report critical incidents to DASA within 48 hours of the critical incident.
b. Language to clarify the requirements for outcomes evaluation, outpatient treatment requirements for patients convicted of DUI or physical control pursuant to chapter 46.61 RCW, and definitions of court ordered treatment in WAC 388-805-330.
c. Language to revise the WAC section on fees collected by DASA for change of agency ownership applications.
d. Language to revise ADATSA assessment center certification and ADATSA requirements.
e. Language to acknowledge faith-based programs.
f. Language to recognize Chemical Dependency Professionals as Alcohol/Drug School Instructors.
g. Language to correct inaccurate WAC section citations and typographical errors.
3. In addition, other sections of this chapter were subject to review and amendment deemed appropriate as required by Governor Locke's Executive Order 97-02 on regulatory improvement.
Proposed amended and new rules in chapter 388-805 WAC: Amending WAC 388-805-005 What definitions are important throughout this chapter?, 388-805-010 What chemical dependency services are certified by the department?, 388-805-015 How do I apply for certification as a chemical dependency service provider?, 388-805-030 What are the requirements for opiate treatment substitution treatment program certification? (amended caption and rule text), 388-805-065 How does the department determine disqualification or denial of an application?, 388-805-075 How do I apply for an exemption?, 388-805-085 What are the fees for agency certification?, 388-805-090 May certification fees be waived?, 388-805-100 What do I need to do to maintain agency certification?, 388-805-120 How does the department assess penalties?, 388-805-130 How does the department suspend or revoke certification?, 388-805-140 What are the requirements for a provider's governing body?, 388-805-145 What are the key responsibilities required of an agency administrator?, 388-805-150 What must be included in an agency administration manual?, 388-805-205 What are agency personnel file requirements?, 388-805-210 What are the responsibilities for approved supervisors of persons who are in training to become a chemical dependency professional? (caption and text amended), 388-805-220 What are the requirements to be a probation assessment officer?, 388-805-250 What are the requirements to be an information school instructor?, 388-805-300 What must be included in the agency clinical manual?, 388-805-305 What are patient's rights requirements in certified agencies?, 388-805-310 What are the requirements for chemical dependency assessments?, 388-805-315 What are the requirements for treatment, continuing care, transfer, and discharge plans?, 388-805-320 What are the requirements for a patient record system?, 388-805-325 What are the requirements for patient record content?, 388-805-350 What are the requirements for outcome evaluation?, 388-805-400 What are the requirements for detoxification providers?, 388-805-410 What are the requirements for detox staffing and services?, 388-805-500 What are the requirements for residential providers?, 388-805-520 What are the requirements for youth behavior management? (caption and text amended), 388-805-530 What are the requirements for incentive inpatient services? 388-805-540 What are the requirements for recovery house services?, 388-805-550 What are the requirements for long-term treatment services?, 388-805-600 What are the requirements for outpatient providers?, 388-805-610 What are the requirements for intensive outpatient treatment services?, 388-805-625 What are the requirements for outpatient services for persons subject to RCW 46.61.5056?, 388-805-700 What are the requirements for opiate substitution treatment program providers? (caption and text amended), 388-805-710 What are the requirements for opiate substitution treatment medical management?, 388-805-720 What are the requirements for drug testing in opiate substitution treatment? (caption and text amended), 388-805-730 What are the requirements for opiate substitution treatment dispensaries?, 388-805-740 What are the requirements for opiate substitution treatment counseling?, 388-805-750 What are the requirements for opiate substitution treatment take-home medications?, 388-805-800 What are the requirements for ADATSA assessment services? (caption and text amended), 388-805-810 What are the requirements for DUI assessment providers?, 388-805-820 What are the requirements for alcohol and other drug information school? and 388-805-850 What are the requirements for treatment accountability for safer communities (TASC) providers and services? (caption and text amended); and new sections WAC 388-805-035 What are the responsibilities for the department when an applicant applies for approval of an opiate substitution treatment program?, 388-805-040 How does the department determine there is a need in the community for opiate substitution treatment?, and 388-805-715 What are the requirements for opiate substitution medication management?
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Dennis Malmer, Division of Alcohol and Substance Abuse, P.O. Box 45330, Olympia, WA 98504-5330, (360) 438-8086, (877) 301-4557 (toll free).
Name of Proponent: Department of Social and Health Services, governmental.
Rule is necessary because of federal law, 42 C.F.R., Part 8.
Explanation of Rule, its Purpose, and Anticipated Effects: See Summary above.
Proposal Changes the Following Existing Rules: See Summary above.
A small business economic impact statement has been prepared under chapter 19.85 RCW.
The purpose of this chapter is to describe the standards and processes necessary for certifying chemical dependency treatment service providers.
The proposed amendments to this chapter include:
• The Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration adopted 42 C.F.R., Part 8, Certification of Opioid Treatment Programs, on January 17, 2001, effective May 18, 2001. The federal rules made changes to the federal requirements for certifying opiate substitution treatment programs.
• The 2001 Washington state legislature amended RCW 70.96A.400-[70.96A.]420, effective July 22, 2001.
In response, emergency WAC adoptions were submitted to the Code Reviser's Office on March 8, 2002, July 5, 2002, November 1, 2002, and February 28, 2003, effective for one hundred twenty days each. The emergency rules amended Washington state administrative codes to recognize CSAT certification standards and implement the changes made to RCW 70.96A.400, [70.96A.]410, and [70.96A.]420.
• DASA stakeholders recommended using the American Society of Addiction Medicine, Patient Placement Criteria (PPC), primarily for patient placement, continued service, and discharge criteria. The proposed WAC revision reduces regulatory use of PPC for treatment planning activities.
• A new WAC section is proposed to require agencies to report critical incidents to DASA within 48 hours of the critical incident.
• Language is proposed to clarify the requirements for outcomes evaluation, outpatient treatment requirements for patients convicted of DUI or physical control pursuant to chapter 46.61 RCW, and definitions of court ordered treatment in WAC 388-805-330.
• Language is proposed to revise the WAC section on fees collected by DASA for change of agency ownership applications.
• Language is proposed to revise ADATSA assessment center certification and ADATSA requirements.
• Language is proposed to acknowledge faith-based programs.
• Language is proposed to recognize chemical dependency professionals as alcohol/drug information school instructors.
• Language is proposed to correct inaccurate WAC section citations and typographical errors.
• In addition, other sections of this chapter were subject to review and amendment deemed appropriate as required by Governor Locke's Executive Order 97-02 on regulatory improvement.
This chapter has been rewritten in plain English, using a question and answer format to make it more understandable to our customers. Unnecessary rules have been eliminated and others have been clarified.
SMALL BUSINESS ECONOMIC IMPACT STATEMENT: Chapter 19.85 RCW, the Regulatory Fairness Act, requires that the economic impact of proposed regulations be analyzed in relation to small businesses and that it outlines the information that must be included in a small business economic impact statement (SBEIS). Preparation of an SBEIS is required when a proposed rule has the potential of placing a more than minor economic impact on business. DASA has analyzed the proposed amendments to its rules and has determined that small businesses will not be impacted by these changes.
INDUSTRY ANALYSIS: DASA is responsible for certifying chemical dependency treatment agencies. As part of its monitoring, DASA keeps a current internal database that identifies all certified agencies. Since internal industry information can be obtained at a more accurate level than is required by chapter 19.85 RCW, it is unnecessary to conduct an industry analysis using the four-digit standard industrial classification (SIC) codes.
DASA previously determined that there were one hundred twenty-six existing agencies (private and for-profit) that meet the criteria for small businesses under RCW 19.85.020. In 2003, DASA decided to consider economic impacts on all DASA certified agencies (private, for-profit, and public funded) therefore the industry analysis includes five hundred eighteen certified agencies.
INVOLVEMENT OF SMALL BUSINESSES AND OTHER DASA CERTIFIED AGENCIES: Many small businesses have been involved in writing the proposed rules and in ascertaining the costs associated with proposed rule changes. DASA engaged assistance of a writing group, which included representation from small businesses. DASA met and talked several times with a number of small businesses to consider costs that would impact their businesses.
Attached to this document is a list of the WAC Revision Committee members who participated in determining the costs associated with new rules [no further information supplied by agency].
COST OF COMPLIANCE: To consider costs of compliance, DASA elected to look at cost per patient. This is because:
• Patients drive the businesses that provide chemical dependency treatment and so using the cost per patient is a more accurate depiction of costs than costs per employee;
• Business decisions and planning are based on the number of patients served; and,
• The number of patients also influences the total amount that the most significant proposed changes will cost.
The costs of proposed rule changes fall in one main area. With proposed changes to WAC 388-805-030 through 388-805-040, and 388-805-700 through 388-805-750, opiate substitution treatment programs will experience increased costs as a result of changes in federal rule 42 C.F.R. Part 8, which requires OTPs to become accredited by a nationally recognized accreditation body. A number of Washington state OTPs have elected to become accredited by DASA and therefore were able to offset the initial costs of accreditation because DASA received a federal grant on April 15, 2002, to assist these agencies in meeting accreditation requirements.
CONCLUSION: DASA, in collaboration with the members of the WAC Revision Committee of 2003, have given careful consideration to the impact on small businesses and other DASA certified agencies of proposed rules in chapter 388-805 WAC, Certification requirements for chemical dependence service providers. In accordance with the Regulatory Fairness Act, chapter 19.85 RCW, DASA has analyzed impacts on small businesses and other DASA certified agencies and has determined that the costs of implementing revisions to chapter 388-805 WAC will generally be reduced.
OTPs will experience increased costs as a result of changes in federal rule 42 C.F.R. Part 8, which requires OTPs to become accredited by a nationally recognized accreditation body. A number of Washington state OTPs have elected to become accredited by DASA. Therefore, the initial costs of accreditation were offset because DASA received a federal grant on April 15, 2002, to assist these agencies in meeting accreditation requirements.
DASA recognizes that there are costs associated with rule making on all DASA certified agencies to change policy and procedure manuals after implementation of new or revised rules.
The majority of the rule changes, however, offer cost and time savings by eliminating, reducing, or streamlining requirements.
A copy of the statement may be obtained by writing to Dennis W. Malmer, Division of Alcohol and Substance Abuse, P.O. Box 45330, Olympia, WA 98504-5330, phone (360) 438-8086, fax (360) 438-8057, toll free (877) 301-4557, e-mail malmedw@dshs.wa.gov.
RCW 34.05.328 applies to this rule adoption. A copy of the cost benefit analysis may be obtained by contacting the person in Name of Agency Personnel above.
Hearing Location: Blake Office Park (East) (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Lacey, WA 98503, on August 5, 2003, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Fred Swenson, DSHS Rules Consultant, by August 1, 2003, phone (360) 664-6097, TTY (360) 664-6178, e-mail swensfh@dshs.wa.gov.
Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, e-mail swensfh@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m. on August 5, 2003.
Date of Intended Adoption: Not sooner than August 6, 2003.
May 29, 2003
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit
Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 03-14 issue of the Register.