Ala. Admin. Code r. 410-2-4-.11
Current through Register Vol. 43, No. 1, October 31, 2024
Section 410-2-4-.11 - Substance Use(1) Discussion (a) The National Household Survey on Drug Abuse (NHSDA) estimated 22.2 million Americans age twelve (12) or older in 2012 were classified with dependence on or use of either alcohol or illicit drugs, a figure significantly higher than in 2000 - about 14.5 million. Most of these persons (14.9 million) were dependent on or used alcohol only. Another 2.8 million were dependent on or used both alcohol and illicit drugs, while 4.5 million were dependent on or used illicit drugs but not alcohol. Persons age eighteen (18) to twenty-five (25) had the highest rates of alcohol dependence or use (14.8%). (Source: www.samhsa.gov)(b) There are more deaths and disabilities each year in the United States from Substance use than from any other cause. One-quarter of all emergency room visits, one-third of all suicides, and more than one half of all homicides and incidents of domestic violence are alcohol-related. (Source: www.ncadd.org)(c) Alcohol and drug use costs the American economy an estimated $276 billion per year in lost productivity, health care expenditures, crime, motor vehicle crashes and other conditions. (Source: www.ncadd.org)(2) Background (a) Substance use services for treating individuals with substance use disorders or those who misuse substances is provided through an array of private and public providers throughout the state. The array of services ranges from inpatient medical detoxification services to residential treatment services to a variety of outpatient types of services including various affiliated support groups.(b) In the past few years the technology for treating individuals with dependence and use problems has changed rather dramatically from a traditional inpatient/residential mode to outpatient treatment. This has occurred for a variety of reasons including financial considerations. These phenomena can be verified through analysis of current utilization of both inpatient and residential services.(3) Methodology (a) The Alabama Department of Mental Health (DMH) has developed a substance use bed need methodology, which is based upon a formula utilized in other states, commonly referred to as the "Mardin Formula". This prevalence base formula was selected in lieu of utilization-based formulas due to the lack of comprehensive statistical information on the current utilization of residential treatment centers. Calculation of needed beds is performed as follows:(b) Step 1: Multiply the population ages 10-17 by 19%, which is the proportion assumed to have problems with chemical dependency;(c) Step 2: Multiply the population ages 18 and over by 7%, which is the proportion assumed to have problems with chemical dependency;(d) Step 3: Multiply the sum of steps 1 and 2 by 12%, which is the proportion who will seek treatment annually;(e) Step 4: Multiply the product in step 3 by 60% which is the proportion of those seeking treatment who will require detoxification services for 3 days. Calculate total number of patient days;(f) Step 5: Multiply those receiving detoxification services by 50%, which is the proportion who will need residential treatment for 10 days. Calculate total number of patient days;(g) Step 6: Add the patient days in steps 4 and 5 to arrive at total patient days;(h) Step 7: Divide by 365 to determine average daily census (ADC);(i) Step 8: Divide by 80% occupancy to arrive at total needed beds;(j) Step 9: Subtract existing public beds to arrive at total private bed need;(k) Step 10: Subtract existing private beds to determine need or excess. The Statewide Health Coordinating Council (SHCC) is aware that the Alabama Department of Mental Health (ADMH) currently utilizes multiple different classifications for residential and inpatient substance use treatment beds, differentiated based on the level, type and amount of medical care provided in each classification. It is the position of the SHCC that an accurate definition of substance use treatment beds for the purposes of health planning is required in order to be able to provide a more appropriate set of planning policies for these facilities moving forward. Therefore, the State Health Planning and Development Agency (SHPDA) is hereby directed to work with ADMH along with any interested parties to create a formal definition of substance use treatment beds, based on the classifications already utilized by ADMH, to determine which types of these beds would require a Certificate of Need under current law. SHPDA shall, within one (1) year of the effective date of this plan, provide to the SHCC a definition of a substance use treatment bed that would require a Certificate of Need under current law as well as a proposed amendment to this section reflecting that definition. SHPDA is further directed to analyze the existing planning methodology established in this section utilizing the proposed definitions defined above to determine whether the methodology should be amended to more accurately and appropriately determine need for these providers in the state.
For a listing of Substance Use Treatment Centers or the most current statistical need projections in Alabama contact the Data Division as follows:
MAILING ADDRESS (U. S. Postal Service) | STREET ADDRESS Commercial Carrier) |
PO BOX 303025 MONTGOMERY, AL 36130-3025 | 100 NORTH UNION STREET, SUITE 870 MONTGOMERY, AL 36104 |
TELEPHONE: (334) 242-4103 | FAX: (334) 242-4113 |
EMAIL: data.submit@shpda.alabama.gov | WEBSITE: http://www.shpda.alabama.gov |
(4) Methadone Treatment (a) Definition. Methadone is an opioid agonist medication used to treat heroin and other opiate addiction. Methadone reduces the craving for heroin and other opiates by blocking receptor sites that are affected by heroin and other opiates.(b) Background 1. Prior to June 1991 Alabama operated two methadone clinics in Birmingham and in Mobile, both of which were operated through a DMH contract. These clinics are part of the UAB Mental Health Center and the Mobile Mental Health Center. The average number of clients served in any given month never exceeded 380 of which fewer than 5% were clients from out of state.2. As of April 2015, Alabama has twenty-two (22) certified methadone treatment programs.(c) Recommendations 1. A methadone treatment program should provide adequate medical, counseling, vocational, educational, mental health assessment, and social services to patients enrolled in the opioid treatment program with the goal of the individual becoming free of opioid dependency, with oversight by the Alabama Department of Mental Health.2. The Methadone Advisory Committee suggests the following information be submitted with Certificate of Need applications: (i) The number of arrests for the previous year regarding the sale and possession of opioids by county for the area to be served.(ii) Data from the Medical Examiner regarding all deaths related to overdose from opioids by county for the area to be served during the previous year.(iii) Data from all hospital emergency rooms regarding the number of persons diagnosed and treated for an overdose of opioids by county for the area to be served.(iv) The number of clients within specific geographic areas who, out of necessity, must travel in excess of 50 miles round-trip for narcotic treatment services.(v) The name and number of existing narcotic treatment programs within 50 miles of the proposed site.(vi) Number of persons to be served by the proposed program and the daily dosing fee.(vii) Applicant shall submit evidence of the ability to comply with all applicable rules and regulations of designated governing authorities.(d) Need1. Basic Methodology(i) The purpose of this need methodology is to identify, by region, need for additional treatment facilities to ensure the continued availability, accessibility, and affordability of quality opioid replacement treatment services for residents of Alabama.(ii) A multi-county region shall be the planning area for methadone treatment facilities. A listing of the counties in each region is attached as part of this section. These were derived from the regions used by the Alabama Department of Mental Health (ADMH), Division of Mental Health and Substance Abuse Services.(iii) The Center for Business and Economic Research, University of Alabama, (CBER) population data shall be used in any determination of need for methadone treatment facilities in Alabama.(iv) Data from the National Survey on Drug Use and Health (NSDUH) shall be used in the calculation of national rates of dependency on heroin or prescription pain relievers in Alabama.(v) Data from ADMH shall be used in the determination of the number of current patients seen by each clinic within a region. ADMH shall supply, on an annual basis, an Annual Report to SHPDA with rates of prevalence, service utilization and epidemiological data to assist with implementation of the methodology and publication of statistical updates to this plan.(vi) For each region, need shall be calculated using the following methodology: (I) For each county in the region, list the population, ages 18 and over, as reported by CBER, for the year matching the year for which need is being projected.(II) Using NSDUH data for the same time period, determine the rate of dependency on heroin and prescription pain relievers nationally.(III) For each county in the region, multiply the population from step (I) above by the dependency rate in step (II) above to determine the projected number of residents in that county addicted to heroin or prescription pain relievers.(IV) Multiply the estimate from step (III) above by 20% (0.2) to determine the projected number of residents of that county likely to seek Medication Assisted Therapy for opioid dependency.(V) Add the county totals determined in step (IV) above to determine the regional totals.(VI) Using data supplied by ADMH, determine the current census of each treatment center in the region on the last day of the year matching the year of population and NSDUH dependency data used in step (I) and step (II) respectively.(VII) Add the facility census totals determined in step (VI) above to determine regional totals.(VIII) If the number of residents projected to seek treatment in a region as determined in step (V) is greater than the current census of all treatment centers in the region as determined in step (VII) by more than 10%, a need shall be shown for a new methadone treatment facility in that region.(IX) Only one methadone treatment facility may be approved in any region showing a need under this methodology during any application cycle, defined here as the period of time between the date of publication of one statistical update and the date of publication of a successive update.(X) Upon the issuance of a Certificate of Need for a new methadone treatment facility in a region, no additional CONs shall be issued for the development of a new methadone treatment facility in that region for a period of eighteen (18) months to allow for the impact of a new provider in the region to be shown and reflected in the next statistical update.2. The provisions of subsection 1 above shall not prohibit the grant of a Certificate of Need for the relocation and replacement of an existing methadone treatment facility within the same planning region.3. All methadone clinic applications shall be site specific. No CON shall be granted for a new methadone treatment facility to be located within fifty (50) linear miles of an existing methadone treatment facility.(e) Adjustments. Need for additional methadone treatment facilities, as determined in subsection 1 above, is subject to adjustment by the SHCC as provided below. The SHCC may adjust the need for a new methadone treatment facility only upon demonstration of one or more of the following conditions listed in 1 through 3 below. Applicants seeking an adjustment under this section shall include, as part of the application, supporting documentation from ADMH. 1. The opioid-related arrest or death rate in the region exceeds the national average, and there are no methadone treatment facilities within fifty (50) miles of the county for which the proposed adjustment applies.2. Hospital emergency room admissions for opioid-overdose related conditions in the region exceed the national average, and there are no methadone treatment facilities within fifty (50) miles of the county for which the proposed adjustment applies.3. Admissions to drug-free programs specifically treating opioid dependency in the region exceed the national average, and there are no methadone treatment facilities within fifty (50) miles of the county for which the proposed adjustment applies.(f) Preference for Indigent Patients. In considering CON applications filed under this section, whether pursuant to the regular need methodology or an adjustment, preference shall be given to those applicants demonstrating the most comprehensive plan for treating patients regardless of their ability to pay. Methadone Treatment Facility Regional County Listings
Region I | Region II | Region III | Region IV |
Cherokee | Bibb | Autauga | Baldwin |
Colbert | Blount | Bullock | Barbour |
Cullman | Calhoun | Chambers | Butler |
DeKalb | Chilton | Choctaw | Clarke |
Etowah | Clay | Dallas | Coffee |
Fayette | Cleburne | Elmore | Conecuh |
Franklin | Coosa | Greene | Covington |
Jackson | Jefferson | Hale | Crenshaw |
Lamar | Pickens | Lee | Dale |
Lauderdale | Randolph | Lowndes | Escambia |
Lawrence | Shelby | Macon | Geneva |
Limestone | St. Clair | Marengo | Henry |
Madison | Talladega | Montgomery | Houston |
Marion | Tuscaloosa | Perry | Mobile |
Marshall | | Pike | Monroe |
Morgan | | Russell | Washington |
Walker | | Sumter | |
Winston | | Tallapoosa | |
| | Wilcox | |
Ala. Admin. Code r. 410-2-4-.11
Effective April 23, 1991. Amended: Filed June 19, 1996; effective July 25, 1996. Repealed and New Rule: Filed October 18, 2004; effective November 22, 2004. Amended: Filed August 16, 2012, effective September 20, 2012. Amended: Filed November 20, 2013; effective December 25, 2013.Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 03, December 31, 2014, eff. 1/6/2015.Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 12, September 30, 2015, eff. 10/14/2015.Amended by Alabama Administrative Monthly Volume XXXVIII, Issue No. 06, March 31, 2020, eff. 5/15/2020.Adopted by Alabama Administrative Monthly Volume XLII, Issue No. 07, April 30, 2024, eff. 6/14/2024.Author: Statewide Health Coordinating Council (SHCC)
Statutory Authority:Code of Ala. 1975, § 22-21-260(4).