DEPARTMENT OF CHILDREN AND FAMILIES
RULE NO.:RULE TITLE:
65E-14.021Schedule of Covered 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. 48 No. 175, September 8, 2022 issue of the Florida Administrative Register.
65E-14.021 Schedule of Covered Services.
This rule provides guidelines and requirements applicable to service providers under direct contract with the Department or service providers under subcontracts with a Managing Entity.
(1) Unless specifically authorized otherwise in advance by the Department, service providers shall only use the following Substance Abuse and Mental Health (SAMH) Covered Services to report contracted or subcontracted substance abuse and mental health services.
(a) through (hh) No change.
(ii) Respite Services Level II,
(jj) through (rr) are redesignated (ii) through (qq) No change.
(rr)(ss) Treatment Accountability Alternatives for Safer Communities (TASC), and
(ss)(tt) No change.
(2) No change.
(3) Measurement Standards for Covered Services.
(a) Measurement standards document the amount of service delivery, regardless of the method of payment for the service To account for services provided pursuant to contracts with SAMH-Funded Entities., The the following common measurement definitions shall apply to each SAMH Covered Service as specified in subsection (4), of this rule:
1. through 4. No change.
(b) through (e) No change.
(4) The descriptions, applicable programs, measurements standards, and data elements for SAMH Covered Services are as follows:
(a) through (d) No change.
(e) Community Action Treatment (CAT).
1. through 2. No change.
3. Measurement Standard: Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III) (3)(a)1., of this rule.
4. No change.
(f) through (k) No change.
(l) Florida Assertive Community Treatment (FACT) Team.
1. through 2. No change.
3. Measurement Standard – Number of Enrolled Participants, notwithstanding the requirements of paragraph (3)(a), of this rule. The total value of a service provider’s FACT team contract divided by the number of contracted slots establishing the annual cost per participant. The annual cost per participant may be divided by 365 days per year to establish the daily enrollment cost.
4. No change.
5. Reimbursement for this Covered Service shall be based upon the total value of a service provider’s FACT team contract divided by the number of contracted slots establishing the annual cost per participant. The annual cost per participant may be divided by 365 days per year to establish the daily enrollment cost.
(m) through (q) No change.
(r) Intensive Case Management.
1. Description – These services are typically offered to persons who are being discharged from an acute care setting, and are in need of more professional care, and have contingency needs to remain in a less restrictive setting. The services include the same components as case management as described in sub-sub-paragraph (4)(d)1., of this rule, but are provided at a higher intensity and frequency, and with lower caseloads per case manager sufficient to meet the needs of the individuals in treatment.
2. through 4. No change.
(s) through (v) No change.
(w) Outpatient.
1. Description – Outpatient services provide clinical interventions to improve the functioning or prevent further deterioration of persons with mental health and/or substance use disorders. These services are usually provided on a regularly scheduled basis by appointment, with arrangements made for non-scheduled visits during times of increased stress or crisis. Outpatient services may be provided to an individual or in a group setting. The maximum number of individuals allowed in a group session is 15. This covered service shall include clinical supervision provided to a service provider’s personnel by a professional qualified by degree, licensure, certification, or specialized training in the implementation of this service.
2. through 4. No change.
(x) through (bb) No change.
(cc) Recovery Support.
1. Description – This Covered Service is comprised of nonclinical activities that assist individuals and families in recovering from substance use and mental health conditions. Activities include social support, linkage to and coordination among service providers, life skills training, recovery planning, coaching, education on mental illness and substance use disorders, assisting individuals using digital therapeutics approved by the United States Food and Drug Administration, and other supports that facilitate increasing recovery capital and wellness contributing to an improved quality of life. Recovery capital is the personal, family, social, community resources and natural supports that promote recovery. These activities may be provided prior to, during, and after treatment. These services support and coach an adult or child and family to regain or develop skills to live, work and learn successfully in the community. This Covered Service shall include supervision provided to a service provider’s personnel by a professional qualified by degree, licensure, certification, or specialized training in the implementation of this service, or by a certified peer specialist who has at least 2 years of fill-time experience as a peer specialist at a licensed behavioral health organization. This Covered Service must be provided by a Certified Recovery Peer Specialist pursuant to section 397.417, F.S. These services exclude twelve-step programs such as Alcoholics Anonymous and Narcotics Anonymous.
2. through 4. No change.
(dd) Residential Level I.
1. Description – These licensed services provide a structured, live-in, non-hospital setting with supervision on a twenty-four hours per day, seven days per week basis. For adult mental health, Residential Treatment Facilities Level IA and IB, as defined in Rule 65E-4.016, F.A.C., are reported under this Covered Service. For children with serious emotional disturbances, Level 1 services are the most intensive and restrictive level of residential therapeutic intervention provided in a non-hospital or non-crisis stabilization setting. Residential Treatment Centers, as defined in Rule 65E-9.002, F.A.C., are reported under this Covered Service. For substance use treatment, Residential Level 1, as defined in Rule 65D-30.007, F.A.C., provides a range of assessment, treatment, rehabilitation, and ancillary services in an intensive therapeutic environment, with an emphasis on treatment, and may include formal school and adult education programs.
2. through 4. No change.
(ee) Residential Level II.
1. Description – Level II facilities are licensed, structured rehabilitation-oriented group facilities that have twenty-four hours per day, seven days per week, supervision. Level II facilities house persons who have significant deficits in independent living skills and need extensive support and supervision. For adults with a mental illness, Residential Treatment Facilities Level II, as defined in Rule 65E-4.016, F.A.C., are reported under this Covered Service. For children with serious emotional disturbances, Level II services provide intensive therapeutic behavioral and treatment interventions. Therapeutic Foster Homes are reported under this Covered Service. For substance use treatment, Level II, as defined in Rule 65D-30.007, F.A.C., services provide a range of assessment, treatment, rehabilitation, and ancillary services in a less intensive therapeutic environment with an emphasis on rehabilitation and may include formal school and adult educational programs.
2. through 4. No change.
(ff) Residential Level III.
1. Description – These licensed facilities provide twenty-four hours per day, seven days per week supervised residential alternatives to persons who have developed a moderate functional capacity for independent living. For adults with a mental illness, Residential Treatment Facilities Level III, as defined in Rule 65E-4.016, F.A.C., are reported under this Covered Service. For substance use treatment, Level III, as defined in Rule 65D-30.007, F.A.C., provides a range of assessment, rehabilitation, treatment and ancillary services on a long-term, continuing care basis where, depending upon the characteristics of the individuals served, the emphasis is on rehabilitation or treatment.
2. through 4. No change.
(gg) Residential Level IV.
1. Description – This type of facility may have less than twenty-four hours per day, seven days per week on-premise supervision. It is primarily a support service and, as such, treatment services are not included in this Covered Service, although such treatment services may be provided as needed through other Covered Services. Level IV includes satellite apartments, satellite group homes, and therapeutic foster homes. For adults with a mental illness, Residential Treatment Facilities Level IV, as defined in paragraph 65E-4.016, F.A.C., are reported under this Covered Service. For substance use treatment, Level IV, as defined in Rule 65D-30.007, F.A.C., provides a range of assessment, rehabilitation, treatment, and ancillary services on a long-term, continuing care basis where, depending upon the characteristics of the individuals served, the emphasis is on rehabilitation or treatment.
2. through 4. No change.
(hh) Respite Services Level I.
1. Description – Respite care services support the family or other primary care giver by providing time-limited, temporary relief, including overnight stays, from the ongoing responsibility of care giving. Respite Services Level I are billed as a direct staff hour when the duration of the services is less than ten hours.
2. through 4. No change.
(ii) Respite Services Level II.
1. Description – Respite care services support the family or other primary care giver by providing time-limited, temporary relief from the ongoing responsibility of care giving. Respite Services Level II are billed as a day rate when the duration of the services is for ten hours or more.
2. Programs – Community Mental Health and Community Substance Abuse.
3. Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II), of this rule.
4. Data Elements:
a. Service Documentation – Census Log:
(I) Covered Service,
(II) Program,
(III) Recipient name and identification,
(IV) Clinical diagnosis,
(V) Service date, and
(VI) Respite service type.
b. Audit Documentation – Recipient Service Chart:
(I) Covered Service,
(II) Recipient name and identification number, and,
(III) Service date.
(jj) through (ll) are redesignated (ii) through (kk) No change.
(ll)(mm) Room and Board with Supervision Level IV.
1. Description – This Covered Service solely provides for room and board with supervision on a twenty-four hours per day, seven days per week basis. It corresponds to Respite Services Level II as defined in paragraph (4)(ii), of this rule.
2. through 4. No change.
(nn) through (pp) are redesignated (mm) through (oo) No change.
(pp)(qq) Supported Employment.
1. Description – Supported employment is an evidence-based approach that assists assist individuals with gaining competitive integrated employment. All individuals enrolled in one of the Department’s priority populations and interested in work are eligible for these services. Evidence-based Supported supported employment can be is a team-based approach and that focuses on the full range of community jobs that match the job seeker’s strengths and preferences. Job supports are individualized and include: job development, job placement, and long-term job coaching. provided as long as desired and needed. Individuals are assisted in making job changes to promote career advancement.
2. through 4. No change.
(rr) is redesignated (qq) No change.
(rr)(ss) Treatment Accountability Alternatives for Safer Communities (TASC).
1. through 4. No change.
(5) through (7) No change.
Rulemaking Authority 394.78(1), (5), 394.9082(3), 397.321(5), 402.73 FS. Law Implemented 394.74(2)(b), (3)(d), (e), (4), 394.77, 394.78(1), (5), 394.9082, 397.321(10), 402.73(1) FS. History–New 7-1-03, Amended 12-14-03, 1-2-05, 7-27-14, 6-28-15, 4-27-16. Amended________________.
