Some Good News During Difficult Times – PHP Remains

By: Jeffrey Lynne March 16, 2020 11:58 pm

Time to read: 5 Minutes

Hello friends. I know I speak for all of us when I express my gratitude to be surrounded by so many people who think of “community” before “self” during these difficult times. I understand the hoarding that is going on for basic supplies, generally, but we here in Florida are hurricane hardened, and have been through physical devastation of our neighborhoods in the past. For us, if we have electricity, everything else is temporary!

I write with some good news – the Florida Legislature did not progress the bill that would have eliminated the PHP/ASAM 2.5 level of care in Florida. This “Florida Model” of licensure links outpatient clinical services directly with sober living.  This level of service remains, at least for the next year.

Some have asked: “Does this mean that I may continue to offer free rent?”

The answer has always been “no.” A licensed service provider was never allowed to offer free rent to any patient, as it could be viewed as an illegal inducement. I can personally attest that during the late-2000’s and early years of the 2010 decade, free rent was the # 1 inducement used to get clients/patients/residents to leave one sober living residence and attend another, “so long as they had insurance.”

Aside from being despicable, patients started brokering themselves out, having learned that they had inherent value to the highest bidder. Sad state of affairs.

As for PHP programs (the “Day or Night Treatment with Community Housing” license pursuant to 65D-30.0081, FAC), room and board were “assumed” to be included in the reimbursement from insurance (which it is not). It was assumed that a patient in a minimum of 5 hours a day of clinical services for no less than 25 hours a week did not have the ability to find meaningful employment to be able to pay for room and board and attend intensive clinical services as well. Most of these patients were recently in a Detoxification program, denied the ability to enter into a Residential Treatment program. I think all of these are reasonable assumptions, which can be corroborated on a patient-by-patient basis.  Many people entering such programs likely spent their last dollar on getting high, or just getting to the treatment program itself.

I have been more than vocal for more than a decade that insurance should be required to pay for some levels of sober housing under the Parity Act of 2008, no differently than room and board is covered for other health care treatments.  But the mere assumption, without more, that a patient is suffering a financial hardship, and then using that assumption to waive room and board fees for PHP patients, could get a program into trouble under current interpretations and applications of the Patient Brokering Act by state officials, as well as other states following Florida’s lead.

But that was not the purpose of the legislation. DCF had opined in recent past that Community Residences under the PHP license do not have to obtain FARR certification, notwithstanding s. 397.4873, Fla. Stat., because in their interpretation, the housing is inseparable from the clinical program. If so, then why isn’t insurance paying for it, if it’s Florida law?!

This is not the end of this discussion. It is very likely new legislation will be introduced in the 2021 Florida legislative session, seeking to eliminate any reference to housing from the PHP licensure. All recovery residences associated in any way with a treatment program, from that point forward, will require FARR certification and will put to bed any concept that free room and board are allowed under that license.

In the interim, treatment and recovery advocates have a one-year window to figure out how they are going to assist these patients at this level of care from making the transition from inpatient to outpatient care, where in addition to co-pays and co-insurance, they now will have to pay for rent and other costs of living.

Stay safe, stay healthy, and thank you for reading.