The proposed amendments to Children’s Medical Services Rules 64C-8.001-.004, F.A.C., update and reflect the standards for Child Protection Teams.

DEPARTMENT OF HEALTH
Division of Children’s Medical Services

RULE NO: RULE TITLE
64C-8.001: Definitions Used in the Child Protection Team Rule
64C-8.002: Child Protection Team Organization, Roles and Responsibilities
64C-8.003: CPT Services
64C-8.004: Waivers
PURPOSE AND EFFECT: The proposed amendments to Children’s Medical Services Rules 64C-8.001-.004, F.A.C., update and reflect the standards for Child Protection Teams.
SUMMARY: Amendments provide new and updated definitions; revises minimum criteria for a Child Protection Medical Director, Team Coordinator, Psychologist, Team Physicians, Physician Assistants, and Advanced Registered Nurse Practitioners, and Team Attorneys; updates eligibility criteria and services; and clarifies waiver procedures.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 39.303, 415.514 FS.
LAW IMPLEMENTED: 415.5055 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Janet Evans, [e-mail]

THE FULL TEXT OF THE PROPOSED RULE IS:

64C-8.001 Definitions Used in the Child Protection Team Rule.

For the purpose of this rule chapter, the following definitions will apply:

(1) “ARNP” means – advanced registered nurse practitioner.

(1)(2) “Case” means – an individual child referred to and accepted by a child protection team for assessment services as a result of a report of alleged abuse or neglect made to the Hotline who receives services from the child protection team.

(2)(3) “Case Coordinator” means – a member of the child protection team professional staff who provides or directs the activities on behalf of clients to complete team assessment services.

(3)(4) “Medical Consultation” means – the rendering by a Child Protection Team physician’s or a Physician’s Assistant’s, under the supervision of a physician, or Advanced Registered Nurse Practitioner’s rendering, for the evaluation of suspected child abuse or neglect, of a medical opinion regarding a child, based upon oral or written information having been obtained by the Child Protection Team physician. Physician’s Assistant, or Advanced Registered Nurse Practitioner, where the child may not have been physically examined by the Child Protection Team physician, Physician’s Assistant, or Advanced Registered Nurse Practitioner.

(4)(5) “Medical Diagnostic Examination” means – a medical evaluation performed by a Child Protection Team physician, Physician’s Assistant, or an Advanced Registered Nurse Practitioner, resulting in a written report with a clear statement of findings and conclusion.

(5)(6) “Psychological Evaluation” means – an evaluation performed by a licensed psychologist, resulting in a written report.

(6)(7) “Team Assessment” means – the medically-directed multidisciplinary process of evaluation.

(7) “Team Attorney” – a member of the Florida Bar who is available on a part time basis to work with the Child Protection Team to provide legal services and consultation.

(8) “Team Coordinator” – the person in charge of managing the day to day operation of a Child Protection Team.

(9) “Telemedicine” – the use of telecommunication and information technology to provide clinical care to individuals at a distance and to transmit the information needed to provide that care.

Specific Authority 39.303, 415.514 FS. Law Implemented 415.5055 FS. History–New 3-2-93, Amended 5-7-96, Formerly 10J-10.002, 65C-7.001, Amended________.

 

64C-8.002 Child Protection Team Organization, Roles and Responsibilities.

(1) Each Child Protection Team will function under the oversight direction of and be supervised by a CMS approved provider consultant pediatrician whose title will be Child Protection Team Medical Director. The minimum qualifications for this position are:

(a) Graduation from an accredited school of medicine with board certification in pediatrics and licensed to practice in Florida.

(b) An approved CMS physician provider.

(c) Demonstrated interest in the field of child abuse and neglect and satisfactory completion of training deemed necessary by the department for evaluating alleged abuse and neglect.

(d) Availability to provide oversight of team and client assessments.

(2) Each Child Protection Team will have an on-site Team Coordinator who will be responsible for the daily coordination of Team activities and services. The minimum qualifications for this position are:

a. Bachelors or Masters Degree in a Human Services field, Psychology, Social Work, or Nursing.

b. At least three years of experience in the field of child abuse and neglect, one of which must have been in program management.

(3) The qualifications for the position of Team Coordinator include a Bachelor’s or Masters degree in Psychology, Social Work, Nursing, or another behavioral science, at least three years of experience in the field of child abuse and neglect, and experience in program management.

(3)(4) Child Protection Team staff shall consist of one or more case coordinators with Bachelors or Masters degrees in Psychology, Social Work, Nursing, or another behavioral science and not less than three years of experience in working with children and their families, one year of which must be with abused and neglected children. who complete assessment activities and referrals, and perform related duties. The minimum qualifications for this position are:

(a) Bachelors or Masters Degree in a Human Services field, Psychology, Social Work, or Nursing.

(b) At least two years of experience working with children and/or families, one year of which must be working with abused and neglected children.

(4)(5) Physicians, Advanced Registered Nurse Practitioners, attorneys, psychologists (or psychiatrists) will be available as needed or appropriate for consultation and diagnosis and evaluation.

(5)(6) Each team shall have available a Florida licensed psychologist with training and experience in evaluation and treatment of child abuse and neglect. The minimum qualifications for this person are:

(a) Licensure under Chapter 490, Florida Statute, and adherence to standards established by the Department of Health, the American Psychological Association, and the Florida Department of Business and Professional Regulation (DBPR).

(b) Ongoing education, experience, and training as required by the Department of Health, Children’s Medical Services.

(c) Sufficient professional experience and expertise to be qualified as a mental health and family violence expert in criminal, civil and dependency courts in Florida.

(6)(7) Each Child Protection Team shall have team Pediatricians or Advanced Registered Nurse Practitioners who work part-time with the Team, under the supervision of the Team Medical Director, CPT on a contractual or fee for service basis and respond to requests for medical consultation and evaluation of children suspected of being abused or neglected, under the supervision of the CPT Medical Director. These evaluations may take place in a hospital space or in an out-patient or private office setting. The qualifications for this position are:

(a) Physician.

1. Graduation from an accredited school of medicine with board certification/eligibility in pediatrics and licensed to practice in Florida.

2. An approved CMS physician medical provider.

3. Experience in the evaluation and treatment of child abuse and neglect or agreement to receive training deemed necessary by the department for evaluating alleged abuse and neglect.

(b) Advanced Registered Nurse Practitioner.

1. Licensure in the state of Florida to practice professional nursing and certification in advanced or specialized pediatrics or family medicine nursing practice.

2. Experience in the evaluation and treatment of child abuse and neglect or agreement to receive training deemed necessary by the department for evaluating alleged abuse and neglect.

(7) The Child Protection Team can use Physician’s Assistants under the supervision of a Child Protection Team physician in accordance with Section 458.347, Florida Statutes.

(8)(7) Each Child Protection Team shall have a Team Attorney who works with the team on a part-time basis under the general oversight supervision of the Team Medical Director to provide legal services and consultation to the team. The attorney shall be a member of the Florida Bar. The qualifications for this position are:

(a) Member of the Florida Bar.

(b) Availability to work with the team on a part-time basis

Specific Authority 39.303, 415.514 FS. Law Implemented 415.5055 FS. History–New 3-2-93, Amended 5-7-96, Formerly 10J-10.006, 65C-7.002, Amended________.

 

64C-8.003 Child Protection Team Services.

(1) A Child Protection Team physician or Advanced Registered Nurse Practitioner and a case coordinator must be available 24 hours a day, seven days a week for consultation. or Oon-site services provision. will be provided as deemed necessary for child safety.

(2) Child Protection Team services are provided in cases of suspected abuse or neglect without regard to income. All children, reported as being abused or neglected by an adult caretaker and accepted by the Florida Abuse Hotline for Children and Families protective investigation, are eligible for Child Protection Team team assessment services.

(3) A full-team staffing will be conducted when requested by the Children and Families case manager. A staffing will be scheduled by the CPT case coordinator and must include at a minimum the following team members:

(a) Team Medical Director or a physician/ARNP designated to take his/her place.

(b) Case coordinator responsible for the case.

(c) Team attorney as designated by the CPT.

(d) Team Psychologist (or psychiatrist).

(e) Children and Families case manager.

(4) If consensus cannot be reached in the staffing, the matter must be taken to the Children and Families supervisor who will try to resolve it with the team coordinator. If the problem cannot be resolved at that level, it must be taken through the established channels, to the district administrator or his designee. Each district must develop a procedure for achieving consensus in disputed cases including representation from the Child Welfare Legal Services.

(3) Each Child Protection Team must work with its local child protection agency to develop a local protocol for achieving consensus, including representation from appropriate legal staff, and follow this procedure in disputed cases. If the issue cannot be resolved at the local level, the team coordinator should contact his or her program office liaison for assistance.

(4)(5) All Child Protection Teams must use CMS approved consultant board certified pediatricians as provided in Rule 64C-4.001, F.A.C., 10J-5.007, F.A.C., to provide medical diagnosis and evaluation. With approval of the CMS Medical Director, Child Protection Teams may also utilize the services of an Advanced Registered Nurse Practitioner to provide medical diagnosis and evaluations.

(5) Medical diagnosis and evaluation can be conducted in person or through the use of telemedicine technology. Use of telemedicine requires the presence of a CMS approved physician or Advanced Registered Nurse Practitioner at the hub site and a Registered Nurse at the remote site to facilitate the evaluation.

(6) Child Protection Team members Physicians and Psychologists providing expert court testimony in a non-dependency proceeding may shall request reimbursement from the court, not the CPT.

Specific Authority 39.3031, 415.514 FS. Law Implemented 39.0133, 92.231, 415.5055, 415.507(4), 960.28 FS. History–New 3-2-93, Amended 5-7-96, Formerly 10J-10.007, 65C-7.003, Amended________.

 

64C-8.004 Waivers.

(1) In the event that compliance with any standard contained herein is not attained, a program may request a waiver of that standard.

(2) All requests for waiver of a specific standard shall be submitted in writing to the Children’s Medical Services Program Office, Director of Prevention and Intervention, through the District Administrator and shall include documentation of the need for the waiver.

(3) A waiver of a specific standard shall be granted only for a specific period of time which shall not exceed the contract period.

(3)(4) Final approval or disapproval of all requests for waiver shall be made by the Deputy Secretary for Children’s Medical Services or their designee, who will make. The Deputy Secretary for CMS shall base the decision to grant or deny a specific request for waiver of a standard upon the documented rationale presented for the request. Waiver requests shall contain at least these sections:

(a) Identification of the facility standard or personnel standard for which the waiver is requested;

(b) Description of the attempts to meet the standard;

(c) A plan for remediating the need for the waiver;

(d) Assurance and an explanation in the request that the granting of such a waiver will not adversely affect the quality of care rendered by the provider; and

(e) An assessment of need and lack of existence of alternative solutions.

(4)(5) The Children’s Medical Service Program Office shall notify the program in writing, through the district administrator, that the request for waiver of a specific standard has been granted or denied. If a request for a waiver is denied, the denial letter shall include advice of the right to request an administrative hearing under Section 120.57, Florida Statutes.

Specific Authority 39.3031, 415.514 FS. Law Implemented 39.303 FS. History–New 3-2-93, Amended 5-7-96, Formerly 10J-10.008, 65C-7.004, Amended________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Janet Evans, [e-mail]
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Peggy Scheuermann
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 8, 2007
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: October 12, 2007