Yesterday, the Florida Department of Children and Families (DCF) published a Notice of Proposed Rule Development to revise Rule 65D-30.007 relating to Residential Treatment. While most of the language creates distinctions among adult and adolescent inpatient residential treatment programs, the real reason for the rule proposal was to eliminate what was commonly referred to as “Residential Level 5” housing.
Knowingly, intentionally, and in my opinion, negligently, as well as recklessly, DCF has sought to eliminate this level of housing rather than confront and address the issue of necessary housing to support outpatient treatment services.
Actually, I am not completely surprised, as DCF’s main office in Tallahassee has stated to us via telephone on more than one occasion that: “DCF regulates treatment providers and is not involved in housing.” While DCF would like to be out of the housing regulation and oversight business altogether, that is akin to AHCA saying they want to regulate procedures and surgeries, but have someone else oversee hospital rooms and rehabilitation centers.
Aside from flying in the face of conventional wisdom about the continuum of care and the necessary role that therapeutic housing plays in ensuring sustained recovery, the origin of this rule change stems back from our efforts to get DCF to openly acknowledge (rather than behind the scenes) that the original intent of “Res. 5 housing” was to afford treatment providers the opportunity to provide housing and meals to their patients in dwellings the provider controls, on par with the same standards as “Community Housing” under Rule 65D-30.0081 (“Day or Night Treatment with Community Housing” aka “PHP” or “Partial Hospitalization care).
The rule adoption in 65D-30.007, however, was an after-the-fact “oops” when they (DCF) realized that, by putting Res. 5 Housing in that section, they made such housing subject to all of the rules that inpatient residential treatment is subject to. That was never the intent, and DCF will quietly admit that.
As a result, we had filed a “Petition for Rule Waiver” back in November of 2014, asking DCF to simply treat these two housing options the same, as Res. 5 Housing was being held to a much higher and more expensive standard.
We simply asked that, if PHP-level care was deemed the “most intense” outpatient level of care, that the residential component associated with that license be the standard for all lower levels of outpatient housing.
Moreover, to the extent insurance companies were only reimbursing for services at the outpatient level (oftentimes below PHP), it was the responsibility of DCF to recognize that safe, therapeutic housing be made available, particularly in light of all of the abuses arising from the so-called “sober house” industry.
As a result of us expressing these concerns to DCF, the agency told us, point blank, that they were going to engage in this Rule Development process and create what was the equivalent of “IOP with Community Housing” and “Outpatient Services with Community Housing” and so forth. This would, in turn, allow all housing associated with treatment providers to be provided at no charge and effectively “even the playing field” by eliminating the patient brokering scheme of “live here for free so long as you go to the treatment center of our choice.”
On the back end, we were hopeful that FARR or its equivalent would then be able to train providers how to create a true therapeutic community and “certify” those homes as meeting the minimum standards for therapeutic housing associated with outpatient treatment.
When DCF continued to sit on their hands, we took them to court (technically, the Division of Administrative Hearings) to assert that DCF had waived that opportunity by delaying for so long and must approve our petition seeking to have Res. 5 Housing treated the same as Community Housing under a PHP license.
When the hearing came before the Special Magistrate, DCF represented once again that they would be seeking Rule Development and apologized for the delay (which they attributed to both the 2015 legislative session in Tallahassee as well as the new hiring of DCF Asst. Secretary John Bryant, the SAMH Program Director).
We all agreed that DCF would have until 9/28/15 (yesterday) to start its Rule Development and, if they did so, we would not pursue our petition.
Low and behold, DCF did issue its Notice of Rule Development, on the day it was due (and not a second earlier). However, nowhere in that proposed rule is there any discussion about adding housing opportunities to outpatient treatment. Rather, they are simply eliminating Res. 5 Housing altogether.
As for the proposed rule development for 65D-30.007, and pursuant to Chapter 120, F.S., DCF will hold a public workshop to receive comments. If you have an interest in this topic, I strongly encourage you to be involved.
My experience to date has been that DCF is completely unaware of how the Substance Use Disorder industry works, and is either in denial, or is completely naïve, of the plethora of issues confronting honest and ethical treatment providers across our state as it relates to providing housing options for their patients. In light of the overwhelming national consensus that housing opportunities must be provided commensurate with treatment, combined with the need to work with local stakeholders in the non-recovery community about the proper role that such housing has and needs to have, we continue to fight an uphill battle by the very agency (the only agency) who is supposed to be our ally.
Rule 65D-30 007 FAC – Notice of Development of Rulemaking FAR Vol. 14_188 (September 28, 2015)