We should all be afraid when there is a “war” declared on anything in our culture because it usually means the complex will be simplified, the innocent will be presumed guilty, details will be ignored and the baby will be thrown out with the bathwater. Nowhere is that more apparent than the current War on Sober Homes in Palm Beach County.
It is illegal for a sober home to receive payment from an addiction treatment facility for providing so called “case management” services;
Addiction treatment providers unethically bill thousands of dollars for urine tests that could be provided for pennies via a cup for sale at Walgreens; and
The Patient Brokering Act, a state criminal law, is being broken left and right by sober homes and addiction treatment providers.
Hooey! It’s completely misleading. Here’s why:
Case Management Issue. The arrangement reported In the Post and described in charging documents describes a business arrangement where sober homes are paid by state licensed addiction treatment providers for helping addicts along their path of recovery. Addiction treatment sees these patients maybe 20 hours a week. Where are they the rest of the time? What are they doing? Addicts seeking treatment often have soft life skills from being off the grid, are often receiving assistance from supportive staff at sober homes who help them get on their feet. They often come into treatment with no clothes, no money, no food, no job skills and a whole host of medical and psycho social needs. And addiction treatment facilities want (and sometimes pay for) sober home staff to serve a function in the continuum of care, sometimes want to give them food cards, clothing, cigarettes and whatever they need to accept treatment. And our sole focus is to do what, focus our regulatory attention on a business relationship that may exist in the treatment industry? Continue reading →
Several clients have inquired in the past few weeks about the new Florida law regarding recovery residences, or sober living facilities. Implementation of the new law has been slow, leaving a lot of questions unanswered and room for opinions to be taken as facts.
Many have asked us if recovery residences are required by law to obtain certification. It is not mandatory for all sober homes to become certified prior to July 1, 2016. However, as of that date, a DCF-licensed substance abuse treatment facility may not refer a current or discharged patient to a recovery residence unless any of the following applies:
the recovery residence holds a valid certificate of complianceor
the recovery residence is owned and operated by a licensed service provider or
the recovery residence is a licensed service provider’s wholly owned subsidiary.
The term “refer” means to inform a patient by any means about the name, address, or other details of the recovery residence. The effect of the law is to squeeze sober homes into obtaining certification if they are not owned and operated by a DCF-licensed treatment provider. Continue reading →
Medical Directors are used in an administrative capacity to oversee all medical services and care, specifically referring to substance abuse programs and services. Increasingly, commercial healthcare plans are targeting their role in addictions treatment facilities and denying payment of claims based on audit findings that Medical Directors in Florida may be responsible for far too many treatment facilities and too many patients.
Does Florida have any specific requirements or published guidance on the number of treatment facilities or number of patients for which responsibility falls to the Medical Directors in addictions treatment?
Florida’s Administrative Code directed to substance abuse programs and services does not have any directive which talks about a restriction on the number of facilities or patients recommended for oversight by a Medical Director. It specifies that addictions receiving facilities, detoxification, intensive inpatient treatment, residential treatment, day or night treatment with host homes and medication and methadone maintenance treatment must designate a Medical Director who oversees all medical services. This Medical Director must hold a current license in the state of Florida. Continue reading →
Medical necessity is the driving force for the payment of any service, but is especially worth noting when discussing laboratory testing. Standing Orders for urine drug testing in residential treatment settings are not prohibited, per se, but this practice must be built upon detailed policies and procedures that are precisely followed and are directed to individual patient needs.
The following conditions may help to determine whether Standing Orders are appropriate in a residential treatment setting: Continue reading →
A confluence of forces brought about by lawmakers, insurance companies and regulators have caught recovery residences in the eye of a perfect storm here in Florida. Senate Bill 582 proposes to mandate that Florida sober homes and their owners be registered, inspected and licensed; but really, that bill may not be necessary due to other factors. Florida’s Department of Children and Families (“DCF”) has been using Section 65D-30.007 of its Administrative Code to require that sober homes be licensed for Residential Treatment if any resident at that sober home is also a patient at a licensed treatment program owned by the same person or entity that owns the sober home.
The recent and drastic cut in reimbursement for point-of-care urinalysis has caused just about all of our substance use treatment program clients to consider integrating clinical laboratories into their enterprise models. These programs long for a way to restore the revenue stream that urinalysis had generated. For sober living programs, the lost revenue often means the difference between profitability and breaking even. For more comprehensive programs, the lost revenue can hinder their ability to expand or provide scholarships to those who could not otherwise afford treatment. Regardless of their specific goals, our clients are amazed and dismayed at the regulatory minefield that awaits them; especially since their lab consultant (read “reagent salesperson”) makes the process sound so simple. Continue reading →
Many drug and alcohol treatment facilities see continuity of care and income opportunities in providing qualitative (and even quantitative) toxicology screening to make sure they know (1) what their residents/patients are taking, and (2) in what quantities. Facilities need to make sure they know that federal and state law will view them as a clinical lab, even when they are simply taking urine and using cups. CLIA will require they obtain “waived” status (since dipsticks are in that category). Facilities also need to examine whether state licensure (as a “Healthcare Clinic”) is also required. Chapter 400, Florida Statutes requires any entity to obtain a healthcare clinic license if (a) healthcare services are provided, and (b) claims for those services are submitted. Even though most facilities are out of network, most do submit claims to insurance carriers and hence implicate the state healthcare clinic license law (which is different from the CLIA law).