La. Admin. Code tit. 48 § I-11509

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-11509 - Chemical Dependency Services

A. Description

1. Chemical dependency services are provided in general acute care hospitals, in psychiatric hospitals, or in licensed free-standing substance abuse facilities. The only free standing facilities subject to section 1122 review are those licensed as hospitals or for which the expenditure is by or on behalf of a health care facility. The incidence of alcohol and drug abuse in the population has increased significantly in the past twenty years, particularly among adolescents and youth, and has stimulated public concern about substance abuse and its treatment.

2. A 28-day inpatient period is the average established treatment course, followed by outpatient or community-based after care. Treatments offered in chemical dependency units (CDU's) include detoxification, education, and individual, group, and family therapy.

B. Bed Need and Supply

1. Because of extreme differences in level of abuse, physical deterioration, emotional involvement and resource exhaustion associated with the illness, a variety of treatment models have evolved in the field of substance abuse. Among the clinical programs are detoxification services, acute medical care services, short and long term intermediate rehabilitation, and short term residential care. Nonclinical programs include social detoxification, half way houses and long term residential programs.

2. The average length of stay varies greatly among these treatment models. Among the clinical programs, it ranges from less than one week for detoxification to an excess of three weeks for short term residential care. It is this latter service, usually with detoxification, education, and individual, group, and family therapy components, which is offered in chemical dependency units (CDU's). While these programs are designed for approximately 28 days for adults and somewhat longer for adolescents, the average length of stay is usually shorter than this because of individual differences in programs, accommodation to unique requirements of patients and failure of some patients to remain for the full program. A recent survey conducted in Louisiana yielded an average length of stay of 27.44 days for this type of facility.

3. Although occupancy levels of existing CDU's in a region is the most reliable indicator of bed need at this time, there is a need to have a bed need determination methodology for planning purposes. Such a methodology can be used to project bed need estimates into regions not having established substance abuse facilities and, therefore, no occupancy data on which to base bed need. It can also be used to detect underserved areas of the state and to estimate the level of need for services.

4. To serve these several purposes, a methodology based on the prevalence of substance abuse would obviously be most appropriate. Unfortunately, there is no single, valid formula for estimating prevalence. A review of the literature turned up some 18 methods of estimating the prevalence of alcoholism alone.

5. Faced with this condition, a study committee organized by the plan development staff synthesized an algorithm for estimating bed need that is based on the Keller formula for estimating prevalence of alcohol abusers, the Massachusetts procedure for converting prevalence data to an estimate of residential bed need, and parameter values for Louisiana obtained from a survey of treatment facilities.

6. This algorithm follows:

a. determine the drinking age population (DAP) for the area (population 15 years old and older);

b. multiply DAP by 65 percent to obtain the number of drinkers;

c. multiply number of drinkers by 10.4 percent to estimate the number of abusers;

d. multiply number of abusers by 20 percent to estimate number in need of services;

e. multiply number in need of service by 7 percent to estimate the number needing short term inpatient rehabilitation;

f. divide number needing inpatient rehabilitation by 11.3 to determine number of beds needed for inpatients at 27.44 days average length of stay (AL OS) and 85 percent occupancy rate (The derivation of this factor is as follows: At 85 percent occupancy the patient days generated by 1 bed annually 310.25. At 27.4 days ALOS the average length of stay of 1 patient 1/11.3 of the annual patient days generated by 1 bed or 10.25-27.44);

g. multiply alcohol abuser population needing short term inpatient rehabilitation by 10 percent to estimate the drug abuser population requiring beds;

h. divide drug abuser population requiring beds by 11.3 to determine number of beds needed by this population;

i. add beds needed by alcohol and drug abuser populations.

7. Utilizing 1984 population data, the algorithm yields the following estimate of short term residential beds needed in the state for that year:

a. 3,338,569=DAP - State population 15 years old and older;

b. X .65=2,179,069, Estimated number of drinkers;

c. X .104=225,687, Estimated number of alcohol abusers;

d. X .20=45,137, Estimated number in need of services;

e. X .07=3,160, Estimated number needing short term rehabilitation;

f. - 11.3=280, Estimated number of beds needed for alcohol abusers;

g. 3,160 X .10=316, Estimated number of non alcohol substance abusers requiring short term rehabilitation;

h. - 11.3=28, Estimated number of beds needed for non alcohol substance abusers;

i. + 280=308, Estimated number of short term residential beds needed.

8. The number of chemical dependency beds existing in the state in 1984 actually exceeded 308, but there were then and are now areas of the state in need of substance abuse services. The reasons for this apparent paradox are that: the 308 figure represents only one type of substance abuse bed need, the state was over-bedded in some districts while under-bedded in others, and the algorithm has not been sufficiently refined to be completely accurate.

9. In the case of specific substance abuse beds needed, the 308 figure represents only the need for short term residential beds. To have estimated the need for detoxification services a factor of .33 would have been used in step 5 of the algorithm; for medical recuperation, a factor of .03; for halfway house services, a factor of .08; for long term care, a factor of .02; and for ambulatory care, a factor of .8. Of course, appropriate adjustments would have had to have been made in step 6 also. These adjustments were not made in the present Health Plan because, at this time, new services are largely limited to short term residential beds.

10. Addressing the fact that the service need algorithm is not completely accurate, it is recognized that this accuracy cannot be achieved until there has been sufficient time to explore the relationship between estimates yielded by the algorithm and empirical utilization data. Consequently, it is assumed for Section 1122 review purposes at the present time, that the most valid indicator of level of need for chemical dependency services is the utilization experience of existing services.

C. Service Area. The service area for CDU services is the health planning district in which the facility (or proposed facility) is located.

D. Resource Goals

1. Proposals for chemical dependency services which would result in an increase in general acute care hospital beds or psychiatric hospital beds must meet the resource goals for the relevant hospital type and for chemical dependency services (below). Proposals for chemical dependency services which would not result in an increase in general acute care hospital beds or psychiatric hospital beds must meet only the resource goals for chemical dependency services (below).

a. Occupancy: 60 percent occupancy for the four complete quarters prior to the application being deemed complete in all free standing CDU facilities in the service area; or

b. 60 percent occupancy for the four complete quarters prior to the application being deemed complete in all CDU units of general acute care hospitals in the service area.

c. In determining occupancy rates, beds used in the calculations are those beds carried in the DPPE inventory of chemical dependency beds, which is composed of chemical dependency beds which are exempt from prospective payment by medicare or in free standing facilities for which the expenditure was by or on behalf of a health care facility.

La. Admin. Code tit. 48, § I-11509

Promulgated by the Department of Health and Human Resources, Office of Management and Finance, LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with P.L. 93-641 as amended by P.L. 96-79, and R.S. 36:256(b).