Addiction Medicine: Closing the Gap between Science and Practice

and facilities.^169 Joint Commission

accreditation is widely accepted by state

licensing agencies toward the fulfillment of

licensing requirements for addiction

treatment programs and facilities.^170

 The Council on Accreditation (COA). COA
is an international accrediting organization.
Originally known for accrediting family and
children services agencies, COA currently
accredits numerous services, including
addiction treatment.^171 COA accreditation is
accepted by fewer states (approximately 10)
relative to accreditation by CARF or the
Joint Commission.^172

 The National Committee for Quality
Assurance (NCQA). NCQA is a nonprofit
health care quality improvement
organization that accredits health care
organizations.^173 As of 2005,* Florida and
Michigan were the only states that accepted
NCQA accreditation as fulfilling licensing
requirements for addiction treatment
programs and facilities.^174

 The National Commission on Correctional
Health Care (NCCHC). The NCCHC is the
only organization authorized by the federal
government to accredit opioid maintenance
therapy programs that specialize in
correctional settings.^175

Of the 13,339 addiction treatment programs and
facilities voluntarily responding to a national
survey:†

 56.9 percent (7,595 facilities) are not
accredited by CARF, the Joint Commission,
COA or NCQA;

 21.8 percent (2,909 facilities) are accredited
by CARF;

• The most recent data available. More states may

currently accept the accreditation.
† The National Survey of Substance Abuse Treatment

Services (N-SSATS). Accreditation by the NCCHC
was not measured in the survey. The categories are
not mutually exclusive, as programs and facilities
may have multiple accreditations.

 19.2 percent (2,556 facilities) are accredited

by the Joint Commission;

 5.0 percent (664 facilities) are accredited by

COA; and

 2.8 percent (371 facilities) are accredited by

NCQA.^176

Professional Staffing Requirements ...........................................................................

In licensing standards for medical facilities,

physicians generally are responsible for patient

care.‡ 177 In contrast, addiction treatment may be

provided not only by people who lack medical

training, but by individuals with no license and

no graduate education or clinical training at

all.^178

State licensing laws, federal requirements and

accreditation standards regarding which

professionals may provide and supervise

addiction treatment services in facilities and

programs vary significantly. While some states

require addiction treatment programs to have a

medical director who is an M.D. on staff, others

impose minimum education/training

requirements on directors, supervisors and staff.

Accreditation standards do not recognize

addiction treatment generally as requiring

medical care; rather, they only require physician

oversight for certain services, deferring to states

with regard to which professionals are qualified

to provide addiction treatment. Similarly,

federal requirements stipulate that some types of

care must be provided under the supervision of a

physician, while services such as “rehabilitation

services” do not require supervision by a

physician.^179

State Staffing Requirements. In licensing

regulations for addiction treatment facilities and

programs, states typically specify:

‡ Dentists and other health professionals may be

responsible for services they are qualified to perform

or supervise.