Behavioral Health Compliance for Addiction and Mental Health Treatment

, ,
behavioral health compliance

When you launch a behavioral health treatment program, you may become overwhelmed by the numerous compliance mandates you’ll encounter. In fact, mental health and addiction treatment centers face the same federal and state laws that all healthcare centers do. Behavioral health compliance is indeed driven by a commitment to patient safety and best practices.

About Behavioral Health Licensing

Patients who enroll in a mental health or addiction recovery program are placing their trust in your program. State licensing provides a set of benchmarks that are designed to ensure that patients entering a behavioral health center are protected. These benchmarks address safety staffing qualifications, caseload limits, and other minimum standards that protect both patients and employees.

Every state agency has its own licensing requirements specifically designed for behavioral health centers. The licensing agencies provide the criteria that must be met to be able to operate within the state. Behavioral health compliance requires that the treatment center renew its license at specified intervals to update standards as needed.

It is up to the treatment center leadership to designate a person or department to maintain compliance with these standards.

Behavioral Health Licensing Entities

It isn’t only the state that is involved in licensing rehabs and mental health clinics. There are also international agencies that provide accreditation above and beyond the state requirements. These are the main licensing entities for the behavioral health field:

  • State Licensing. Professionals within the health and human services industries must adhere to the state licensing requirements. Because each state may use a slightly different title for the various treatment roles, the state requirements apply based on the role, not the title.

For instance, within the behavioral health field, mental health and addiction counselors go by various titles depending on the state. The titles might be professional counselor, mental health counselor, clinical professional counselor, clinical mental health counselor, and mental health practitioner. All of these would require a certain education and training level and a license to practice.

The National Survey of Substance Abuse Treatment Services (N-SSATS) identifies which programs require licensure, and what types of programs can operate.

  • CARF. The Commission on Accreditation of Rehabilitation Facilities (CARF) is an independent, non-profit agency that established industry standards for healthcare. This includes providers in the behavioral health field. When a treatment center is CARF accredited, it ensures patients receive quality, value, and optimal outcomes. CARF assures prospective clients that the facility is committed to the highest standards of care.
  • Joint Commission. The Joint Commission is an independent, non-profit entity that offers a certification program for healthcare organizations and programs. Behavioral health providers choose to pursue Joint Commission certification because it shows prospective clients that it is following state-of-the-art standards. Joint Commission standards were developed by health care professionals, government agencies, consumers, and other experts in the field. Today, most insurance companies require behavioral healthcare programs to be accredited by either the Joint Commission or CARF.

HIPAA Compliance for Behavioral Health Treatment Providers

In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was passed in to establish national privacy standards. This law required the healthcare and related fields to comply with privacy protections for patients. The law was further fortified in 2016 with an amendment that addressed electronic medical records and digital privacy.

HIPAA compliance is overseen by the Office of Civil Rights  (OCR) within the Department of Health and Human Services. The OCR is tasked with enforcing the privacy laws, and randomly selects providers to audit their compliance.

HIPAA addresses these areas of focus:

  • The Privacy Rule. The privacy rule ensures the privacy of protected health information and includes putting standards in place to protect EHR.
  • The Security Rule. The security rule requires that treatment centers put administrative, technical, and physical safeguards in place to protect patient health data.
  • Notification in Event of Breach. When a HIPAA breach occurs, the treatment center is required to notify various parties about the violation.

5 Ways to Improve Behavioral Health Compliance

Behavioral health providers must develop systems to help them maintain compliance. Some may prefer to have a contractor assist with this cumbersome task, so a compliance consultant fits that role. There are several methods that a compliance consultant can employ to improve a provider’s compliance. These include:

  1. State and federal regulatory guidance. They can offer guidance on how to meet state and federal requirements regarding various criteria. They can help with administrative structure, financial planning, human resources, staff training, and client and staff safety planning.
  2. Local zoning guidance. They will acquire use permits and public relations assistance for local city operating requirements. Behavioral health organizations with multiple locations, they’ll address each local entity’s specific zoning and licensure requirements.
  3. Quality assurance. They can install ongoing quality assurance systems to improve clinical documentation, medical necessity, and compliance with insurance, state, and accreditation. Because the efficiency of these systems rests on staff and management oversight, they will ensure that procedural guidelines are followed.
  4. Accreditation and certification. The consultant can ensure that complex guidelines set by CARF and Joint Commission are met. A careful review of the requirements helps identify missing elements in existing licensing efforts. If just starting out, they will provide guidance from start to finish.
  5. Monitoring outcomes. They will install outcome measurement systems for value data tracking and performance improvements. The systems provide invaluable compliance data that allows for timely adjustments, improved staff training, and better treatment programming.

Circa Behavioral Healthcare Solutions Can Oversee and Improve Compliance Adherence

Circa Behavioral Healthcare Solutions is a professional consultancy that specializes in the behavioral health field. If you wish to improve your addiction or mental health treatment center’s behavioral health compliance standing, we can help. Reach out to us today at (888) 458-6619.