A significant number of states exempt state
agency-run programs (e.g., in the justice and
welfare systems) from licensure. A national
study of state-run treatment programs found that,
excluding programs provided or operated by the
state addiction treatment agencies, only about
one-half of state agencies that operate treatment
programs require the programs they operate to
meet state licensure standards:^144
38 states report that the department of
corrections operates treatment programs, but
only 18 of these require treatment programs
operated by the corrections departments to
meet state licensing standards.* 145
13 states report that their juvenile justice
system operates treatment programs, with
only six states requiring these programs to
adhere to state licensing standards.^146
Seven states identify their departments of
child and family services as operating
treatment programs, with only four requiring
adherence to state licensing standards.^147
18 states identified 21 other government
agencies (e.g., departments of public
welfare, mental health and criminal justice-
related agencies other than the department of
corrections) that operate treatment
programs, but in only 11 states are these
programs required to adhere to state
licensing standards.^148
CASA Columbia also found substantial
inconsistencies in the regulation of faith-based
programs that offer addiction-related services.
While most states do not appear explicitly to
address faith-based programs in their laws or
regulations, some states explicitly exempt such
programs from regulation.†
- A few states qualified the licensing requirement,
saying that it only applied to certain types of facilities
(e.g., one state noted that the requirement was for
residential treatment facilities only).
† Exemptions appear to apply to programs that solely
are spiritual or religious in nature.
Federal Regulatory Requirements ..............................................................................
The federal government does not regulate
addiction treatment facilities or programs, with
the exception of those that provide opioid
maintenance therapy.^149 However, the federal
government imposes certain conditions of
participation on qualifying programs and
facilities through federal health insurance
programs, including Medicare, Medicaid,
TRICARE for members of the active duty
military and the veterans’ health insurance
program (CHAMP VA)--whether they are
mainstream health care or addiction treatment
providers.^150 Like state licensing laws, these
provisions include requirements regarding
staffing, services and quality assurance
mechanisms.To be eligible to receive Medicare/Medicaid
reimbursement, most treatments must be
provided by or under the supervision of a
physician.^151 State Medicaid programs have the
option of covering addiction treatment under the
Medicaid rehabilitation option, Medicaid clinic
services, targeted case management and
Medicaid managed care waiver programs. The
rehabilitation option is the most flexible for
treatment coverage in that it does not require
services to be medically provided or
supervised.^152 The Medicare/Medicaid
Conditions of Participation impose extensive
requirements on participating facilities including
staffing, services and quality assurance
provisions.‡ 153‡ In addition, under the Government Performance
Results Act (GPRA) of 1993, federally-operated
programs or those that receive federal funds for
addiction treatment are required to meet certain
reporting requirements.