OTN Responses (11) to Query from Louisiana

OTN Responses (11) to Query from Louisiana Regarding Patient Advocates Compiled by NASADAD Staff by/on January 21, 2011

82. Request from Brenda Lands (LA), 01.12.2011 1. Are patient advocates available for opiate dependent individuals? If so, please describe.

2. Do you have policies and procedures for programs that tend to operate contrary to guidelines and licensing standards?

3. Is there a corrective action protocol? If so, please provide a copy.

Summary: While some States, like Illinois and Rhode Island, do have patient advocates through the National Association of Methadone Advocates (NAMA), many States said advocacy was established at the OTP level, not the State level. Many of the States noted that they had some policies and procedures around programs operating contrary to licensing standards, and that programs were monitored through site visits or programming evaluations. The consequences for programs operating contrary to standards were most frequently sanctions or approvals revoked (Illinois), suspension of licenses (Kansas, West Virginia, or being prohibited to treat State-funded individuals (Michigan). All States suggested that corrective action protocol wasn’t formalized, but most States required programs to provide some sort of corrective action plan.

Documents Collected by NASADAD: IN – Plan of Correction Form (contact Louise Polansky at [email protected]) KS – Denial, Suspension, or Revocation of License and Corrective Action Policy (contact Stacy Chamberlain at [email protected]) KS – Addiction and Prevention Services Corrective Action Plan Form KS – Standards for Licensure/Certification of Alcohol and/or Other Drug Treatment Programs

IL, Richard Weisskopf: 1. Illinois and the Chicago area have National Association of Methadone Advocates (NAMA) patient advocates. The SOTA also functions as a patient advocate where appropriate on a regular basis. 2. Non-compliant programs may be sanctioned, placed on probation, or have approvals revoked through a progressive process involving citation and hearings. 3. There is not a specific protocol.

IN, Louise Polansky: 1. My understanding is that most if not all of Indiana’s 13 OTP have created a patient advocacy committee which operates on behalf of the particular OTP’s patients, but the State has not mandated this, and we are not monitoring this at all. We have spoken with some of the patient advocates during past audits, and they always were positive about their work. It could be that particular OTP providers, such as CRC Health or Colonial Management, both of which have clinics in Indiana, have procedures in place that outline the patient advocacy efforts of their clinics. 2. I’m afraid I don’t understand Questions #2. Indiana only recently implemented its OTP rules (as of January 26, 2010), and presently, OTPs which are non-compliant with any of the 222 standards are being required to submit a plan of correction that assures the State the OTP is bringing the noncompliance into compliance. It’s a moving target of course because we only conduct an annual audit, meaning we are only able to find out if the correction has occurred the following year. Our new rules do allow for a one-year conditional approval which can be applied if we find a program has not met any requirement in the standards, however. Since rule implementation is recent, we have not used this status yet. 3. Our ‘corrective action protocol’ is merely a basic form, and I’m attaching a copy. I’m sure there are more sophisticated processes out there to use as a model however.

KS, Stacy Chamberlain: In Kansas, we have regulations, Standards of Care which are adopted by reference that all providers are required to follow. Methadone clinics have to follow the overall Standards and the ones specific to the clinics. We do not include anything in our regulations regarding client advocates; however, I know most of the 7 clinics in Kansas do have these per their own program policy. We conduct annual onsite licensure visits to ensure compliance with the regulation. If they are not compliant, they must submit a corrective action plan within 30 days and it must be implemented within 90 days. We have the authority to revoke their license (which is needed to operate a treatment program of any kind in this State) if they are not compliant. I have attached our Standards, policy, a CAP form, and a feedback form used by my staff to track provider compliance.

MI, Jeffery Wieferich: 1. Not exactly sure what you mean when you say advocate however I do not believe that this is something that MI has available. 2. Licensing in MI is through another division of the state but any program that operates contrary to licensing standards is not able to provide services to publicly funded individuals. This is the only impact our office has on this issue. Licensing can provide a citation in a letter but that is about the extent of it. 3. There is not protocol that we use.

NE, Blaine Shaffer: Nebraska answers NO to all of these questions.

NH, Rosemary Shannon: 1. No, nothing formal. Each provider is required to have a grievance procedure. It occasionally rises to the state level (me), mostly regarding patients' administrative discharge(s) and suspension(s) of take homes, but we deal with the specific patient themselves, not an advocate or other person (like a family member). NH does not fund the OTPs, but is required by state statute to regulate them.

2. We do biannual certification site visits, at a minimum, and participate in CARF exit interviews. However, most site visits the last 2 years have been based on critical incidents and/or sentinel events. We have one provider with 3 sites that has consumed all of our regulatory activity for the past 2 years. They have experienced a great deal of turnover at the Regional Director and state program director level (terminations from their corporate office and from the regional level). We have required them to come into the office, most recently last fall, and to develop written corrective action plans, that we monitor for compliance. There is also significant involvement of both the Regional DEA Office and the NH Board of Pharmacy which also regulates NH OTPs.

3. Here is the link to the NH Administrative Rule, He-A 304. There is no specific CAProtocol or form. Note that He-A 301-303 are expired and currently under revision. OTPs must meet those provisions as well as He-A 304. http://www.gencourt.state.nh.us/rules/state_agencies/he- a300.html

RI, Rebecca Boss: 1. There is nothing formal. RI does have certified (NAMA) methadone advocates. Currently our new Recovery Center director is one of those certified and is available to any methadone client. As with other states, the SOTA can also act as a patient advocate. Through regulation, each licensed program is required to have a Human Rights Officer and an official grievance policy that needs to be followed (and I usually ask patients when they contact me if they were aware of the grievance policy and if it was followed). 2. Programs are reviewed with licensing every two years minimally and then in response to issues or complaints. Programs out of compliance with regulations, contract standards or their own policies will receive written citations requiring a plan of correction which will then be reviewed for implementation. 3. No real protocol, just a requirement that a plan of correction be submitted to the state which will later be reviewed for implementation.

UT, Dave Felt: The Division of Substance Abuse and Mental Health does not license or formally regulate OTPs. They, and all SA and MH programs are licensed by the Office of Licensing, which is a sister agency under the Department of Human Services.

The Licensing regulations are largely health and safety, as our legislature is very conservative and avoids regulation like the plague.

The only authority I have comes through my mandate to have quarterly meetings with the providers and to approve exceptions.

So I get cooperation, but have little enforcement authority.

Specific answers to the questions:

1. Only if the OTP provides them. As the SOTA, my name is posted in all the clinics, and I occasionally get complaints which I investigate, or pass on to licensing as appropriate. 2. The office of licensing visits all the programs and re licenses them yearly. I typically go along on the visit, but have no real authority, but I provide expertise. 3. Only through licensing.

VT, Todd Mandell: Yes, in Vermont there are advocates for folks on medication assisted therapies. Mostly it is one person who does this on her own and had only had minimal funding from the state. We do visit all of the methadone sites for site reviews. We provide them with written feedback on the findings and set up a schedule for making corrections. WI, Deb Powers (former SOTA): There is a NAMA training that is conducted for individuals (generally happens at the AATOD conferences) interested in being advocates. It is what was developed in response to some 'rogue' individuals who held themselves out as advocates but didn't know about confidentiality, etc.

WV, Dr. Rose Lowther-Berman on behalf of Merritt Moore: 2. Our licensing standards have a mechanism for issuance of provisional licenses when there is substantial non compliance with the regulations but there is no significant risk to the rights, health or safety of a patient. These are good for 6 months. A license may be suspended or revoked in certain instances. 3. We don’t have a protocol, per se. And deficiencies found as the result of a complaint or resurveys are required to be addressed by the OTP via a Plan of Correction.