Department of Alcohol and Other Drug Abuse Services

South Carolina Department of Alcohol and Other Drug Abuse Services
Agency Synopsis to the Regulatory Review Task Force
May 15, 2013
Directive
In accordance with South Carolina Executive Order Number 2013-02, Section II, Paragraph 1a,
the South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS) has
conducted a comprehensive review of all current and proposed statutes, rules, regulations, and
policies in order to assess their effects on South Carolina’s economy and to determine whether
their costs to businesses and employers outweigh their intended benefits. The department’s
review was conducted in accordance with Paragraph 1b of Section II, to wit: “In evaluating
statutes, rules, regulations, and policies, each agency should consider factors to include, but not
limited to, their necessity, complexity, efficiency, effectiveness, redundancy, public complaints or
comments, short- and long-term effects, impact on all affected persons, both intended and
unintended, and unintended negative consequences.”
Methodology
Statutes, regulations, and policies that affect the department, its network of substance abuse
service providers, clients, and businesses were identified and reviewed in accordance with the
Executive Order. As DAODAS provides addiction services to South Carolinians through subgrantees and sub-contractors, the effects of laws, regulations, and policies were considered for
both direct service providers and the service beneficiaries, and the impact on the business
community. (See Attachment 1.)
DAODAS Background
The use of alcohol, tobacco, and other drugs (ATODs) affects South Carolinians of all ages and
from all walks of life. Problems resulting from these substances surface in our homes and
schools, on our roads and highways, and in our workplaces and criminal justice system. As a
result, the social cost to South Carolinians – both direct and indirect – is approximately
$2.5 billion per year.
Recognizing the need for direct services for the general public, as well as for specific high-risk
groups, DAODAS purchases a wide array of prevention, intervention, and treatment services
through a community-based system of care. The department subcontracts with 33 county alcohol
and drug abuse authorities to provide the majority of direct services to citizens in all 46 counties
of the state. Since the county authorities were created in 1973, they have provided intervention
and treatment services to more than 2.4 million South Carolinians and touched the lives of
countless individuals and families through the many prevention activities coordinated and
provided by this system.
DAODAS estimates that approximately 362,000 individuals in South Carolina are suffering from
substance abuse problems that require immediate intervention and treatment; that is one in 10
South Carolinians. With a problem of this magnitude, the department must continue to ensure
1
that individuals and families access the vital core services purchased by DAODAS through the
statewide system of county authorities (i.e., the local provider network), as well as other public
and private contractors. During fiscal year 2012 (FY12), DAODAS and its provider network
met this need for 48,077 South Carolinians.
Key Strategic Goal
“Clients in treatment will achieve sustainable recovery.”
Capitalizing on more than 55 years of success in ensuring access to substance abuse services for
the citizens of South Carolina, DAODAS is undertaking an assessment of internal processes to
better serve its customers; working with the public and private provider networks to increase
health outcomes and – through collaboration with other state systems – better serve all South
Carolinians; collaborating more closely with primary healthcare, behavioral healthcare, and
universal healthcare providers to increase capacity for serving individuals with substance abuse
disorders; and meeting “head on” the challenges that face our state in a time of reduced resources
by developing plans to address the delivery of the agency’s core mission through service
integration as well as tapping underutilized private and public resources and developing solid
partnerships across systems.
State Law and Regulation
The following are applicable state laws and regulations, which are designed to enhance the
health and safety of South Carolinians, but do not directly impact the state’s economy in costs to
businesses. As a core government service, the range of prevention, intervention, and treatment
services coordinated by DAODAS do, in fact, enhance the state’s economy.
•
According to the Institute for Research, Education and Training in Addictions, for every
dollar invested in addictions treatment, taxpayers save at least $7.46 in costs to society,
including the costs of incarceration, drug-related crime, hospitalizations, and other
societal ills.
•
A study commissioned by the University of California, Los Angeles, showed similar
cost-benefit results and pointed to increased employment earnings.
•
South Carolina Office of Research and Statistics data for 2009 showed that substance
abuse is a major contributor to healthcare costs in hospitals.
•
At McDonnell Douglas, absenteeism dropped 44% for employees treated for substance
abuse issues. When the Kennecott Copper Corporation provided mental health
counseling for its employees, its hospital, medical, and surgical costs decreased 48.9%.
•
Outcome data demonstrate the effectiveness of the services provided by DAODAS, as
indicated in Attachment 2.
It should be noted that – while we list regulations that indirectly impact how substance abuse
services are provided – the agency has not promulgated a regulation during its 56 years of
existence.
2
SC Title 44, Ch. 49, Department of Alcohol and Other Drug Abuse Services. The enabling
legislation for the department establishes DAODAS to formulate, coordinate, and administer the
state plans for controlling narcotics and controlled substances and alcohol abuse. These plans
call for the distribution of the federal Substance Abuse Prevention and Treatment Block Grant
(SAPT BG) that in turn is sub-granted to the 33 county alcohol and drug abuse authorities, as
well as targeted community organizations, that provide services in all 46 counties of the state.
This statute has no negative impact on the economy of the state. Recommendation: Retain.
SC Title 61, Ch. 12, Disbursement of Revenue for Programs for Alcoholics, Drug Abusers,
and Drug Addicts. The statute (a) established the county alcohol and drug abuse authorities to
ensure that all South Carolinians have access to prevention, intervention, and treatment services;
and (b) provide for their funding through the tax on liquor. Recommendation: Retain.
SC Title 40, Ch. 75, Professional Counselors, Marriage and Family Therapists, and Licensed
Psycho Educational Specialists. This statute requires subject professionals to obtain licensure
and requires addiction counselors to be certified in Substance Use Disorders (SUDs) in order to
provide treatment services. In addition to providing basic protection to clients, licensure and
state certification also increase quality outcomes. Recommendation: Retain.
Chapter 61-93. Department of Health and Environmental Control. Standards for Licensing
Facilities That Treat Individuals for Psychoactive Substance Abuse or Dependence. This
regulation establishes licensure standards for the protection of staff and clients receiving
services. Recommendation: Evaluate. Work with DHEC and county alcohol and drug abuse
authorities to update regulations.
Departmental Policies/Requirements
As there are numerous federal and state laws, regulations, and requirements that impact the
delivery of substance abuse services to South Carolinians, DAODAS has no regulations and very
few policies that would adversely impact that state’s economy. A review of the largest policy,
the DAODAS Block Grant Governing Terms, will show that it is mainly a means of conveying
federal requirements. However, there are a number of departmental policies (listed below) that
stand out as model practices in terms of positive client outcomes or optimized business practices.
County Plan Guidelines. This policy guides the 33 county authorities’ submission of the annual
county plan that is required by Title 61, Ch.12. It was revised for State Fiscal Year 2014 to
simplify requirements. Recommendation: Retain and evaluate annually.
Policy on Indigence and Fee Assessment. This policy ensures that the terms of the federal
SAPT Block Grant are complied with in a way that is least burdensome on providers and clients
alike. It was revised for State Fiscal Year 2014 to make it less complex and more user-friendly.
Recommendation: Retain and evaluate annually.
DAODAS County Assistance Program. This is a performance management program that
attempts to “head off” provider problems before they worsen and affect quality of care. The
program features intensive technical assistance. Recommendation: Retain.
3
Quality Assurance Policies. DAODAS has a number of complementary policies that help SUD
service providers maintain quality services and satisfy major funders’ requirements for the
department to provide the requisite oversight and leadership. These policies are the DAODAS
Quality Assurance Standards; Substance Abuse Agencies Management Information System
(SAAMIS) Operations Manual; South Carolina Medicaid Internal Audit Standards; Policy &
Procedure for Follow-Up of Client/Customer Complaints; Critical Incident Reporting Policy &
Procedures; and Technical Assistance Policy and Procedures. Recommendation: Retain,
evaluate, and revise as required.
DAODAS Block Grant Governing Terms
The Governing Terms contain the federal requirements of the SAPT Block Grant that apply to
the department as the Single State Authority and to the 33 county alcohol and drug abuse
authorities that are the DAODAS sub-grantees. The Governing Terms are reviewed each year
with the county authorities to ensure that they optimally balance federal and DAODAS
requirements with the operational and financial needs of the sub-grantees. The overall rating of
the Governing Terms is positive, while the department recognizes that it may be possible to
further streamline them. The State Fiscal Year 2014 Governing Terms will contain fewer
deliverables and reduce redundant requirements. Please see Attachment 1 for further evaluative
results.
Perspective
DAODAS is a core government service provider that impacts the state’s health through the
prevention, intervention, and treatment of SUDs across South Carolina. As a healthcare
provider, the department increases the capacity of individuals to seek gainful employment within
the local and state business community. Upon a review of statutes, regulations, and policies and
procedures, DAODAS has determined that that these requirements do not result in undue costs to
businesses or employers.
4
Attachment 1
Efficiency
Effectiveness
Redundancy
Public complaints or
comments
Short-term effects
Long-term effects
Impact on all
affected persons
Intended
consequences
Unintended
consequences
+
0
+
+
0
0
+
0
+
+
0
Retain
Licensure and state certification increase quality
outcomes.
SC Title 44, Chapter 49, Department of Alcohol and Other Drug Abuse Services
+
0
+
+
0
-
+
+
+
+
0
Retain
Enabling legislation.
SC Title 56, Chapter 5, Department of Alcohol and Other Drug Abuse Services,
Alcohol and Drug Safety Action Program
+
0
+
+
0
+
+
+
+
+
0
Retain
Mandates treatment for DUI offenders.
SC Title 61, Chapter 12, Disbursement of Revenue for Programs for Alcoholics,
Drug Abusers, and Drug Addicts
+
0
+
+
0
0
+
+
+
+
0
Retain
Establishment of local substance abuse provider
system.
Chapter 61-93. Department of Health and Environmental Control. Standards for
Licensing Facilities That Treat Individuals for Psychoactive Substance Abuse or
Dependence.
+
-
-
+
-
+
+
+
+
+
-
Review
Work with DHEC and service providers to update
regulations.
DAODAS Block Grant Governing Terms (see next page)
+
-
+
+
-
-
+
+
+
+
0
Revise
Driven by federal and state funders. 2012
Review: Some internal redundancies. Continue
to simplify.
County Plan Guidelines
+
+
+
+
0
+
+
+
+
+
0
Evaluate
Annually
Required by Title 61, Ch.12. Revised for FFY
2014 (made less complex).
Coordinated County Reviews
+
0
+
+
+
0
+
+
+
+
0
Revise
Driven by federal and state requirements.
Revise to reflect current statewide priorities.
Quality Assurance Standards
+
0
+
+
0
0
+
+
+
+
0
Review
Review to reflect updated quality assurance
requirements.
SAAMIS Operations Manual
+
0
+
+
0
0
+
+
+
+
0
Revise
Revise with implementation of new electronic
health record system.
S.C. Medicaid Internal Audit Standards
+
0
+
+
0
0
+
+
+
+
0
Evaluate
Driven by federal and state funders. Revise to
reflect current statewide priorities.
Remarks
Complexity
SC Title 40, Chapter 75, Professional Counselors, Marriage and Family Therapists,
and Licensed Psycho-Educational Specialists
Title
State Laws and Regulations
Recommendation
Necessity
S.C. Department of Alcohol and Other Drug Abuse Services - Internal Review of Laws, Regulations, Policies, and Other Requirements
Departmental Policies/Requirements
Scoring: In terms of the effect on economy, service providers, businesses, and citizens, a given factor is positive (+), negative (-), or not applicable/neutral (0).
As of 5/14/2013
5
Necessity
Complexity
Efficiency
Effectiveness
Redundancy
Public complaints or
comments
Short-term effects
Long-term effects
Impact on all
affected persons
Intended
consequences
Unintended
consequences
Title
DAODAS County Assistance Program
Recommendation
Remarks
+
-
+
+
0
0
+
+
0
+
0
Review
Revise to reflect current statewide priorities.
Technical Assistance Policy and Procedures
0
0
0
0
0
0
+
0
+
0
0
Evaluate
Evaluate effectiveness/need for FY14.
Critical Incident Reporting Policy and Procedures
+
0
+
+
0
0
+
+
+
+
0
Retain
Policy on Indigence and Fee Assessment
+
0
-
+
0
-
+
+
0
+
0
Evaluate
Policy and Procedure for Follow-Up of Client/Customer Complaints
+
0
+
+
0
0
+
+
+
+
0
Retain
+
0
+
+
0
+
+
+
+
+
0
Retain
+
0
0
0
0
+
+
+
+
+
0
Retain
+
-
-
+
-
+
+
+
+
+
-
Evaluate
Work with DHEC and service providers to update
regulations.
+
-
-
+
0
+
+
+
+
+
0
Review
Consistently review to ensure that complexity
and efficiency issues are addressed.
+
0
0
0
0
+
+
+
+
+
0
Retain
+
0
-
+
0
-
+
+
0
+
0
Review
Intravenous Substance Abusers (45 CFR § 96.126): §108
+
0
0
+
0
0
+
+
+
+
0
Retain
Women (45 CFR § 96.131): §109
+
0
+
+
0
0
+
+
+
+
0
Retain
Aligns with statewide priorities.
+
0
-
+
0
0
+
+
+
+
0
Retain
Consistently review to address efficiency issues
related to contracting for HIV services with
partner agencies.
DAODAS Block Grant Governing Terms
Accessibility of Services: §101
Client Non-Discrimination: §102
DHEC Licensure: §103
National Accreditation (45 CFR § 96.136): §104
Personnel (45 CFR § 96.132 (b); SC Title 40, Ch. 75; Civil Rights Act of 1964 and the
Americans With Disabilities Act of 1990): §105
Fees / Financial Assessment / Payment of Last Resort (45 CFR § 96.137; DAODAS
Policy on Indigence and Fee Assessment): §106, §107
Human Immunodeficiency Virus (HIV) (45 CFR § 96.128): §110
Driven by federal law. Simplified for FY14
Implementation.
Consistently review to remove barriers for
services.
Driven by federal law. Simplified for FY14
implementation.
Scoring: In terms of the effect on economy, service providers, businesses, and citizens, a given factor is positive (+), negative (-), or not applicable/neutral (0).
As of 5/14/2013
6
Efficiency
Effectiveness
Redundancy
Public complaints or
comments
Short-term effects
Long-term effects
Impact on all
affected persons
Intended
consequences
Unintended
consequences
-
-
0
0
+
+
+
+
-
Review
Work with partner agencies to decrease negative
consequences in implementation of a federal
requirement.
S.C. Commercial Driver’s License Act and 49 C.F.R. 40: §112
+
0
+
+
0
0
+
+
+
+
0
Retain
Part of the state’s DUI laws.
Ignition Interlock Device Program: §113
+
0
+
+
0
+
+
+
+
+
0
Retain
Part of the state’s DUI laws.
HIPAA, 42 CFR and HITECH Act, Subtitle D, Part 2: §114
Motor Voter (The National Motor Voter Registration Act of 1993 and SC Code Ann.
§ 7-5-310): §115
Quality Assurance (JCAHO and CARF Accreditation Standards; DAODAS Quality
Assurance Standards): §116
Remarks
Complexity
-
Recommendation
Necessity
+
Title
Tuberculosis (TB) Services (45 CFR § 96.127): §111
+
-
0
+
-
+
+
+
+
+
0
Retain
Federal law protecting confidentiality of health
records. Complexity and some overlap between
42 CFR and HIPAA. Needs review to minimize
effects.
+
0
+
+
0
0
+
+
+
+
0
Retain
State law.
+
-
-
+
-
+
+
+
+
+
-
Retain /
Review
Federal and state quality assurance
requirements need to be reviewed to minimize
effects.
-
Retain /
Review
DAODAS reviews annually to maximize efficiency
and effectiveness, to minimize redundancy, and
to mitigate unintended consequences impacting
provider business practices.
DAODAS reviews annually to maximize efficiency
and effectiveness, to minimize redundancy, and
to reduce adverse impact on provider business
practices.
Reporting Systems and Deliverables: §118
+
0
-
-
-
0
+
+
0
+
Coordinated County Reviews (OMB Circular A-133, SC Code Ann. § 44-49-10 (E),
DAODAS/HHS Medicaid Manual, CARF, ASAM, DAODAS Quality Assurance
Standards): §125
+
-
-
+
-
+
+
+
+
+
0
Retain /
Review
Statewide Base Services: §402
+
+
+
+
0
+
+
+
+
+
0
Retain
Core services of government.
Extended Services: §403
+
+
+
+
0
+
+
+
+
+
0
Retain
Enhances core services of government.
Scoring: In terms of the effect on economy, service providers, businesses and citizens, a given factor is positive (+), negative (-) or not applicable/neutral (0)
As of 5/14/2013
7
Attachment 2 Statewide Summary of Client Outcomes, State Fiscal Year 2012 % at Admission % at Discharge % at Outcome Follow‐up Alcohol Abstinence in Prior 30 Days* 36.6%
85.8% 74.0%
Alcohol Intoxication Abstinence in Prior 30 Days* 76.0%
95.7% 96.0%
Drug Abstinence in Prior 30 Days* 49.0%
87.5% 96.7%
Tobacco Use in Prior 30 Days 54.5%
47.7% 48.4%
Outpatient Use in Prior 30 Days for Medical or Mental Health Problems 8.4%
6.1% 12.7%
Emergency Room Use in Prior 30 Days for Alcohol‐Drug Problems 1.1%
0.3% 0.0%
Arrested in Prior 30 Days 5.3%
0.9% 1.4%
Employed in Prior 30 Days 67.4%
72.3% 74.7%
Homeless in Prior 30 Days 1.2%
0.9% 0.6%
Student Expulsions or Suspensions 20.7%
5.8% 2.9%
Aftercare Participation* 10.8%
20.0% 9.0%
Outcome * Alcohol or drug problem clients only Matches: Alcohol Abstinence in Prior 30 Days (Alcohol Problem Clients) Alcohol Intoxication Abstinence in Prior 30 Days (Alcohol Problem Clients) Drug Abstinence in Prior 30 Days (Drug Problem Clients) Tobacco Use in Prior 30 Days (All Clients) Outpatient Use in Prior 30 Days for Medical or Mental Health Problems (All Clients) Emergency Room Use in Prior 30 Days for Alcohol‐Drug Problems (All Clients) Arrested in Prior 30 Days (All Clients) Employment Status in Prior 30 Days (Age 16+) Homeless in Prior 30 Days (Age 18+) Student Clients Suspended or Expelled in Prior 30 Days (Age 12‐21.99) Participation in Aftercare in Prior 30 Days (AOD Problem Clients) A‐D‐O Match 8