65D-30.0061. Standards for Intensive Inpatient Treatment

(1) Intensive Inpatient Treatment includes a planned regimen of evaluation, observation, medical monitoring, and clinical protocols delivered through an interdisciplinary team approach provided 24 hours-per-day, 7 days per week in a hospital setting.

(2) Admission Criteria. Intensive inpatient treatment is appropriate for individuals whose acute biomedical, behavioral, cognitive, and emotional problems are severe enough to require primary medical and nursing care. These individuals may exhibit violent or suicidal behaviors, or other severe disturbances due to substance use. Program services may be offered in an appropriately licensed facility located in a community setting, a specialty unit in a general or psychiatric hospital, or other licensed health care facility. In addition to rule 65D-30.004, F.A.C., the following standards apply to intensive inpatient treatment.

(3) Specialized Services. Providers shall make provisions to meet the needs of individuals with a co-occurring substance use and mental health disorder and related biomedical disorders. This includes protocols for:

(a) Providing clinical services by an interdisciplinary team of qualified staff daily;

(b) Planning clinical program activities designed to stabilize acute substance use and other psychiatric symptoms, adapted to the individual’s developmental stage and level of comprehension;

(c) Monitoring the individual’s compliance in taking prescription medication on a regular basis, including medication education;

(d) Reviewing the individual’s recent psychiatric history and mental status examination;

(e) Developing a comprehensive psychiatric history and conducting a mental status examination as determined by the individual’s needs;

(f) Providing co-occurring enhanced services utilizing best practices; and

(g) Providing related biomedical services, as determined by the individual’s needs.

(4) Standard Services. Standard services shall include a specified number of hours of counseling as provided for in subsection 65D-30.0061(5), F.A.C. Each provider shall be capable of providing or arranging for the services listed below. With the exception of counseling, it is not intended that all services listed below be provided. Services shall be provided in accordance with the needs of the individual as identified in the assessment and treatment plan as follows:

(a) Individual counseling;

(b) Group counseling;

(c) Counseling with family members or members of the individual’s support system;

(d) Substance-related and recovery-focused education, such as strategies for avoiding substance use or relapse, information regarding health problems related to substance use, motivational enhancement, and strategies for achieving a substance-free lifestyle;

(e) Life skills training, such as anger management, communication skills, employability skills, problem solving, relapse prevention, recovery management, decision-making, relationship skills, and symptom management;

(f) Expressive therapies, such as recreation therapy, art therapy, music therapy, or dance (movement) therapy to provide the individual with alternative means of self-expression and problem resolution;

(g) Training or provision of information regarding health and medical issues;

(h) Employment or educational support services to assist individuals in becoming financially independent; and

(i) Mental health services for the purpose of:

1. Managing individuals with disorders who are stabilized;

2. Evaluating individuals’ needs for in-depth mental health assessment;

3. Training individuals to manage symptoms; and

4. If the provider is not staffed to address primary mental health problems which may arise during treatment, the provider should initiate a timely referral to an appropriate provider for mental health crises or for the emergence of a primary mental health disorder in accordance with the provider’s policies and procedures.

(4) Required Hours of Services. Individuals shall receive services each week in accordance with subsections 65D-30.0061(2) and (3), F.A.C., including at least 14 hours of counseling and 20 hours of other structured activities.

(5) Observation of Individuals. Individuals requiring close medical observation, as determined and documented by medical staff, shall be visible and readily accessible to nursing staff. Individuals who do not require close medical observation shall be in a bed area that allows for general nursing observation.

(6) Staff Coverage.

(a) There shall be nursing coverage 24 hours per day, 7 days per week. An R.N. shall supervise all nursing staff and an R.N. or L.P.N. shall be on-site. Nursing staff shall be responsible for monitoring each individual’s medical progress and medication administration. An R.N. or L.P.N. shall conduct a mental health focused nursing assessment at the time of admission. A physician shall be on-call 24 hours per day, 7 days per week.

(b) A psychiatrist or psychiatric A.R.N.P. or P.A. shall be available by telephone to assess the individual’s mental condition, if needed. A face-to-face assessment shall be conducted on individuals with a co-occurring disorder within three (3) calendar days of admission.

(c) A qualified professional licensed under chapter 490 or 491, F.S., shall be a member of the interdisciplinary team and shall be on-site daily. At least one (1) member of the non-medical clinical staff shall be on-site for eight (8) hours daily and be on-call thereafter.

(7) Caseload. No primary counselor may have a caseload that exceeds 10 currently participating individuals.

(8) Transportation. Each provider shall arrange for or provide transportation services to individuals who are involved in activities or in need of services that are provided at other facilities.

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321(1), 397.4103 FS. History–New 12-12-05, Amended 8-29-19.