methadone, the initial dose cannot exceed 30
milligrams.^203
Accreditation Service Requirements.
Accreditation organizations delineate detailed
specifications related to addiction services
provided by facilities and programs.
CARF requires that addiction services be
evidence based, explicitly stating that care
should incorporate “current research, evidence-
based practice, peer-reviewed scientific and
health publications, clinical practice guidelines
and/or expert professional consensus.” The
facility must have written policies regarding
service delivery including screening, referrals,
medication use and control,* discharge and
follow up.^204 CARF sets forth procedural
requirements for the above services, as well as
orientation, assessment and the development of
“person-centered plans” for treatment.† CARF
offers accreditation standards for each of the
“core program areas” that programs and
facilities may elect to have accredited, such as
assertive community treatment (ACT),
community integration,‡ detoxification, day
treatment, drug court treatment, partial
hospitalization and inpatient services. Standards
for the core program areas are very detailed and
cover which services must be provided, by
whom and how often.§ 205
- The process of physically controlling, transporting,
storing and disposing of medications, including those
that are self-administered by patients.
† Treatment plans developed with the input of
patients regarding their goals, needs, strengths,
abilities, preferences, desired outcomes and cultural
background.
‡ A form of treatment that provides opportunities for
community participation as a means of optimizing
personal, social and vocational competency in order
to live successfully in a community.
§ For example, day treatment must be provided at
least three hours a day, four days a week; must
include three interventions from a designated list of
interventions (e.g., family therapy, group counseling,
individual psychotherapy, occupational therapy,
alcohol and other education) plus two additional
activities (nutritional/fitness/leisure/social); the
program must be directed by a qualified behavioral
health practitioner (a person certified, licensed,
registered or credentialed by a governmental entity or
The Joint Commission requires facilities to have
written procedures for eligibility for admission
and for most services. The standards for
addiction treatment programs include procedural
requirements governing essential services such
as screening and assessments; medical
history/physical examinations; screening for
physical pain, nutritional status and signs of
trauma/abuse/neglect/exploitation; special
provisions for services provided to vulnerable
populations (children, individuals with
intellectual/developmental disabilities); care that
reflects patients’ needs, preferences and goals;
coordination of care; necessary referrals;
primary physical care; and discharge/transfer
that assures continuity of care.^206 The standards
do not specify what kind of psychosocial or
pharmaceutical services should be provided,
leaving much room for variability in the quality
of patient care.Because opioid maintenance therapy is
considered “medical care,” Joint Commission
standards for opioid maintenance therapy
programs are more numerous and detailed. For
example, such programs must address relapse
prevention in discharge planning; use DSM-IV
or other accepted clinical criteria to diagnose
addiction; perform an initial toxicology test and
a comprehensive screening of patients’ medical
conditions; document current chronic or acute
medical conditions; provide hepatitis A and B
immunizations; manage current misuse of other
drugs that are not the primary focus of
treatment; and include smoking cessation as an
integral component of care.^207Quality Assurance Requirements ...............................................................................
Quality assurance requirements can be imposed
by state and federal governments, by accreditors
or by payers. Such requirements focus on
assuring specific organizational structures,a professional association as meeting the
requirements necessary to provide mental health or
alcohol and other drug services); screening and
assessments must be provided; and when psychiatric
services are necessary, a psychiatrist must be
available 24-hours a day.