Tag Archives: DCF

Florida DCF Releases Final Draft of Changes to Chapter 65D-30

The Florida Department of Children and Families (DCF) released today its Notice of Hearing relating to further proposed revisions made to Chapter 65D-30 of the Florida Administrative Code. These rules govern the licensure, management, regulation, as well as service delivery of care relating to Substance Use Disorders.

A copy of the revisions made to the initial rule change proposed in January 2018 is attached.

The hearing on the proposed changes is taking place at DCF’s office in Tallahassee on November 7, 2018, 10:00 a.m. – 12:00 p.m.  There will not be live-streamed videoconferencing across the state as had been offered in January 2018.  Considering the very large turnout at those prior gatherings, this comes across as somewhat of a surprise, and disappointing that input is somewhat limited.

However, DCF is offering interested persons to “attend” via conference call: Dial 1(888)670-3525; Code: 800 740 0450 #

Questions or concerns should be addressed to: Jodi Abramowitz at (850)717-4470 or Jodi.abramowitz@myflfamilies.com

A few comments on items that we gleaned from the changes:

  • Definition of “Best Practices” – DCF requires licensed service providers to implement “best practices” and had defined those previously to be the standards adopted by ASAM. The definition is now much more broad and not as specific, seemingly requiring a provider to select which “validation tool” it believes to be “best practices” and to implement same.  We were hoping that the State would require specific standards so that insurance carriers would then not be dictating health care in this space, but that discussion seems to have gone in a different direction.
  • Change of Ownership/Transfer of Licensure – While state statute prevents a transfer of ownership/licensure in the SUD treatment space (unlike medical health care), the proposed revisions to the rules now make it clear that the plain language of the statute controls – that a “transfer” occurs when 51% or more of ownership is sold/transferred/acquired. Anything less would likely continue to only require submittal of notice to DCF of the identification of the new owners/investors and a Level 2 background check (which has been the consistent interpretation of DCF for many years, until recently).
  • Medical Consultant – the term “Medical Consultant” has been created, we believe, to distinguish the term from a “Medical Director”, the latter of which is only required for inpatient treatment services.
  • Clinical Supervisor – the term had been proposed by DCF back in January but has been since proposed for exclusion from the new rules.
  • Licenses for Each Location – it is not clear from the revisions whether DCF is now eliminating the requirement that an existing licensed service provider must submit a complete license application to provide the same services at a second location. Specific language was struck from the rules revision requiring a separate license “for each facility that is maintained on separate premises even if operated under the same management.” We will seek further clarification as to this point, as well as the intended concept of “overlay services.”
  • License Fees – not proposed for significant change (DCF license fees are significantly less than AHCA licensed facilities).
  • Calculation of “Days” – The ways that the number of days from which an event must occur (such as a license renewal application) has been changed from “calendar days” to “business days.” This is a significant and impactful change, when it comes to license review by the Department, but also benefits in a way treatment providers. Renewals were required to be submitted no less than 60 days prior to expiration. That has now been proposed to be changed to “business” days, which is approximately 12 weeks.  On the flip side, the Department is now proposing that it have 30 business days to review a new application to determine initial completeness. So, what would have been a month would now be 6 weeks or more.
  • Medical Directors & Number of Facilities – DCF has endeavored to try to create a methodology for determining the maximum number of individuals a Medical Director may serve (noting that a “medical director” is only still required for addiction receiving facilities; detoxifications; intensive inpatient treatment; residential treatment; and methadone medication-assisted treatment). This methodology, found within proposed Rule 65D-30.004 (Common Licensing Standards), subsection (6), breaks down the maximum number of patients that can be under a single Medical Director’s supervision, based upon license type.  However, a Medical Director is still not required for outpatient services.
  • Critical Incident Reporting – it appears that DCF has attempted to incorporate into rule the IRAS critical incident reporting tool, CFOP 215-6, for ease of reference. It should be noted that a mandatory reporting incident now includes: “Events regarding individuals receiving services or providers that have led to or may lead to media reports.”
  • Delivery of Clinical Services – The proposed changes to the rules appear to continue to require that all clinical services now be provided by either the Qualified Professional or by persons with specific degrees or recognized certifications.  “Mental health counseling interns” have been added.  It currently remains unclear whether non-clinical staff may still provide therapy and counseling.

This information is intended simply to make the reader aware of the proposed changes, and the date for the DCF hearing. It is not intended to be an analysis of the proposed changes or to be a substitute for clinical, compliance and/or legal counsel to determine the impact any of these proposed changes may have upon ownership, management, operations and service delivery.

The proposed rule changes are not final and still must go through a process for final adoption. Therefore, any comments any reader may have regarding the proposed rules should be directed to Jodi Abramowitz at DCF prior to the hearing on November 7, 2018.

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Consistent with the prior rule proposal back from January, DCF is continuing to propose the elimination of Residential Treatment Level 5.

“Day or Night Treatment with Community Housing” had been proposed for elimination but has been kept in the October 2018 proposed rules.

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DCF Advises Treatment Providers That ALL Recovery Residences Must Be Certified

On May 29, 2018, the Florida Department of Children and Families (DCF) issued a memorandum to all licensed service providers reminding them that, effective July 1, 2018, any and all referrals to any recovery residences may only be made to a home certified by the Florida Association of Recovery Residences (FARR).

There had been prior confusion as to whether this law, codified within s. 397.4873, Florida Statutes (“Referrals to or from recovery residences”) applied to outpatient housing owned and/or provided by a treatment provider under a PHP or Level 5 Residential Treatment license.

DCF, in coordination with FARR and the Palm Beach County Sober Home Task Force, has reaffirmed that all PHP (Day/Night with Community Housing) and Res. 5 recovery residences are required to obtain FARR certification in order to refer or accept referrals. There are no longer any exceptions provided in statute or 65D-30.

Applications must be submitted and complete by July 1.

A Trick, or a Treat, from DCF and the Federal Government in the War on Addiction?

Ok, SoberLawNews readers, I am giving you a head’s up that this is going to be a lengthy, ranting post about how the country’s ongoing detrimental reliance on government to solve the opioid epidemic is not only misplaced, but also completely ignores long-tested and proven realities that the private sector is best suited and optimized at addressing pressing issues using marketplace innovation.

To the contrary, government is generally driven by policy that is adopted by politicians.  How long did it take for Florida’s Governor Scott to declare a public health emergency? And President Trump?

Government is, admittedly, and in the sage words of State Attorney Dave Aronberg, better equipped to be responsive rather than proactive. Government is simply not designed nor structured to react quickly, with the exception of our military, our first responders, and our other emergency management services (such as during hurricanes).

There, we can defend ourselves from an approaching enemy; save someone from a fire; and prepare for a natural disaster.

But we are not as good at having resources at our disposal to deal with this unnatural disaster.


In our military, the private sector develops and innovates new weapons to keep us safe, that the government then buys.

For our first responders, the private sector develops effective protections to keep them safe, that the government also buys.

With regard to natural disasters, such as the recent hurricanes, the government looks to the private sector and their innovation to address mass vegetation collection or to create sufficient power generators to keep our gas stations and food stores open.  We look to a private company – Florida Power & Light – to quickly get us up and moving again.

So why is the private sector deemed evil and inappropriate in the drug and alcohol treatment space?

Surely in medical healthcare, we depend upon profit-motivated innovation to develop the next MRI, the next vaccine, the cure to the next unforeseeable disease.

But for addiction treatment, and public health in particular, we depend too much on the government. And how’s that been working out for us?

While we are hopeful these new public health emergency declarations will free up more federal money for public sector providers to treat their client base, that client base is made up almost exclusively of the indigent and uninsured.

As for the rest of the United States that has private insurance either through an employer or the individual marketplaces (thanks Obamacare!), we appear to be on our own, subjected to a litany of out-of-network treatment providers that are repeatedly demonized because they are for-profit.

Ironically, the federal government recognizes that it is the private sector who is best positioned to solve our country’s opioid problem.

Yesterday we posted to the blog “Will Addiction Treatment Be Eliminated from Obamacare Requirements?” about how CMS has proposed a new federal rule aimed at giving states “more flexibility in interpreting the Act’s Essential Health Benefits mandate as a way “to lower the cost of individual and small group health plans.”

And why?

In their own words, “To maximize innovation….. We believe that encouraging innovation is especially important now, given the stresses faced by the individual market,” the proposed rule states.

Not government innovation.  Government does not innovate. There is no incentive to do so.

Why the heavy dependence on non-profits and the government in this space? It is simply our history, as well as the reality that no one was providing addiction treatment services for years because there was no money to be made in the space.

This led, in part, to the creation of Alcoholics Anonymous and associated sober living.

In AA, profiting from addiction treatment is heresy. And I get it.

As interpreted by the 12 Traditions (as opposed to the 12 Steps), it is heretical to profit from providing a path to sobriety (“An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.”).

However, AA was created out of necessity and during a time when medical healthcare viewed mental health and substance abuse in particular, as a failure of self, a failure of personal constitution.

Knowing that not to be the case, the 12 Steps and 12 Traditions were created out of innovation as well.  However, this innovation came from communal support, not government support. It was the rare instance where the saying “it takes a village” has been proven out, without being pejoratively labeled as “Communism.”

Unlike private for-profit drug and alcohol treatment providers, we don’t hear the same public demonizing and shaming of for-profit cancer oncologists or even addiction psychiatrists, all of whom are overwhelmingly out-of-network because in-network insurance significantly underpays for value received.

Once “treatment” became a recognized modality in the early stages of behavioral health systems, Florida and the rest of the nation consisted primarily of individual providers funded by local governments or charitable donations and no organized system of publicly funded mental health programs existed. This changed in 1968, when the Florida Constitution was revised to assign health and social services to the Department of Health and Rehabilitative Services (DHRS). This became one of the first attempts in the nation to integrate health and human services, and was meant to address the increasingly complex health and social needs that were neglected through a disjointed and inadequate system of care.

Florida began the first of many attempts to restructure and improve DHRS in 1975. A de-centralized model was created “to better implement services at the local level.” The old structure was abandoned and the Alcohol and Drug Abuse and Mental Health (ADM) program offices were created. Over time, ADM offices took over the roles of mental health boards, eventually completely replacing them.

Most recently, in 1996, the Florida Legislature made further adjustments. It expanded the de-centralization to make more “districts” and reorganized the health and rehabilitative system once again, dividing DHRS into two separate entities: the Department of Health, which regulates health care providers and facilities; and the Department of Children and Families (DCF), which is responsible for the State’s foster care and child protection system; elder care programs; and the regulation of what is the multi-billion dollar private health care industry of SUD treatment.

But back to modern society….

A vast majority of readers have sent in questions asking what the President’s long-awaited declaration of a public health emergency will entail, and what it means for the future of both the health of our country and the health of the treatment industry itself.

StatNews.com obtained an early release of the President’s Commission on Opioids report, and as I see it, the proposals appear to do a lot for the indigent and those arrested for drug crimes (i.e., let’s turn the spigot back on against addicts in the War on Drugs and make them all unemployable and undesirable second class citizens).

But for the vast majority of Americans who have insurance, I believe the proposals do absolutely nothing.

While there are 53 recommendations set forth in the draft form of the Presidential Commission Report, STAT has identified these highlights:

(1)   Drug courts in all federal judicial districts

The Commission will recommend the Department of Justice establish drug courts in every federal district, and that individuals with substance use disorder who violate probation terms be diverted to a drug court as opposed to prison.  Drug courts combine elements of criminal justice and addiction treatment to help those with substance use disorder avoid criminal sentencing, provided participants comply with a treatment course that can include counseling and medication-assisted treatment.  In other words, in order to get help, you need to get arrested. In federal court. Brilliant.

(2)   Streamline federal funding opportunities

The Commission will recommend a system for distributing federal funding that expands the process for obtaining block grants offered by the Substance Abuse and Mental Health Services Administration (“SAMHSA”). That process should require only one application and should result in states receiving at least equivalent funding while allowing them to redirect resources currently used for paperwork toward program implementation.  In other words, the government funded entities that deal with the indigent and other public health entities will continue to be eligible for block grants.  We’re just shuffling money from Peter to Paul. Does nothing for the millions of Americans suffering through addiction who are not eligible for such services.

(3)   Changes to reimbursement rates set by federal addiction treatment providers

The Commission will “urge” the Department of Health and Human Services to review its rates to more adequately measure and cover the “true costs” of treating substance use disorder, including use of inpatient psychiatric facilities.  Note, this implies that someone at HHS recognizes the inextricable intertwining of SUD and mental health.

According to recent story reported by ModernHealthcare.com (“Study finds providers lack resources to stem opioid crisis”), new research suggests providers need mental health resources to address conditions and trauma that plague more than half of patients who visit emergency rooms for drug misuse. Experts say identifying and treating mental illness could effectively stop people who misuse drugs from relapsing in their recovery.

“In order to truly reach overdose survivors, we need a much better understanding of who they are and the many challenges they face when they seek care,” said Dr. Krista Brucker, assistant professor of Emergency Medicine at Indiana University School of Medicine (Brucker authored a study presented Monday at the annual meeting of the American College of Emergency Physicians, and found that 55% of patients who visited the ERs for substance misuse had mental health issues and 60% were severely traumatized when they were children). “But a lack of mental health care professionals and continued struggles to have insurers cover the services they provide make the request to address behavioral issues a tall order.”

And why a lack of mental health care professionals?  Because of the “continued struggles to have insurers cover the services they provide.”

Stated differently, without significant funding in the private sector, which only comes from insurance reimbursements and not government grants, the private sector cannot and will not innovate and progress forward.

(4)   Incentivizing Use of Medication-Assisted Treatment

The Report recommends “lowering barriers” to substance use disorder treatment, such as those that impose limits on access to any of the three forms of medication-assisted treatment and increasing access to recovery coaches. The Commission Report’s recommendation on the use of MAT is the result of studies which have proven their use in conjunction with treatment to be overwhelmingly successful. But let’s not forget were created by for-profit enterprises seeking a profit through innovation.

Granted, it’s all we have right now to immediately address the urgency of the issue, but this does nothing for the necessary long-term recovery oriented support services that have been proven to SUSTAIN sobriety and recovery.

The Commission will also recommend that CMS review policies that incentivize the prescription of opioids over more expensive non-opioid treatments.  That’s a good thing.

But who is going to pay for all of this? The federal government? And if so, that money will not go to the private sector to find new treatments, but rather to government-funded providers who have little to no motivation to innovate in the addiction healthcare space.

To simplify my point, but for the ability to make a profit on the creation of Gatorade, the University of Florida (Gators) would not have spent funds to find a hydrating beverage to overcome cramping in its student athletes. [By the way, if you didn’t know that’s where the name for Gatorade came from, you owe me a dollar.]

Without meaningful opportunities to make a reasonable profit, there is little motivation for innovation within the drug and alcohol treatment space. Suboxone and Vivitrol are not the answers, any more than methadone is.

But we must accept that the government agencies are the big winners of the federal opioid grant lottery, so we must look to our own agency in Florida – the Department of Children and Families (DCF) – to determine how they are going to end the scourge of addiction to opioids and other substances in our state, notwithstanding economic ability to pay.

Since DCF only funds agencies for the uninsured and indigent, one would assume that the Department would support the historic Recovery Economy that has added to and supported Florida’s financial solvency for decades. [See, “The Positive Economic Impact of the Treatment Industry and Recovery Community”].

And they certainly now have the time to do so, as it now the contracted Managing Entities (“MEs”) that are responsible for regulating the publicly-funded entities.

What is an ME?

The MEs are the management system through which the state delivers behavioral health services to the indigent and uninsured Floridians.

Organizations that make up Florida’s ME system administer millions of dollars’ worth of services to Floridians in need in every community throughout the state.

The regional ME system is built upon a tiered organizational structure, with DCF at the top as the authoritative body. DCF then contracts with non-profit organizations that serve as MEs and, in turn, bring their own established and contracted networks of community mental health and substance abuse providers.

In Florida, MEs also perform several of the administrative functions undertaken by DCF staff pre-reform, such as negotiating, managing, and paying for contracts with local providers. In addition, MEs have taken on many essential tasks not previously executed by DCF, such as credentialing providers, creating provider networks, and performing provider reviews to assess the quality of the services provided.

The MEs do not provide direct services; rather, they allow DCF’s funding to be tailored to the specific behavioral health needs in the various regions of the State.

Ironically, what Florida recognized as necessary for the public sector providers and the MEs, it assumed did not apply to the private sector. What were those assumptions?

For the public sector, Florida recognized that “[f]unding and infrastructure are linked within a causal model that can lead to a regional model’s success or failure. With insufficient funding there is insufficient staff; without adequate staff, providers cannot provide services; and without proper services, MEs are left with gaps in their networks that ensure many individuals will be denied the services they need.”

Why does the State believe this same economic reality does not apply to the private sector?

In March of 2015, Florida TaxWatch issued a report entitled “Analysis of Florida’s Behavioral Health Management Entity Model” which concluded that the ME system is working, but still much work needs to be done.  That non-partisan entity found that one of the most limiting factors for the viability and sustainability of the ME system was the “inflexible structure of funding silos [which] makes shifting money around particularly problematic for clients with concurrent substance abuse and mental health disorders. Such clients are common, but the funding structure for MEs and providers does not allow for a service to be reported or funded simultaneously by substance abuse and mental health dollars, making it difficult to finance treatment as well complicated to record the services provided. But, most importantly, these silos might dictate treatment. MEs show concern that providers may deliver services according to what money is available as opposed to what services are most required. This means that treatment is occasionally insufficient at worst and not tailored to individual needs at best; a problem only exacerbated by limited funding.”

For the private sector, this is EXACTLY the same issue. Except the funding comes solely from private insurance, not from government funding. And for some reason, which continues to perplex us, DCF and other government agencies in this space seem to think their problems are unique.

To address these funding issues, and pursuant to Florida Statute section 394.75, DCF is responsible for developing a “triennial state master plan” for the delivery and financing of a system of publicly funded, community-based substance abuse and mental health services throughout the state.  The most recent State Master Plan was released for fiscal years 2017-2019 and can be accessed here.

According to this most recent report, the Office of Substance Abuse and Mental Health (SAMH), which is housed within DCF, “serves as the single state agency for the provision of mental health and substance abuse services.”  This statement alone is telling of how distanced the Department and SAMH are from understanding and working with the private treatment provider community.

As discussed before, the report recognized that DCF contracts with seven Managing Entities statewide “to manage the delivery of behavioral health services through a network of local service providers.”

Again, the private sector is not even acknowledged.

The report further identified that the Office of SAMH has a “plan” for the administration and regulation of behavioral health services into six topic areas that are “critical to supporting the mission of the Department and current statewide priorities.”

The topic areas include the following:

  • Stakeholder Input;
  • Strategic Initiatives;
  • Financial Management;
  • Grants and Special Projects;
  • Policy Changes; and
  • Contract Management.

What’s missing from this list? Again, collaboration and support of the state’s private sector treatment providers who significantly fill in the gaps of treatment.  This opioid epidemic knows not of socio-economic status or demographics.

As for “stakeholder input,” DCF espouses that it “maintains open communication and works collaboratively with key stakeholders to guide the provision of substance abuse and mental health services, identify priorities and opportunities for improvement, develop statewide plans and legislative budget requests, and inform changes in policy and practice.”

The reality is that these “stakeholder groups” are limited to:

  • Consumers, families of consumers, and consumer advocacy groups;
  • The Substance Abuse and Mental Health Planning Council;
  • Managing entities and their network providers;
  • Provider agency associations; and
  • State and local agencies serving people with behavioral health challenges.

The private sector is generally not included (but for the Florida Association of Drug and Alcohol Abuse or “FADAA”).

Meanwhile, in May 2015, seventy leaders from across Florida gathered in Tallahassee to create a “shared vision to shape the future of Florida’s prevention, treatment and recovery support system.” The focus was moving the current system toward a recovery-oriented system of care (ROSC), defined as “a coordinated network of community-based services and supports that are person-centered and build on the strengths and resilience of individuals, families and communities to achieve abstinence, and improved health and the quality of life for individuals, families and communities.”

While this is excellent and exceptional, these resources, should they materialize, will only be made available to Floridians who are indigent or uninsured or to those non-profit agencies who contract with the MEs.

Recovery-oriented services are the answer, but to be truly viable and sustainable, that requires more consistent money than the federal government is willing to pay. Certainly, insurance is not going to pay for such services (yet), particularly necessary sober living residences.

So this perplexing problem now brings me to my most recent experience with DCF, relating to private treatment providers and the cause celebre for this rant.

In my experience and opinion, having represented over 100 different treatment providers in the State, it feels as if DCF has recently “circled the wagons” and taken a very narrow, black and white approach to the private providers.  In fact, DCF has adopted one set of rules for entities funded by the Managing Entity and a different set of rules for the private sector. In essence, they “support” the public sector and, conversely, now apply the rules (which they themselves wrote and adopted) very strictly and inflexibly against the private sector.

Clearly, the recent crackdown on sober home fraud within South Florida has forced the spotlight on DCF to “do its job,” no differently than when the local press reports the death or injury to a child in protective custody with a foster parent.

Elected officials at all levels sought to rid their communities of the “scourge” and “cancer” of sober homes (as one local Mayor publicly labeled Recovery Residences and the addicts who reside within them).

The problem was that DCF had no guidelines or even an understanding of what a Recovery Residence was or supposed to be.

Fortunately, in  2011, NARR (the National Alliance for Recovery Residences) was created to develop national guidelines to differentiate a true Recovery Residence from a simple boarding house or worse, a flophouse or drug den.  Also in 2011, FARR (the Florida Association of Recovery Residences) was established and eventually became the delegated authority to certify true Recovery Residences in the State of Florida.

But the problem remains very clear – the vast majority of the private sector, at least in Southeast Florida, have no real voice on such matters with DCF, particularly when it comes to the administration of the licensing process.

The industry has been dealing with patently unfair and arbitrary decisions by insurance companies and have historically had to battle discriminatory decisions by municipalities. We are now finding our community partner at DCF does not take these things into consideration when making decisions that affect one’s licensure.

By compromising a license through unwavering and inflexible application of the rules, suspension or revocation of the license is unreasonably threatened, such as when a provider is told, often for the first time, that they failed an audit based upon reasonably unforeseeable matters. Such as arbitrary local requirements for fire sprinklers in a recovery residence, when the same requirement is not required in other dwellings.

Recall what I said before – Florida has recognized that, at least in the public sector, “[f]unding and infrastructure are linked within a causal model that can lead to a [provider’s] success or failure. With insufficient funding there is insufficient staff; without adequate staff, providers cannot provide services; and without proper services, [providers] are left with gaps in their networks that ensure many individuals will be denied the services they need.”

Today, there simply is no meaningful opportunity to be heard on matters regarding the issuance of licenses; or when specific fire improvements must be made; or whether a new financial investor in a treatment program should cause the entire center to need new licensure; all of which decisions often require immediate answers based upon the nature of arbitrary reimbursements in the private health insurance industry.

While there technically is an administrative appeals process with DCF and other state agencies, private providers understandably fear of retaliatory conduct should they appeal an adverse decision. While I do not think there would ever be such retaliatory conduct, the industry is fearful that there is a witch hunt.

And if an adverse decision by DCF is to suspend the license of an entire facility due to the arrest (on probable cause, not guilt beyond a reasonable doubt) that someone (not involved in treatment services delivery) violated the law, even though there is a formal administrative appeal mechanism, such a suspension is effectively the death blow to that program. Jobs are lost. Patients must be relocated. Landlords now sue their treatment center tenants. Insurance companies are given cover for refusing to pay for previously authorized treatment services, without any claim of fraud.

So there really is not an effective and meaningful opportunity to be heard on matters that impact the delivery of private sector services.

What has been DCF’s official response to this commentary?

“DCF [only] has an administrative licensing function and seeks to have compliance with the code, statutes and requirements of law.  [We] cannot speak to other entities or insurance companies.”

In other words, they are here to help fund and support the public sector (much needed).  But the private sector? Not only are they not here to work with the private sector hand-in-hand to meet the universal mission of treatment and stopping the opioid epidemic, but if their actions tend to regulate the private sector out of existence, while that is not their goal, it does not appear to be their concern either.

When I speak and write these words, some have stated that my comments are to be discounted because I am a lawyer; that I am not a true advocate for the industry because I get paid to do so; and that I am being unnecessarily adversarial.

Walk quietly but carry a big stick.

That just not me.

To the contrary, I’m speaking truth to power. No different than the press. That is why I created SoberLawNews.com.

Join the movement to support free enterprise in the delivery of addiction treatment and recovery support services. Only there will innovation occur. It is time tested and proven.

It creates well-paying jobs and supports the local community.

In fact, it helps create a community. A recovery community.

Florida DCF to (Finally) Revisit Regulations Governing Treatment Providers

It’s been a long time coming, and perhaps it took an act of the Legislature to make it so, but this morning the Florida Department of Children and Families (DCF), the entity charged with licensing, regulating and overseeing Florida’s multi-billion dollar drug and alcohol treatment industry, issued a “Notice of Development of Rulemaking” placing the public on notice of its intention to “modify regulatory language to comport with Chapter 2017-173, Laws of Florida, and other current laws and policies related to standards for the provision of substance abuse services.”

We had brought to the attention of the Palm Beach County Sober Home Task Force and made an extensive PowerPoint presentation about how the existing regulations, found within Chapter 65D-30 of the Florida Administrative Code, were overwhelmingly outdated and did not comport with updated ASAM (American Society of Addiction Medicine) criteria. They were written during a time where only non-profits and state-funded agencies delivered treatment services. My, how that paradigm has changed!

While workshops are not a requirement of rulemaking (DCF can unilaterally rewrite the regulations and then take public comment), we would suggest anyone with any medical, social work, recovery housing, or other practical (not anecdotal) experience to take the time to pre-prepare written comments relating to 65D-30 and send them to DCF now, rather than later. This is expected to be a relatively fast-tracked process.

As always, we will endeavor to keep you timely informed. Please feel free to contact DCF or our offices should you have any questions.


Pushback Against Plan to Medicalize Drug and Alcohol Treatment

Pressure has been mounting in Florida and across the country for state departments of health to take over regulation of public and private treatment providers, the thought being that we have for far too long bifurcated healthcare at the neck.

We had previously written about NJ Gov. Chris Christie announcement on July 11, 2017, of his decision to reorganize the $1.2 billion NJ agency (Dept. of Human Services) in charge of mental health and addiction services. In NJ, that agency is funded at a rate of approximately 10:1 as contrasted with Florida and other states, where the local humans services agency tends to be the least funded and the one with the lowest morale. (To that point, Palm Beach’s WPTV (NBC affiliate) ran a story on July 28, 2017, about how Florida’s Department of Children and Families’ employees were falsifying records relating to child welfare inspections simply because they were overworked, overburdened, and underpaid.)

Back to NJ, last week, experts appeared before legislators in Trenton to testify on how the plan, proposed by Gov. Chris Christie, to shift mental health and addiction services to the state Department of Health would create probable disruption for providers and clients.

“While we strongly believe integration of behavioral health and substance abuse is important to integrate with physical care, we believe this move is not a viable way of making this happen,” said Barbara Johnston, director of policy and advocacy for the Mental Health Association in New Jersey.

The shift could involve moving millions in state funding, a couple hundred employees and regulation changes between the two departments.

According to a copy of his reorganization plan, Christie said the shift would “remove bureaucratic obstacles to the integration of physical and behavioral health care, and effectively address substance-use disorder as the public health crisis that it is.”

A Physician’s Perspective

We interviewed Dr. Robert Moran, a well-regarded South Florida psychiatrist who specializes in addiction medicine. He is also the founder, CEO and Medical Director of the Family Center for Recovery in Boynton Beach, Florida.

Psychiatric illness means that an organ of the body is dysfunctional–the brain. It is silly and naive to think that a social service agency is capable of overseeing the licensure and quality of care of psychiatric treatment centers. It is also misguided to see the disease of addiction as something that should be treated differently than other psychiatric illnesses; that is, in a ‘rehab’. As a physician trained in medical school to diagnose all medical illnesses, I do not see brain illness differently from heart or lung illness with regard to the fact that we illicit symptoms, identify signs, make diagnoses and prescribe treatment. Of all the medical specialties, psychiatry is the most difficult and most sophisticated. [DCF has] no idea as to whether we are providing quality standard-of-care because they have no medical training. They may see that I have a patient on 7 psychotropic medicines and have no idea whether it is appropriate, but they will point out that one digit in the phone number for the abuse hotline is incorrect.

I, personally, am licensed by the [Florida Department of Health]. My psychiatric practice is under their auspices. The treatment that I provide to the patients in my facility should be monitored by that same agency.

Moving licensure and oversight to DOH is not only logical, it is absolutely necessary if we expect to get the opioid epidemic under control. DOH knows what standard of care is for all illnesses. It is able to recognize when a facility/practitioner is not meeting the standard. DOH would be able to identify that a licensed entity is not recommending anti-craving medicines which have been proven to decrease use of substances (almost all patients referred to us from other facilities have not been offered/prescribed proven anti-craving medicines at the referring facility).

The Perspective of Recovery Support Providers

The majority of speakers said they favored more integration but not at a time when community agencies are already undergoing a major transition from a contract-based payment system to a fee-for-service system.

Johnston and others said the timing for reorganization of the mental health division, which oversees community-based mental health and substance-use programs, the state’s four psychiatric hospitals and other behavioral health programs, could hurt agencies already struggling with the payment transition.

Debra Wentz, CEO and president of the New Jersey Association of Mental Health and Addiction Agencies, said on top of that, uncertainty on the impacts of what a federal health care repeal could do to mental health and addiction services in New Jersey is another reason for hesitation.

Others were hesitant to separate mental health and addiction services from wrap-around services such as housing, food assistance, employment, Medicaid oversight and others that currently exist within the human services department.

John Lehman of the Florida Association of Recovery Residences brings a unique and educated perspective to this issue, particularly the interplay between treatment and recovery support services:

Though integration of SAMH [Substance Abuse and Mental Health] and Medical Healthcare continues to present challenges to New Jersey, Florida and many other states, the greater challenge is the profound failure of federal and state agencies to fully embrace recovery-oriented support systems. Contrary to much rhetoric, recovery support systems are largely ignored by payer systems. This results in what can be described as the Catapult Practice wherein persons exiting quality addiction treatment are launched towards mutual aid and other recovery support platforms in hopes they will make it across the relapse chasm. Over two-thirds fail to cross the divide resulting in either premature death or repeated and costly episodes of acute care. We must build bridges to recovery predicated on evidence-based practices and interventions appropriate for delivery by credentialed peers in nonclinical settings. One of the most appropriate settings from which to provide these evidence-based interventions is certified recovery residences measured to be complaint with NARR Quality Standards.

John Jacobi, Seton Hall director of the Center for Health and Pharmaceutical Law and Policy, said years of research and study on integration issues has shown that the fragmentation of health care delivery systems is one of biggest issues legislators have had to face.

Jacobi said regardless if the plan gets passed or not, integration between mental and physical health must happen, which should include a streamlined process where providers can get a single license to provide behavioral, substance and medical treatment.

“I believe, from our research, that behavioral health integration saves lives,” he said. “That reform of New Jersey’s licensure system for outpatient care is necessary, but the process for integration is a long one.”