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.firstname.lastname@example.org
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.