Three critical terms in the drug and alcohol testing industry - TPA, C/TPA and Service Agents, let’s identify these important parties.
So what exactly is a TPA or Third Party Administrator in the drug and alcohol testing industry? In simple terms the TPA is an organization that provides direct and administrative services to help an employer or other organization manage a drug and alcohol testing program or a complete drug free workplace program.
The term Consortia/Third Party Administrator (C/TPA) was coined by DOT with the rewrite of 49 CFR Part 40 back in 2001. C/TPA’s providing DOT drug & alcohol testing services should be intimately familiar with program 49 CFR Part 40, read it over and read it over again. Refer back to this regulation often to insure your answering questions properly and setting up your operations to be in compliance.
In 49 CFR Part 40 the C/TPA is defined as: A service agent that provides or coordinates the provision of a variety of drug and alcohol testing services to employers. C/TPAs typically perform administrative tasks concerning the operation of the employers' drug and alcohol testing programs. This term includes, but is not limited to, groups of employers who join together to administer, as a single entity, the DOT drug and alcohol testing programs of its members.
The term consortium came about as a result of smaller companies needing TPA services to effectively comply with the DOT drug and alcohol regulations, specifically random testing.
As a C/TPA we are providing or coordinating the provision of a variety of drug and alcohol testing services to employers. This is for DOT and Non DOT programs. The variety of drug and alcohol testing services are provided by service agents. Many times the C/TPA provides some of these services directly as the service agent and often some or all of these services are outsourced to service agents. Let’s discuss each of the service agents involved in the business of providing drug and alcohol testing and drug free workplace programs.
- Specimen Collectors (the collector) – These folks operate on a mobile basis traveling to and from client locations and/or work from a brick and mortar facility. The specimen collector works directly for the client, the laboratory, the third party administrator (TPA) or others. The collector is collecting a biological specimen (urine, hair, blood, sweat or oral fluid-saliva) for a testing device or a laboratory to determine the presence or absence of specified parent drugs or their metabolites.
- Collection Site: A facility where specimens are collected. This could be the employer’s place of business. Typically this is a brick and mortar facility, it could be a TPA office, a medical facility, hospital, occupational health clinic, walk in clinic, doctor’s offices – any type of business that might have a set up for urine collections and employ collectors to collect specimens. Major laboratories such as Quest Diagnostics and LabCorp operate brick and mortar facilities that employ collectors to collect specimens; these are commonly referred to as Patient Service Centers (PSC’s). Other laboratories have contracts with occupational health clinics, walk in clinics, doctor’s offices and other facilities that operate brick and mortar facilities to collect specimens.
- Breath Alcohol Technician (BAT) and/or Screening Test Technician (STT) – commonly a collector also, the BAT or STT is a person who instructs and assists persons in the alcohol testing process and operates an evidential breath testing device (Breathalyzer) or an alcohol screening device. These folks also operate on a mobile basis traveling to and from client locations and/or work at collection site; they also work directly for the client, the laboratory, the third party administrator (TPA) or others.
- Laboratories (Lab)- After collection from the donor, a specimen is sealed with a tamper-evident seal and sent to a laboratory for analysis. The primary advantages of utilizing a laboratory for testing include compliance with regulations, accuracy, legal defensibility, and the ability to customize tests for the needs of you client. A laboratory is a brick and mortar facility that does the testing, not the facility that collects the specimen. Folks get confused about this and say I’m going to the lab for my drug test, they actually mean they are going to the collection site for specimen collection. A very big investment is required to own and operate a laboratory. Major laboratories currently involved with drug testing include Quest Diagnostics, LabCorp, MedTox, Alere Toxicology, and Clinical Reference Laboratory (CRL) – there are many others also both regional and national laboratories. Testing for Federal Agency employees, DOT testing program and many State laws stipulate using labs that are certified by the Department of Health and Human Services (DHHS). Commonly called SAMHSA certified labs, it is a best practice to always use these labs which have required quality control standards and a rigorous inspection process to insure accurate test results. SAMHSA maintains a current list of certified laboratories available at: http://www.samhsa.gov/workplace/lab-list
- Instant Testing Manufacturers and Distributors - On-site instant or rapid drug testing is becoming more widely used as a more cost-efficient method of effectively detecting drug abuse amongst employees, as well as in rehabilitation programs to monitor patient progress. These instant tests are available for both urine and saliva testing. These instant test kits are visually read and subject to interpretation by the collector. They provide an indication of drug use within minutes but they are only equivalent to the immunoassay stage of laboratory testing; confirmatory laboratory testing is required for test results that are not negative. There are many industry players in the business of selling these test kits as a distributor of products. Also, many service providers use these kits in conjunction with other testing methods and services they make available to their clients. Note that under some State laws as well as DOT rules and under HHS rules for Federal workplace drug testing, these instant testing devices cannot be used.
- Medical Review Officer (MRO) - A Medical Review Officer (MRO) is a person who is a licensed physician and who is responsible for receiving and reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for certain drug test results. The MRO receives the laboratory drug test results from the lab and reports the results to the employer. Many TPA’s have in house MRO’s working for them. For Federal Programs, DOT programs and under many State laws and State law programs the MRO must be trained, qualified and certified by a nationally-recognized MRO certification board or subspecialty board for medical practitioners in the field of medical review of DOT-mandated drug tests. The MRO is required for testing for Federal Agency employees, DOT testing programs and under many State laws and State law programs. It is a best practice to use an MRO for all workplace laboratory drug testing.
- Walk in Clinics, Hospitals, Doctors Offices, and Occupational Health Clinics – All of these types of facilities might be in the drug and alcohol testing business perhaps as collection sites, third party administrators (TPA) and/or Medical Review Officers (MRO). All are potential competitors and/or potential clients and most definitely potential strategic partners for a C/TPA. Due diligence, care and verification is required to insure these facilities have the proper training and qualifications to provide any services you are requesting.
- Employee Assistance Program (EAP) Provider – EAP’s are employee benefit programs offered by many employers, many times in conjunction with a health insurance plan. EAPs help employees deal with personal problems that might adversely impact their work performance, health, and well-being. EAPs generally include assessment, short-term counseling and referral services for employees and their household members. Employers will refer employees with drug and/or alcohol problems to the EAP.
- Substance Abuse Professional (SAP) – Under DOT regulations, the SAP is a person who evaluates employees who have violated a DOT drug and alcohol program regulation and makes recommendations concerning education, treatment, follow-up testing, and aftercare. There are credentials and certifications required by DOT for one to be a qualified to act as a SAP (40.281).
- Policy Consultant or Writer – A TPA often provides to employer clients a service of developing written drug and alcohol testing policies. TPA’s sometimes have in house policy consultants or outsource this function. This manual includes a further discussion of developing drug free workplace policies.
- Third Party Administrator (TPA) – This is basically a service provider that provides two or more of the services involved in the drug testing process. A TPA or C/TPA might coordinate for an employer the entire process of the specimen collection, breath alcohol testing, the laboratory testing, the review and reporting by the Medical Review Officer (MRO) thereby providing all of these services under a one stop shop. A TPA will typically provide everything to the employer client to keep the client in compliance with the applicable regulations – DOT, State Laws etc.
A TPA decides what services they will offer to clients, some TPA’s offer all services and some only offer some services. Be clear as to what you are offering and be upfront with your clients as to what you can do and what you cannot do. Services typically provided by C/TPA’s include:
- Review existing or create new drug free workplace policies
- Sell drug and alcohol testing
- Set up collectors, collection facilities, lab and MRO accounts
- Provide custody and control forms (CCF) and other drug/alcohol testing supplies
- Set up electronic ordering of drug testing using electronic CCF
- Coordinate transfer of test results from MRO to the employer client
- Set up and manage random testing programs as a consortium or stand-alone program
- Assistance with blind specimens as needed
- Assistance with MIS reports as needed
- Various recordkeeping functions
- Troubleshoot missing or abnormal results (fatal flaw, canceled test, etc.)
- Combined billing of multiple services at multiple locations
- Employee education and supervisor training
- Provide access to Employee Assistance Program (EAP) or Substance Abuse Professional (SAP)
- Updating customer on regulations and State laws
- Ongoing customer service including consultation, guidance and answering questions
- Other occupational health testing services
Remember the employer, is ultimately responsible for compliance with the DOT drug and alcohol testing regulations; therefore, the employer must ensure that the service agent used meets all the DOT required qualifications before using the service agent. A C/TPA must take all the same pre-cautions when utilizing another service agent.
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