Inpatient Chemical Dependency Treatment Facilities
"Chemical dependency" is "the use of any chemical substance, legal or illegal, that creates behavioral or health problems, or both, resulting in operational impairment. This term includes alcoholism, drug dependency, or both, that endanger the health, interpersonal relationships, or economic functions of an individual or the public health, welfare or safety" (53-24-103, Montana Code Annotated [MCA]). Further, 50-5-101(10), MCA, states that a "chemical dependency facility" is a facility whose function is the treatment, rehabilitation and prevention of chemical dependency as defined above.
Inpatient chemical dependency treatment includes inpatient treatment in a hospital setting and inpatient treatment in a free-standing facility outside a hospital. It does not include day treatment, intermediate care or transitional living, intensive outpatient treatment or outpatient treatment.
Under 50-5-301, MCA, all proposals for new services, or expansion of existing services, of inpatient chemical dependency treatment, both hospital-based and freestanding, are subject to Certificate of Need (CON) review by the Department of Public Health and Human Services (DPHHS).
When chemical dependency treatment is necessary, services should be available and accessible to all Montanans in the least-restrictive, most community-based setting possible. The most appropriate treatment model should be determined through the utilization of dimensional criteria, as reviewed by the Department’s Quality Assurance Division.
- To maintain the number and capacity of inpatient chemical dependency services at the present level to encourage financial feasibility of existing facilities and accessibility to services
- To reinforce the goals and objectives outlined in the Addictive and Mental Disorders Division’s (AMDD) Comprehensive Alcohol and Other Drugs Prevention and Treatment Plan during the CON review of inpatient chemical dependency applications.
- To encourage applicants to incorporate the county chemical dependency plans when applying for an inpatient chemical dependency CON to accurately assess the community need for such services.
Certificate of Need Guidelines:
As outlined in 50-5-304, MCA, any applicant seeking to establish an inpatient chemical dependency treatment facility should address the review criteria in its CON application, including an evaluation of the proposal with the guidelines established in this section. The review criteria consider consistency with this State Health Care Facilities Plan, but also allow consideration of additional data and information.*
- No new inpatient chemical dependency facilities will be approved. Replacement of an existing facility would require the submission of a CON application to aid in an accurate need determination.
- No additional inpatient chemical dependency beds should be granted unless evidence of a need for services can be presented to the Department. Evidence could include the county chemical dependency plans, patient origin information, and other supporting data.
Need Methodology for Inpatient Chemical Dependency Services:
See " Discussion" below. There is no longer a bed need projection used to determine the need for services in particular health planning regions.
Certificates of Need should not be granted for additional inpatient chemical dependency treatment beds. While Region I has no beds, utilization rates at existing facilities in the state indicate that an inpatient facility in that region would not be feasible.
The Treatment and Prevention Services Bureau of the AMDD produces the Comprehensive Alcohol and Other Drugs Prevention and Treatment Plan every four years, with a biennial update.
During the early 1980s, the current Community Health Development Section and the former Department of Correction and Human Services (DCHS) (now DPHHS, AMDD) developed a bed need projection method for inpatient chemical dependency facilities. In their most recent plan update, the AMDD no longer includes a projection of inpatient bed need. Because the number of inpatient chemical dependency beds in the state exceeds any of the projections used in past plans and the growth of managed care has resulted in decreased utilization of inpatient programs with an increased reliance upon outpatient community-based settings, any projections are currently unnecessary.
Absent any formal methodology for determining need, any CON applicant should adhere to the "Guidelines" stipulated within this plan, and all other statutory requirements as contained in Title 50, Chapter 5, Part 3. In order to become an approved treatment facility by the AMDD, the facility must demonstrate that a "local need currently exists and that those services do not duplicate existing local services" (53-24-208(2), MCA). Furthermore, the Department should "encourage planning for the greatest utilization of funds by discouraging duplication of services, encouraging efficiency of services through existing programs, and encouraging rural counties to form multi-county districts or contract with urban programs for services" (53-24-204(2)(g), MCA).
In addition to the influence of managed care, the decline in earmarked alcohol tax revenue, a funding source for treatment facilities, will continue to impact the utilization of inpatient chemical dependency services. In order to maintain outpatient services in rural areas and meet the demand for intensive outpatient services in these communities, funding to inpatient services will most likely decrease. While the transition occurs between the inpatient and outpatient treatment setting, facilities must address the increased admissions for "poly drug use," alcohol abuse in addition to the abuse of some other substance, and a treatment population that is getting progressively younger.
The availability of services at Montana Chemical Dependency Center (MCDC), the continued development of intensive outpatient treatment services which provide a less-restrictive and more cost-efficient method of providing such services, and the departmental commitment to maintain services in rural areas of Montana all contribute to the move away from the inpatient arena.
*The State Health Care Facilities Plan (SHCFP) was last updated in 1997 and is in the process of being examined. The Inpatient Chemical Dependency Treatment component of the SHCFP contains one goal, various objectives, and two guidelines. The first guideline for the Inpatient Chemical Dependency Treatment component is no longer relevant when evaluating a CON application. The second guideline is feasible and consistent with statute. It states, "No additional inpatient chemical dependency beds should be granted unless evidence of a need for services can be presented to the department." Thus, the department will adhere to statutory requirements for direction "that a local need currently exists for proposed services and that the proposed services do not duplicate existing local services," 53-24-208(2), MCA.
Office of Inspector General
Licensure Bureau Certificate of Need Program
CON Statute and Rules
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