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Addiction Treatment Center Resources - Massachusetts
Frequently Asked Questions

Addiction Treatment Centers

Overview
  1. What types of chemical dependency services are offered in Massachusetts?

  2. The following types of treatment services may be offered in Massachusetts with appropriate licensure: Read More


  3. What does it mean to be “licensed,” “certified,” or “accredited” in this industry?

  4. A license means that a facility or professional may operate or may deliver services with the advance and continuous authorization of a designated government agency, which is done to ensure protection of public health, safety, and welfare. Read More


    Licensing & Certification
  5. What kind of licensure and certifications are required to operate a chemical dependency treatment program in Massachusetts?

  6. Facilities must be licensed to operate programs that provide treatment services. Certification is generally optional; however, alcohol and drug free housing must be in order to obtain referrals from state agencies. Read More


  7. How can the licensing and credentialing agencies in Massachusetts be reached?

  8. Bureau of Substance Abuse Services
    Department of Public Health
    250 Washington Street Read More


  9. How does a treatment facility obtain a license?

  10. Applicants for an initial license or approval must submit an application to the Department on an approved form obtained from the Department, together with any other documents and materials that the Department deems appropriate. Read More


  11. How does a treatment facility renew, amend, or terminate its license?

  12. Applicants for renewal must submit completed forms and fees required by the Department at least 60 days prior to the expiration of the current license or approval. Read More


  13. What kinds of inspections might there be for licensure determination?

  14. The Department or its agents may visit at any time without prior notice and inspect the facility, its staff, activities, and records to determine compliance with the licensing regulations and applicable state and federal laws. Read More


  15. How can a facility prepare for inspections, on-site reviews, and audits?

  16. Facilities must ensure that staff are well-trained and ready to answer questions that may be asked of them by the Department, reflecting knowledge of compliance and operational requirements. Read More


  17. Under what circumstances will the Department deny, suspend, modify, or revoke licensure?

  18. If a facility does not comply with the licensure process, licensing regulations, or other applicable laws, an initial license may be denied. Read More


  19. Under what circumstances can a facility challenge the Department’s decision to deny, suspend, modify, or revoke licensure?

  20. The regulations specify that the Department may hold hearings if an applicant wishes to challenge a decision to deny, suspend, or revoke licensure. Read More


    Operational Requirements
  21. What kinds of information must a facility submit to the Department?

  22. Pursuant to applicable regulations, certain incidents must be reported to the Department as follows: Read More


  23. What kinds of internal policies and procedures must a licensed substance abuse facility have?

  24. Licensed facilities must also have a set of written policies and procedures made available to staff, clients, and Department inspectors. These written policies must address, at a minimum, the following: Read More


  25. What are the requirements for client records for licensed substance abuse facilities?

  26. Facilities must maintain separate records for each client in a secure and confidential manner, which is discussed in further detail in the Privacy Section below. Read More


  27. What kind of governance must a licensed substance abuse facility have?

  28. Licensed facilities must have a governing body that is responsible for the policies and activities of the service. The governing body must consist of persons with expertise in management, finance, and substance abuse treatment. Read More


  29. What personnel requirements exist for licensed facilities?

  30. Licensed facilities must have a set of written personnel policies and practices made available to all staff members. These written policies must address, at a minimum, the following: Read More


  31. What other operational requirements are there for licensed facilities?

  32. Licensees must have general and professional liability insurance, and be able to demonstrate compliance with workers’ compensation insurance requirements. Read More


  33. What are the protections afforded to small group homes used for the purpose of residential substance abuse treatment?

  34. 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. Read More


  35. Are there any proximity restrictions regulating how close treatment centers may be to each other? Can an operator open a residential treatment center right next to one that is already there?

  36. There is no statewide rule or regulation preventing multiple facilities from operating in close proximity. Notwithstanding the lack of legal or regulatory prohibitions... Read More


  37. What are the basic physical plant requirements for treatment facilities?

  38. Please note, these regulations concern the physical requirements for licensure and certification and do not constitute all environmental requirements. Read More


    Admissions Agreement
  39. What information must be disclosed to the client during intake and what must a licensed facility put in its admissions agreement?

  40. 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. Read More


  41. What other documentation must be provided to clients?

  42. Licensed facilities must create and maintain a current policy manual for clients. Topics that must be covered in the manual include: Read More


    Placement
  43. How does a facility decide whether a client meets criteria for placement in a particular level of care?

  44. 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 must carry out an assessment of the client’s treatment and rehabilitation needs and goals. Read More


    Requirements by Program Type
  45. What staffing must be offered at each level of care?

  46. Substance abuse treatment facilities must meet the needs of admitted clients, as identified during the admission assessment process. Read More


  47. What services must be offered by each type of program?

  48. There are minimum treatment service requirements for all licensed facilities. Certain services must be provided directly by the licensee, while others may also be provided by QSOs. Read More


    Treatment Planning
  49. What are the requirements of a chemical dependency assessment?

  50. In addition to the requirements set forth above based on types and levels of care, all licensed facilities must complete an initial assessment for each client that includes the following elements: Read More


  51. What must be included in an individual treatment plan?

  52. For each client admitted, licensed facilities must complete an individual treatment plan based on the client’s treatment, medical, psychiatric, and social histories. The treatment plan must address the following elements: Read More


    Medication & Medication Assisted Treatment
  53. What rules govern administration of client medications in a licensed facility?

  54. Licensees providing medically managed or medically monitored detoxification services shall ensure that management, storage, and administration of medication comply with requirements established by... Read More


  55. What requirements are there to start an opioid treatment facility?

  56. As an initial matter, opioid treatment programs must comply with all applicable laws, including Massachusetts state laws governing controlled substances and federal regulations promulgated by... Read More


  57. What other requirements apply to medication assisted opioid treatment?

  58. In addition to the general requirements for licensed facilities, the admissions and staffing regulations specific to opioid facilities described above, and the special application process described above, there are specific licensing rules that must be satisfied to provide medication assisted opioid treatment. Read More


  59. How can an opioid treatment facility discharge a patient?

  60. Discharge depends on the circumstances. Clients who are undergoing medically supervised withdrawal as a planned goal in a maintenance program may request a blind dosage reduction, i.e. a gradual decrease of dosage without prior notice to the client of the decrease. Read More


    Client Rights
  61. What rights are guaranteed to clients?

  62. Facilities must protect the legal and civil rights of each client at all times during treatment and discharge from treatment. Read More


  63. When policies and procedures must be in place to address behavior management?

  64. Facilities must establish and maintain written policies and procedures for managing disruptive behavior, including aggression, harm or threats of harm to self or others, destruction of property, and refusal to comply with program policies. Read More


    Discharge
  65. What termination and discharge policies need to be in place?

  66. Licensed facilities must have written termination and discharge policies and procedures and make these available to prospective clients at the time of admission. Read More


  67. What grounds are needed in order to dismiss a client from a program?

  68. 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. Read More


  69. If a facility needs to discharge a client that relapsed, is the facility at risk if the client overdoses tonight? If so, how can the facility protect itself?

  70. The discharge of a client must be handled carefully given the risks if a client suffers negative health consequences in the aftermath of discharge. Read More


  71. What needs to be done if a patient dies while in treatment?

  72. The facility must develop procedures to be followed in the event of the death of a patient. These procedures must conform with laws governing the report of death to local authorities. Read More


    Privacy
  73. How must clients’ privacy be protected?

  74. Replace preview sentence with “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 to safeguard confidentiality. Read More


    Payment
  75. How can a facility respond to clients who are unable to pay the required deductibles? Can the facility waive a program participant’s financial responsibility?

  76. 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. Read More


  77. What are the key issues insurers raise to demand recoupment of fees from chemical dependency treatment programs?

  78. 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. Read More.


    Marketing
  79. What marketing practices are prohibited?

  80. By law, advertising cannot: (1) be false, deceptive or misleading; (2) have the effect of intimidating or exerting undue pressure; (3) guarantee a cure; and/or (4) make claims of professional superiority that a licensee cannot substantiate. Read More


  81. What are the limits of gift giving to potential referral sources?

  82. 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. Read More


  83. What kind of benefits can a facility offer existing or new clients?

  84. 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 inducements and patient brokering. Read More


    Alcohol and Drug Free Housing

    Overview
  85. What is alcohol and drug free housing?

  86. Alcohol and drug free housing, also known as sober living facilities, are transitional alcohol and drug free residential settings with rules, peer-led groups, activities and/or other structured operations. Read More


    Licensing & Certification
  87. Is a license or certification required to open alcohol and drug free housing?

  88. Alcohol and drug free housing are unlicensed facilities, which can offer sober housing with rules, peer-led groups, staff activities and/or other structured operations for persons in early recovery... Read More


  89. How can alcohol and drug free housing facilities demonstrate their commitment to meeting minimum quality standards?

  90. Sober homes may devise their own quality standards. NARR provides a Code of Ethics that is used by sober homes in many states and is available here: Read More


  91. What kind of services can alcohol and drug free housing offer?

  92. Alcohol and drug free housing provides a structured alcohol and drug free environment for congregate living that offers regularly scheduled peer-led or community gatherings (self-help groups, etc.) Read More


    Zoning and Land Use
  93. What are the protections afforded by federal law to small group homes used for the purpose of sustained recovery?

  94. 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. Read More


  95. Can local governments put special restrictions on alcohol and drug free housing?

  96. 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... Read More


  97. What other aspects should an operator consider before choosing a location for alcohol and drug free housing?

  98. In siting alcohol and drug free housing, 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... Read More


    Residents’ Rights and Responsibilities
  99. What are alcohol and drug free housing operators’ obligations to residents?

  100. In general, operators of sober living houses should agree to the following: (1) to enforce that the premises remain safe and free of intoxicant use; (2)... Read More


  101. What kind of agreement should alcohol and drug free housing operators ask residents to sign?

  102. As a general matter, the housing agreement should include: (1) a pledge from the client to live by the house rules, including to abstain from drug and alcohol use and... Read More


  103. Can an alcohol and drug free house insist on drug tests and searches?

  104. As a general matter, alcohol and drug free housing does not have the right to impose testing or searches without consent. Read More


  105. Can alcohol and drug free housing bill insurance for required and/or random drug testing?

  106. Alcohol and drug 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... Read More


  107. Can an alcohol and drug free house make clients’ obligations contractually enforceable?

  108. Yes, as long as the obligations are enforceable under Massachusetts law in general and any applicable laws relating to landlord and tenants. Read More


    Governance and Staffing
  109. What kind of ownership and staffing structures are common with alcohol and drug free housing?

  110. Alcohol and drug free housing may be structured as a nonprofit corporation, a for-profit corporation, limited liability company, partnership, or a sole owner arrangement. Read More


  111. Are there any other organizations from which alcohol and drug free housing operators could find more information?

  112. Substance Abuse and Mental Health Services Administration
    http://www.samhsa.gov/ Read More


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