Q23: On September 14, 2011, the Office of the Inspect General (OIG) released the
“Excerpt of Report of Special Evaluation: The Addiction Prevention and Recovery
Administration Detoxification and Stabilization Center” (IG19-0041). Please provide an
update on APRA’s response to the findings of this report, including any planned
adjustments in APRA organization, policy, or procedure. At a minimum, please address
the OIG’s recommendations contained in the report:
 That substance abuse treatment providers promptly respond to OCR’s requests;
 That substance abuse treatment providers have adequate policies and procedures
that are readily available to all employees in accordance with the DCMR;
 That substance abuse treatment facilities establish regular schedules and
standardized processes for updating policies and procedures;
 That substance abuse treatment facilities maintain adequate nursing staff in
compliance with the mandatory nurse-to-patient ratio set forth in the DCMR;
 That detoxification centers maintain 24-hour a day on-site physician coverage in
accordance with the DCMR;
 That substance abuse treatment facilities accurately track and document their daily
patient populations to ensure staff-to-patient ratio requirements are consistently
met;
 That substance abuse treatment facilities provide and document effective employee
supervision;
 That substance abuse treatment facilities provide employees both the initial and
ongoing training needed to competently fulfill their job responsibilities; and
 That the D/DOH establish and promulgate clear criteria for closing substance abuse
treatment facilities that do not meet the District’s standards, and define conditions
and events that would automatically trigger the closure of a substandard facility.
Response: In October 2011, APRA provided the Office of the Inspector General (OIG) its
response to the findings released in the Excerpt of Report of Special Evaluation: The Addiction
Prevention and Recovery Administration Detoxification and Stabilization Center. In its
response, APRA notes that the Detoxification and Stabilization Center (DSC) was closed two
years prior to the issuance of the Report. Its closure was precipitated by a DOH commissioned
evaluation of APRA conducted by KPMG, LLC and an evaluation of the DSC conducted by Dr.
Peter Luongo, former Alcohol and Drug Abuse Administration (ADAA) director in Maryland.
These two evaluations revealed that the dual roles of APRA as regulator and provider of direct
services represented a conflict of interest and that the operation of services at the DSC was
inefficient, costly, and clinically outmoded. These findings and the recommendations of KPMG,
LLC and Dr. Luongo prompted APRA and DOH management to close the direct service
treatment programs in its portfolio, including the DSC, and to undertake a realignment in 2009.
This realignment allowed APRA to strengthen its oversight functions, to enhance service quality,
and to fully realize its role as the Single State Authority for substance abuse services in the
District of Columbia. Prior to the realignment, the majority of APRA staff was devoted to
providing direct substance abuse treatment services. Following the realignment, the majority of
staff at APRA is now devoted to oversight and monitoring of the treatment provider network in
the District of Columbia.
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Pursuant to the District of Columbia Substance Abuse Treatment and Prevention Act of 1989
("Act") effective March 15, 1990 (D.C. Law 8-80; D.C. Code § 32-1601 et seq.), a substance
abuse treatment program or facility must be certified by the Department of Health in order to
operate lawfully in the District of Columbia. Regulations promulgated to enforce the Act
include a provision for denial, suspension, or revocation of certification for failure to comply
with provisions of the Act, the regulations, and all other applicable provisions of law. See 29
DCMR 2367. In addition to describing criteria for the denial, suspension, or revocation of
certification, the regulations also permit the Department to summarily suspend a certification of
any facility or program if the Department determines that existing deficiencies constitute an
imminent or serious danger to the health, safety or welfare of its patients. DOH/APRA
continuously monitors certified substance abuse treatment programs and facilities to ensure
compliance with regulatory standards. In addition, DOH/APRA investigates complaints and
unusual incidents made against certified treatment programs and facilities. If circumstances exist
that meet the criteria in 29 DCMR 2367, DOH/APRA would not hesitate to follow the steps
outlined in the DCMR to suspend or revoke a facility’s certification.
The Certification and Regulation Division (CRD) is responsible for certifying substance abuse
treatment programs and ensuring adherence to the standards within the DCMR. Following the
realignment in 2009, APRA implemented several critical changes to the processes and protocols
that CRD utilizes to certify and monitor substance abuse treatment providers. APRA now
notifies providers of the need to submit an application for recertification 180 days prior to the
expiration of the existing certification. APRA also revised the recertification notice to clearly
indicate that programs will not be permitted to continue to provide treatment services in the
event that the existing certification lapses. This is a change from past agency practice, which
permitted programs to continue to provide treatment services after certification lapsed.
CRD conducts an inspection of the facility and a review of all policies and procedures during
each program’s initial application for certification, the recertification inspection process, and
routine follow-up site visits that now occur at each program at least once per year. During these
inspections, CRD staff reviews program policies and procedures to ensure that they are being
updated on a regular basis and are readily available to all staff, and observes counseling sessions
and other activities provided by the program to ensure that they are consistent with applicable
DCMR standards and program policies and procedures. The inspection also includes a review of
a sample number of personnel folders to ensure that all staff have the appropriate credentials and
have received the necessary training and supervision to competently fulfill their job
responsibilities. Training and supervision is a major component of the regulations for licensed
certified addiction counselors recently implemented by the Department of Health and must be
documented in employee personnel folders.
APRA has also developed a bulletin system to communicate with providers regarding APRA
policy and interpretation of standards within DCMR Title 29, Chapter 23. Utilizing this system
APRA has developed a bulletin reiterating and reinforcing the DCMR standards regarding nurseto-patient ratio and the need for 24 hour on-site physician coverage at detoxification facilities.
Chapter 23 currently authorizes APRA to summarily suspend the certification of any facility or
program if the Department determines that existing deficiencies constitute an imminent or
serious danger to the health, safety or welfare of its patients. In addition to APRA’s existing
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authority to summarily suspend a provider for serious deficiencies, DOH and APRA have drafted
a civil penalties rule to apply to Title 29, Chapter 23 of the D.C. Municipal Regulations. At
present, DOH/APRA does not have the authority to fine programs determined to be noncompliant with Chapter 23. DOH/APRA finalized the civil penalties rule in FY12 and intends to
publish the rule in FY13.
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