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Is Your Drug Screening “Medically Necessary”?

Under what circumstances is a drug screening “medically necessary” when conducted by a Recovery Residence?

When considering this question from the perspective of the proposed legislation introduced by Senator Clemens and Representative Hager (SB 582 and HB 479), several interesting facts emerge that may help refine the ongoing debate surrounding the possible registration and regulation of sober homes.

The Florida Association of Recovery Residences (FARR) asserts that a recovery residence is a home and that firms that own and manage these homes are “specialty landlords” providing recovery-oriented housing to those in early recovery from addiction. All stakeholders agree that drug screening is necessary for the protection of both the community and the residents themselves. FARR Standards require Certified Residences to drug screen all residents a minimum of once per month or once per week, depending on the Level of Support and suggest that drug screenings are also necessary upon intake as well as on a random basis whenever there is evidence suggesting a resident might have returned to active addiction.

However, do these screenings fall within the more narrow definition of “medically necessary”?  Or are they a useful management tool to help ensure the home remains alcohol and drug free for all those tenants who chose this residence based, in part, on management’s promise to meet that expectation? Yes, without doubt, they are necessary… but are they medically necessary?

Doesn’t the answer depend on the particular recovery residence’s support level? FARR adopted the National Alliance of Recovery Residences (NARR) definitions for four distinct levels of support (Levels 1-4).

 

RR_Levels_Graph At present, here in Florida, Levels 1-3 are not licensable entities as defined by the Department of Children & Family Services – Substance Abuse and Mental Health. Note 65D-30.007:

 

“Facilities Not required to be licensed as Residential Treatment. Licensure as residential treatment as defined in paragraph 65D-30.002 (16)(c) F.A.C., shall not apply to facilities operated by a provider that provides only housing, meals, or housing and meals to individuals who are substance abuse impaired or in recovery and where the provider:

a)       Does not mandate that the individuals live in the residential facility as a condition of treatment in a separate facility owned and operated by the provider; and

b)       May make available or provide support groups such as Alcohol Anonymous and Narcotics Anonymous as the only services available to residents in the facility where housing, meals, or housing and meals are provided. All other facilities that provide housing to residents that are substance abuse impaired and provide services as defined in Section 397.311(18)(d), F.S., and as described in subsections 65D-30.007(2) and (3), F.A.C., either at the facility or at alternate locations, must be licensed under this rule.”

 

By applying this exclusion, isn’t the residence also forfeiting any claim to CLIA privileges, which by definition, require a medical doctor to assess the medical need for a drug screening?  Can a landlord contract with a doctor to order tests for his/her tenants?

 

Earlier this month, Joe Bryan of the Beachcomber, a well-established and respected operator of a DCF licensed residential substance abuse treatment program in South Palm Beach County asked me a similar question. Mr. Bryan suggested that CLIA is the key to many of the challenges we currently face in the long-standing debate over when, under what circumstances, and by whom recovery residences should be regulated. I believe he may have found a path to the answer.

 

FARR contends that a recovery residence is a home; not a substance abuse treatment provider. But is this contention always a perfect fit? Surely the presence of a CLIA waiver suggests that more has been taken on by that particular recovery residence than housing. If there is a medical necessity for the drug screening, and that drug screening is ordered by a doctor who has been contracted by the recovery residence itself, then isn’t this also evidence of clinical support? In NARR (and FARR) terminology, this elevates the recovery residence to Level 4, which here in the State of Florida, necessitates licensing by DCF.

 

If this argument holds water, then the current standard as defined by DCF in 65D-30.007 remains appropriate. FARR would begin to ask applicants for certification “Do you possess a CLIA waiver?” If the answer is affirmative, then they would fit our definition of a housing provider who also offers clinical services and would require proof of DCF Licensure. Surely, this is something for our Advisory Board to consider carefully. We publish this in hopes of constructive comment and as an opportunity to spark discussion. Frankly, I’m not smart enough, experienced enough, or confident enough to suggest that this assessment meets all tests or that it meets any other than that of common sense. My closest friends and supports might suggest that common sense isn’t my strongest suit. However, generally, if it waddles and quacks like a duck, it goes great with wild rice and orange sauce.

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