Recent discussions with the Florida Department of Children & Families (DCF) has led us to believe that the agency will be undertaking rulemaking in the coming months if not weeks to eliminate what is commonly referred to as “Residential Level 5 Housing” or simply “Res. 5” (technically referred to “Residential Treatment, Level 5”).
In contrast to Residential Treatment, Levels 1-4 (which are true “inpatient” care), Res. Level 5 programs “are those that provide only housing and meals to clients who are mandated to receive services at alternate locations in facilities that are owned and operated by the same provider.” See Rule 65D-30.007(2)(e), Fla. Admin. Code.
The intent of this rule was to allow outpatient providers to require their clients to reside at housing the facility provided (as opposed to relying upon third-party housing providers, which can be particularly concerning in South Florida, with its over-concentration of unregulated treatment-oriented residences).
Res. 5 housing both made licensed recovery housing more accessible (for all outpatient services for clients once stepped down from PHP level of care) but also afforded treatment providers the ability to protect their clients from the “bodysnatching” which pervade the industry in South Florida. Res. 5 also allowed the treatment provider to provide a more complete continuum of care while the clients were away from the counseling center.
However, as with all aspects of healthcare, Res. 5 wasn’t without its own financial abuses.
First, some providers with outpatient licenses who had obtained the Res. 5 license for their housing have apparently tried to bill insurance companies for providing “Residential Treatment,” since the license does say “Residential Treatment Level 5”. Aside from clearly billing for unlicensed services, some of the services that were be provided also fell under the facility’s outpatient services, creating a double-billing scam. Others utilized the Res. 5 license to bill for urinalysis testing at the residence itself, in addition to at the clinical location.
Second, some providers were attempting to use the Res. 5 license as a vehicle to avoid patient brokering since the payment of rent is no longer a requirement if the housing is licensed as it is tied into the outpatient clinic license (though, insurance still was not paying for the room and board). Rather, providers were using Res. 5 as a marketing tool of “free rent” in exchange for getting access to the client’s insurance benefits. Granted, the same could be said of PHP providers (“Day or Night Treatment with Community Housing”) but the Res. 5 license opened up this practice to a much larger pool of licensees.
With the current fast-tracking of Florida House Bill 21 (2015) relating to the certification of recovery residences, the impact of the possible elimination of Res. 5 housing remains to be seen.
We anticipate being very involved at the state level in discussions with DCF as to replacing this vacuum with additional housing options so that treatment providers and their clients are not adversely affected. In our opinion, safe and well-run recovery housing is not an “option” but rather a therapeutic necessity when it comes to caring for people in treatment.
Read more here:
65D-30007 Standards for Residential Treatment