AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-4.027Behavioral Health Overlay Services
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 39, No. 204, October 18, 2013 issue of the Florida Administrative Register.
The following changes have been made to the Florida Medicaid Behavioral Health Overlay Services Coverage and Limitations Handbook.
Page 1-2 New definition is added:
Emotional Disturbance
A person under the age of 21 years who is diagnosed with a mental, emotional, or behavioral disorder of sufficient duration to meet one of the diagnostic categories specified in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, but who does not exhibit behaviors that substantially interfere with or limit the role or ability to function in the family, school, or community. The emotional disturbance must not be considered to be a temporary response to a stressful situation.
Page 1-2 Institution for Mental Disease
This section will now read:
A hospital or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care to persons with behavioral diseases in accordance with 42 CFR 435.1010.
Page 1-2 New definition is added:
Serious Emotional Disturbance
A person under the age of 21 years who is all of the following:
- Diagnosed as having a mental, emotional, or behavioral disorder that meets one of the diagnostic categories specified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.
- Exhibits behaviors that substantially interfere with or limit the role or ability to function in the family, school, or community, which behaviors are not considered to be a temporary response to a stressful situation.
Page 1-5 Clinical Services Supervisor
The phrase “as defined in Chapter 394, F.S.” is deleted from the section.
Page 1-6 Medical Assistant
This section will now read:
A medical assistant must be registered or certified in accordance with Chapter 458, F.S.
Page 1-7 Psychiatric Clinical Nurse Specialist (CNS)
The last paragraph will now read:
A registered nurse currently enrolled as an LPHA must be licensed as a CNS with a subspecialty of child/adolescent psychiatric and mental health or psychiatric and mental health by January 1, 2016.
Page 1-11 Required Policies and Procedures
The first bullet is deleted.
Page 1-12 Psychiatric Advanced Registered Nurse Practitioner (ARNP)
This section will now read:
A psychiatric ARNP must have education or training in psychiatry and be authorized to provide these services in accordance with Chapter 464, F.S., and protocols filed with the Florida Board of Nursing. An ARNP must enroll as a provider type 07 and must also be linked to a group provider type 05.
Page 1-12 Psychiatric Physician Assistant (PPA)
This section will now read:
A PPA must be a licensed prescribing physician assistant as defined in Chapter 458 or 459, F.S., with a Psychiatric Certificate of Added Qualification. The PPA’s supervising physician must be a provider type 25 or 26 that is linked to the community behavioral health group provider type 05.
Page 2-3 Eligibility Criteria
The first paragraph will now read:
The recipient must meet the diagnostic eligibility criterion described in Section A and also meet at least one of the risk factors in Section B.
The text for Section A will now read:
Section A: Diagnostic Criterion
The recipient is under the age of 21 years and has an emotional disturbance or a serious emotional disturbance.
Page 2-4 Recipient Clinical Record
The paragraph after the bulleted list is deleted:
The note has the word more deleted.
Page 2-5 General Service Documentation Requirements
The last paragraph is deleted.
A note is added after the bulleted list that reads:
Note: For information about electronic signatures, see the Florida Medicaid Provider General Handbook.
Page 2-5 Compliance and Quality of Care Reviews
The last sentence in the section is deleted.
Page B-2 Certification of Eligibility
The paragraph before Section A will now read:
The recipient meets the eligibility criterion described in Section A and one of the five risk factors in Section B.
Section A will now read:
Section A: Diagnostic Criterion. The recipient is:
Under the age of 21 years and has an emotional disturbance or a serious emotional disturbance.
Page C-2 Provider Agency Self-Certification
The F.A.C. citation in the second numbered item is changed to 65C-14.
Document Information
- Related Rules: (1)
- 59G-4.027. Behavioral Health Overlay Services