AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-4.295Specialized Therapeutic 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 Specialized Therapeutic 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 1-3 Multidisciplinary Team (MDT)
The third paragraph is deleted.
Page 1-12 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 1-12 Specialized Therapeutic Foster Parents
The F.A.C. citation in the first paragraph is changed to Chapter 65C-14, F.A.C.
Page 1-14 Specialized Therapeutic Foster Care Provider Self-Certification
The seventh bullet is deleted.
Page 1-15 Therapeutic Group Care Provider
The first sentence of the last paragraph will now read:
Eligible group providers must submit an enrollment application to the Medicaid fiscal agent and must submit the Provider Agency Acknowledgement for Therapeutic Group Care Services form, found in the appendices, which has been completed by the provider’s executive director, to the Agency as directed on the form.
Page 1-16 Therapeutic Group Care Services Required Provider Capabilities
The sixth bullet will now read:
- Access to, and coordination with, an accredited educational program for each recipient that complies with the State Board of Education, Rule 6A-6.0361, F.A.C.
The F.A.C. citation in the last bullet is changed to Rule 65E-9.006, F.A.C.
Page 2-3 Recipient Clinical Record
The third paragraph is deleted.
The note has the word more deleted.
Page 2-4, 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 Who Can Receive
The first paragraph will now read:
To receive a comprehensive behavioral health assessment, a recipient must be under the age of 21 years and meet all of the following criteria:
The second paragraph and the second bulleted list will now read:
Or the recipient must meet all of the following criteria:
- Have committed acts of juvenile delinquency
- Be suffering from an emotional disturbance or a serious emotional disturbance
- Be at risk for placement in a residential setting
Page 2-6 Components for Recipients Under the Age of Six Years
The first bullet will now read:
- General identifying information (name, birth date, Medicaid identification number, sex, address, siblings, school, referral source, and diagnosis).
Page 2-7 Components for Recipients Under the Age of Six Years, continued
The last bullet in the first list will now read:
- Completion of a standardized assessment tool, such as the Child & Adolescent Needs and Strengths An Information Integration Tool for Early Development CANS-0 to 3 Manual (CANS 0-3) and the Florida’s Child and Adolescent Needs and Strengths (CANS) Comprehensive Assessment 0-5 Manual (CANS 0-5).
Page 2-8 Components for Recipients Ages 6 Years through 20 Years
The first bullet will now read:
- General identifying information (name, birth date, Medicaid identification number, sex, address, siblings, school, referral source, and diagnosis).
Page 2-9 Components for Recipients Ages 6 through 20 Years, continued
The last bullet in the first list will now read:
- For recipients ages 6 years through 20 years, completion of a standardized assessment tool, such as the Child & Adolescent Needs & Strengths An Information Integration Tool for Children and Adolescents with Mental Health Challenges CANS-MH Manual (CANS-MH) or the Child and Adolescent Needs and Strengths (CANS) Comprehensive Multisystem Assessment Manual (CANS-Comprehensive).
Page 2-10 Documentation
The first sentence of the first paragraph will now read:
A comprehensive behavioral health assessment must be written in narrative form and provide detailed information on the aforementioned components (pp. 2-6 and 2-8 for recipients under the age of six years and recipients ages 6 years through 20 years, respectively).
Page 2-12 Who Can Receive (the first one on this page)
The first paragraph will now read:
Level I specialized therapeutic foster care is for recipients with a history of abuse or neglect, or delinquent behavior, and who have an emotional disturbance or serious emotional disturbance. The recipient must qualify for foster care and must meet at least one of the following criteria:
Page 2-12 Level II
The first paragraph will now read:
Level II specialized therapeutic foster care is characterized by the need for more frequent contact between the specialized therapeutic foster parents, the recipient, primary clinician, and the psychiatrist as a result of the recipient exhibiting the maladaptive behaviors listed below.
Page 2-12 Who Can Receive (the second one on this page)
The first paragraph will now read:
A recipient requiring Level II specialized therapeutic foster care must meet the following criteria:
The last paragraph will now read:
The recipient must require the availability of highly trained specialized therapeutic foster parents as evidenced by at least one of the behaviors or deficits listed above.
Page 2-13 Who Can Receive
The last sentence in the first paragraph will now read:
An Authorization for Crisis Intervention form, found in the appendices, must be completed and a copy placed in the recipient’s clinical record by the provider.
Page 2-15 Treatment Plan and Treatment Plan Review Signature Exceptions
The first bullet will now read:
- As allowed by Section 397.601(4)(a), (b), F.S., recipients under the age of 18 years seeking substance abuse services from a licensed service provider. Recipients ages 13 years and older, experiencing an emotional crisis in accordance with Section 394.4784(1), (2), F.S.
Page 2-17 Who Can Receive
The section will now read:
The multidisciplinary team, using the Authorization for Therapeutic Group Care Services, found in the appendices, must confirm that the recipient is appropriate for therapeutic group care placement by a licensed clinical psychologist, per Section 490, F.S., or a board certified psychiatrist in compliance with Section 394.4781 or 39.407, F.S., and has an emotional disturbance or serious emotional disturbance.
Page H-2 Authorization for Therapeutic Group Care Services
The partial paragraph and bulleted list after the Date of Birth entry will now read:
has been determined by a multidisciplinary team as appropriate for therapeutic group care placement by a licensed clinical psychologist, per Section 490, F.S., or a board certified psychiatrist in compliance with Section 394.4781 or 39.407, F.S., and has an emotional disturbance or serious emotional disturbance.
