59A-3.278. Rehabilitation, Psychiatric and Substance Abuse Programs

(1) All rehabilitation, psychiatric, and substance abuse programs provided by hospitals shall provide to the patient:

(a) An evaluation upon referral;

(b) Establishment of goals;

(c) Development of a plan of treatment, including discharge planning, in coordination with the referring individual and rehabilitation staff, and after discussion with the patient and family;

(d) Regular and frequent assessment, performed on an interdisciplinary basis, of the patient’s condition and progress, and of the results of treatment;

(e) Maintenance of treatment and progress records; and

(f) At least a quarterly assessment of the quality and appropriateness of the care provided.

(2) When any rehabilitation activity, psychiatric or substance abuse treatment is provided from outside the hospital, the source shall be available whenever needed for patient care, meet all safety requirements, abide by all pertinent rules and regulations of the hospital and medical staff, and document the quality assurance measures to be implemented.

(3) The scope of services offered, and the relationship of the rehabilitation, psychiatric or substance abuse program to other hospital units, as well as all supervisory relationships within the program, shall be defined in writing. Responsibility for the performance of clinical services also shall be clearly defined. Delegation of authority within the program shall be specified in job descriptions and in organizational plans. Written policies and procedures to guide the operation of the rehabilitation program shall be developed and reviewed at least annually, revised as necessary, dated to indicate the time of last revision, and enforced.

(4) There shall be a current written plan of care for each patient receiving rehabilitative, psychiatric or substance abuse services. The plan shall state the diagnosis, and problem list when appropriate, pertinent to the rehabilitation or treatment process; precautions necessitated by the patient’s general medical condition or other factors; the short-term and long-term goals of the treatment program; and require monthly or more frequent review of the patient’s progress. The medical record and the written plan shall evidence a team approach, with participation of the professional and administrative staffs, the patient, and, as appropriate, the patient’s family. The medical record shall document the written instructions given to the patient and the family concerning appropriate care after discharge from the hospital.

(5) The rehabilitation, psychiatric or substance abuse program must have notes and log records that are separately identified from the other admission and discharge records in the hospital in which it is located, and are separately retrievable.

(6) The beds assigned to the program must be physically separate from and not commingled with beds not included in the unit. Rehabilitation, psychiatric or substance abuse programs and beds may be located on the same floor as other programs or beds.

(7) In addition to meeting the requirements of subsections (1) through (6) of this section, rehabilitation programs provided by hospitals must place responsibility for the medical direction of the rehabilitation program on a physician member of the organized medical staff who, on the basis of training, experience and interest, is knowledgeable in the rehabilitation services offered. Unless otherwise permitted by law, rehabilitation services shall be initiated by a physician. The written request for services shall include reference to the diagnosis or problems for which treatment is planned.

(8) In addition to meeting the requirements of subsections (1) ‒ (6) of this section, psychiatric, or substance abuse rehabilitation programs provided by hospitals shall meet at least the following additional standards:

(a) The program, unit, service or similarly titled part shall treat only those patients whose primary reason for admission was a diagnosis contained in the third edition of the American Psychiatric Association Diagnostic and Statistical Manual.

(b) The program, unit, service or similarly titled part shall have medical direction by an appropriately qualified practitioner, including a physician who is certified by the American Board of Psychiatry and Neurology or is eligible for examination by the Board or similar specialty board recognized by the American Osteopathic Association, a clinical psychologist, or a licensed physician with postgraduate training and experience in the diagnosis and treatment of nervous and mental disorders.

(c) The program, unit, service or similarly titled part shall furnish, through qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy, as appropriate to the needs of the patient.

(d) The program, unit, service or similarly titled part shall have a charge nurse who is a registered professional nurse qualified in psychiatric or mental health nursing.

(9) In addition to the medical direction required in subsection (7), overall supervision and administration of the following specialty rehabilitation programs may be provided by staff with the following credentials:

(a) Physical Therapy – A qualified physical therapist who shall be a graduate of a physical therapy program approved by a nationally recognized accrediting body or have documented equivalent training or experience, shall meet any current requirements for licensure or registration, and shall be currently competent in the field.

(b) Occupational Therapy – A qualified occupational therapist who shall be a graduate of an occupational therapy program approved by a nationally recognized accrediting body; or shall currently hold certification by the American Occupational Therapy Association as an Occupational Therapist, Registered; or shall have documented equivalent training or experience; and shall meet all current requirements for licensure under Chapter 468, Part IV, F.S.

(c) Speech Pathology and Audiology – A qualified speech-language pathologist or audiologist who shall hold the Certificate of Clinical Competence or a Statement of Equivalence in either speech pathology or audiology issued by the American Speech-Language-Hearing Association, or have documented equivalent training or experience; and shall meet all current requirements for licensure under Chapter 468, Part II, F.S.

(d) Rehabilitation Nursing – A professionally qualified licensed registered nurse who shall have documented training in rehabilitation nursing and at least one year of rehabilitation nursing experience.

(e) Vocational or Educational Rehabilitation – A qualified individual who shall be a graduate of vocational rehabilitation program at the graduate level, or have documented equivalent training or experience.

(f) Comprehensive Medical Rehabilitation – A qualified physician who shall be a member of the organized professional staff and who is certified, or eligible for examination, either by the American Board of Physical Medicine and Rehabilitation or by a specialty related to rehabilitation.

(10) Nothing in this section shall be construed to prevent a hospital from providing rehabilitation, psychiatric or substance abuse programs to its patients. However, no hospital shall have rehabilitation, psychiatric, intensive residential treatment program, or substance abuse beds unless it has obtained a valid certificate of need as required by Section 408.031 through 408.045, F.S., and meets the requirements of this section.

Rulemaking Authority 395.003, 395.1055 FS. Law Implemented 395.003, 395.1055, 408.032, 408.036 FS. History–New 9-4-95, Formerly 59A-3.229.