Introduction
Substance use disorder (SUD) is a pressing issue in Virginia, affecting individuals and communities across the state. Establishing a SUD treatment program can make a significant difference in addressing this challenge and providing support to those in need. Most states highly regulate these types of programs, including an extensive licensing and review process. In this blog post, we’ll outline a step-by-step guide for individuals interested in opening a substance use disorder treatment program in Virginia.
What Programs Need to be Licensed
States determine which programs need to be licensed to legally operate. Virginia’s Department of Behavioral Health and Developmental Services (DBHDS) is the state agency responsible for licensing facilities that require a license. Virginia has an extensive list of programs requiring licensing and it includes the following:
- Assertive community treatment (ACT)
- Case management;
- Clinically managed high-intensity residential care or Level of care 3.5;
- Clinically managed low-intensity residential care or Level of care 3.1;
- Clinically managed population specific high-intensity residential or Level of care 3.3;
- Community gero-psychiatric residential;
- ICF/IID;
- Residential crisis stabilization;
- Nonresidential crisis stabilization;
- Day support;
- Day treatment, includes therapeutic day treatment for children and adolescents;
- Emergency;
- Group home and community residential;
- Inpatient psychiatric;
- Intensive in-home;
- Medically managed intensive inpatient service or Level of care 4.0;
- Medically monitored intensive inpatient treatment or Level of care 3.7;
- Medication assisted opioid treatment;
- Mental health community support;
- Mental health intensive outpatient;
- Mental health outpatient;
- Mental health partial hospitalization;
- Psychosocial rehabilitation;
- Residential treatment;
- Respite care;
- Sponsored residential home;
- Substance abuse intensive outpatient;
- Substance abuse outpatient;
- Substance abuse partial hospitalization;
- Supervised living residential; and
- Supportive in-home
As you can see, substance abuse residential, substance abuse partial hospitalization, substance abuse intensive outpatient and substance abuse outpatient all fall under the category of programs that need to go through the licensing process.
The Licensing Process for Substance Use Disorder Treatment Programs in Virginia
Virginia actually makes the licensing process very streamlined! The entire process is done through their Connect portal, which means it’s entirely paperless. We love to see it! There is also a wealth of information on their website, which you can find here.
Essentially, you will register as a new provider within the Connect portal. You will need Provider Organization information to create your account. Once granted access you can begin the application process!
Virginia requires all new providers to select one level of care for initial licensing. That means you cannot receive an initial license for PHP, IOP and OP. You would select on level of care and after that is approved, you can submit a variance request to add on additional levels. The state believes that programs are better set up for success when they start small as opposed to trying too much at once.
The Connect portal includes all of the information needed including the following:
- Policies and procedures
- Job Descriptions
- Service Description
- Annual Budget
- Proof of Available Funds
- Floor Plan
- Use & Occupancy
- Location Information
- Owner Information
The application for a substance use disorder treatment program in Virginia cannot be submitted without all of the above. The portal makes this process easy as you will know if there is information missing.
Once your application has been submitted, it will be sent to a Policy Review Specialist within DBHDS to confirm that all of the documents are correct. If more information is needed, you will receive an alert through your Connect portal requesting updates or additional documents.
SUD treatment programs are given “priority” status in Virginia, meaning the applications will be reviewed within 10 days! That is very expedited compared to other states. After the review process is complete, the application is then sent to your regional Licensing Specialist who will issue your conditional license! Conditional licenses are given to providers for a duration of 6 months, during which time an onsite review will be conducted by DBHDS. Note: Residential SUD services require an onsite review PRIOR to receiving the conditional license, outpatient programs have their onsite review after receiving their license.
At this point you are legally able to operate as a SUD facility in Virginia!
Enrolling with Virginia Medicaid
Once you’ve obtained your license, you will want to start the process of enrolling with Virginia Medicaid. Virginia’s Department of Medical Services (DMAS) is the agency that oversees this process. You will enroll with DMAS and the accompanying five MCOs. The MCOs are:
- Aetna Better Health – 1-800-279-1878 or TTY: 711
- Anthem HealthKeepers Plus – 1-800-901-0020 or TTY: 711
- Molina Healthcare – 1-800-424-4518 or TTY: 711
- Sentara Community Plan – 1-800-881-2166 or TTY: 711
- UnitedHealthCare Community Plan – 1-844-752-9434 or TTY: 711
Virginia launched an enhanced substance use disorder treatment benefit – Addiction and Recovery Treatment Services (ARTS) in 2017. ARTS provides treatment for members with substance use disorders across the state. The ARTS reimbursement guide is what you will follow for billing purposes for SUD services.
Is Accreditation Required?
Accreditation is through companies such as CARF and Joint Commission. Holding accreditations means that, in addition to meeting the requirements to be licensed by the state, the addiction treatment program adheres to certain policies, guidelines, and standards of practice and care set by a respected third-party organization in the addiction and mental health treatment industry.
Some states, such as Maryland and Ohio, require accreditation before even being licensed through the state. While Virginia does not have such a requirement, accreditation is always an added step to ensure your program meets certain standards. Some insurance payers ever require it, including some of the Virginia Medicaid MCOs. We always suggest that programs take the extra step and receive accreditation.
Conclusion
In conclusion, the process to open a substance use disorder treatment program in Virginia has many steps to follow. Our experience has shown that the process is more streamlined in other states and the portal makes the work very straightforward. What is most important though is following through on all of the guidelines DBHDS requires to ensure that you’re set up for a successful program once operational.
Revive BHS has extensive experience working in Virginia, both with licensing/accreditation and credentialing/billing. Our team is here to help guide you through the process. Reach out today to learn how we can help!