Licensing rules stymie treatment centers

By MARK HAYWARD of the New Hampshire Union Leader. Excerpts:

"Three New Hampshire residential drug treatment centers are being forced to get health care facility licenses, an expensive endeavor that involves upgrading old buildings to meet hundreds of regulations, everything from elevator installation to bedroom size.

Heads of two organizations said they face the prospect of spending hundreds of thousands of dollars to meet the requirements. If they don't or can't, they won't be able to tap private insurers and Medicaid to pay for treatment services.

“It's bureaucracy at its finest,” said Heidi Moran, clinical administrator of Southeastern New Hampshire Services in Dover, the only residential drug treatment center in the Seacoast. In the middle of a statewide heroin epidemic, Southeastern has already reduced the number of treatment beds in order to meet the standards.

Serenity Place in Manchester would have to spend $1 million if it wanted to retrofit its Manchester Street facility to meet the licensing requirements, said Executive Director Sharon Drake. Rather, it hopes to move to a new location."

"All face a deadline of June 30, 2016, to have licenses in hand. Joe Harding, the director of Bureau of Drug and Alcohol Services for the state of New Hampshire, said the treatment centers have known for two years that the regulations were coming.

Harding acknowledged that organizations skirted the regulations for years. Private insurers had stopped paying for residential substance abuse treatment, and organizations relied on whatever they could — state funds, private donations and other sources — to keep their programs going.

Now, the Obamacare law requires Medicaid and private insurers to pay for substance abuse services.

“With the increased resources come increased requirements,” Harding said. “These services need to be in the mainstream of health care.”

Harding said many of the requirements are for health and safety codes."

"In Manchester, Serenity Place would have to spend $1 million and still end up with fewer beds, Drake said.

Earlier this year, the organization tried to move to vacant space that had been used as a school for troubled teenagers. But the effort was thwarted when the city rejected the move because of neighborhood opposition. Serenity Place has made an offer on a second location, Drake said.

But whether it moves or decides to stay and upgrade, it has less than a year to meet licensing standards. At risk is $760,000 it receives for 30 beds of transitional living.

“The loss of that state funding will close us,” Drake said. Moran said her agency will have to spend $500,000 to meet the standards. She hopes to get a loan or grant for $300,000, the other $200,000 will come out of cash flow.

She's said she's been working on the licensing standards for two years.

She finds a requirement for bedrooms aggravating. Two-person bedrooms must be 160 square feet, a standard that Moran said was developed with nursing homes in mind. Southeastern's bedrooms are 122 square feet, and the state has rejected her request for a waiver.

“In a nursing home, grandma might live in her room (and need the space),” Moran said. “My clients sleep in their room, that's it. When you're recovering, it's not healthy to be alone in your own head.”"