Certain subsections of Rule 65E-5.100 defining terms are being repealed because they are redundant to statute. The repealed subsections (2), (4), (16), and (17) merely reference definitions found in Sections 394.455(1), 394.4573(1)(b), 394.455(28) ...

 

DEPARTMENT OF CHILDREN AND FAMILY SERVICES
Mental Health Program

RULE NO.: RULE TITLE:
65E-5.100: Definitions
65E-5.1302: Admissions to State Treatment Facilities
65E-5.1303: Discharge from Receiving and Treatment Facilities
65E-5.1304: Discharge Policies of Receiving and Treatment Facilities
65E-5.1305: Discharge from a State Treatment Facility
65E-5.1703: Emergency Treatment Orders
PURPOSE AND EFFECT: Certain subsections of Rule 65E-5.100 defining terms are being repealed because they are redundant to statute. The repealed subsections (2), (4), (16), and (17) merely reference definitions found in Sections 394.455(1), 394.4573(1)(b), 394.455(28) and 394.455(29), F.S., respectively. Subsection (6), which defines emergency treatment orders (ETOs) is being revised to clarify that ETOs for seclusion and restraint are to be addressed in subsection 65E-5.180(7), F.A.C.; while ETOs for psychotropic medications are to be addressed in Rule 65E-5.1703, F.A.C. Subsection (3) is inserted to provide a definition of certified recovery specialist. Subsection (18), renumbered to (15), is amended to include certified recovery specialists among the members of a Seclusion and Restraint Oversight Committee. The remaining definitions in Rule 65E-5.100, F.A.C., are being renumbered accordingly.
Subsection (3) of Rule 65E-5.1302, F.A.C., is being deleted because it merely restates a requirement found in Section 394.469, F.S.
Rule 65E-5.1303, F.A.C., is being expanded to include the provisions currently found in Rules 65E-5.1304 and 65E-5.1305, F.A.C.; the latter two rules are being repealed. Thus the provisions of these three rules are effectively being consolidated into a single rule. All of these Rules 65E-5.1303, 65E-5.1304, and 65E-5.1305, F.A.C., relate to the same topic (discharge planning). There are no substantive changes to these rules.
Rule 65E-5.1703, F.A.C., is being amended to clarify that the requirements for an emergency treatment order (ETO) for psychotropic medication are different from the requirements for seclusion and restraint. The ETO requirements for psychotropic medication are addressed in Rule 65E-5.1703, F.A.C. The seclusion and restraint requirements are contained in subsection (7) of Rule 65E-5.180, F.A.C., which is not being amended. This change clarifies and simplifies reporting requirements for service providers.
SUMMARY: Certain definitions and provisions redundant to statute are repealed. Certain definitions are amended or inserted for clarity. Certain rules dealing with discharge planning are consolidated without substantive changes. Emergency treatment orders for psychotropic medication are distinguished from orders for seclusion and restraint.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:
The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.
The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The nature of the rule and a preliminary analysis conducted to determine whether a SERC was required.
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.
RULEMAKING AUTHORITY: 394.457(5), 394.46715 FS.
LAW IMPLEMENTED: 394.455, 394.457, 394.4573, 394.459(2), 394.459(3), 394.459(11), 394.4598, 394.460, 394.4625, 394.463(2)(f), 394.4655, 394.467, 394.468, 394.469 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Joe Anson, Substance Abuse and Mental Health Program Office, Department of Children and Families, 850-717-4330

THE FULL TEXT OF THE PROPOSED RULE IS:

65E-5.100 Definitions.

As used in this chapter the following words and phrases have the following definitions:

(1) No change.

(2) Administrator means a person as defined in Section 394.455(1), F.S.

(2)(3) Assessment means the systematic collection and integrated review of individual-specific data. It is the process by which individual-specific information such as examinations and evaluations are gathered, analyzed, monitored and documented to develop the person’s individualized plan of treatment and to monitor recovery. Assessment specifically includes efforts to identify the person’s key medical and psychological needs, competency to consent to treatment, patterns of a co-occurring mental illness and substance abuse, as well as clinically significant neurological deficits, traumatic brain injury, organicity, physical disability, developmental disability, need for assistive devices, and physical or sexual abuse or trauma.

(4) Case manager means a person as defined in Section 394.4573(1)(b), F.S.

(3) Certified recovery specialist means an individual credentialed by the Florida Certification Board as a Certified Recovery Peer Specialist, Certified Recovery Peer Specialist – Adult, Certified Recovery Peer Specialist – Family, Certified Recovery Peer Specialist – Veteran, or Certified Recovery Support Specialist.

(4)(5) Discharge plan means the plan developed with and by the person which sets forth how the person will meet his or her needs, including living arrangements, transportation, aftercare, physical health, and securing needed psychotropic medications for the post-discharge period of up to 21 days.

(5)(6) Emergency treatment order (ETO) means a the written emergency order for psychotropic medications, seclusion, and restraints ordered by a physician in response to a person presenting an imminent danger to self or others, and as described in Rule 65E-5.1703, F.A.C.; or a written emergency order for seclusion or restraint, as described in subsection (7) of Rule 65E-5.180, F.A.C., of this rule chapter.

(6)(7) Examination means the integration of the physical examination required under Section 394.459(2), F.S., with other diagnostic activities to determine if the person is medically stable and to rule out abnormalities of thought, mood, or behavior that mimic psychiatric symptoms but are due to non-psychiatric medical causes such as disease, infection, injury, toxicity, or metabolic disturbances. Examination includes the identification of person-specific risk factors for treatment such as elevated blood pressure, organ dysfunction, substance abuse, or trauma.

(7)(8) Health care proxy means a competent adult who has not been expressly designated by an advance directive to make health care decisions for a particular incapacitated individual, but is authorized pursuant to Section 765.401, F.S., to make health care decisions for such individual.

(8)(9) Health care surrogate means any competent adult expressly designated by a principal’s advance directive to make health care decisions on behalf of the principal upon the principal’s incapacity.

(9)(10) Person means an individual of any age, unless statutorily restricted, with a mental illness served in or by a mental health facility or service provider.

(10)(11) Personal Safety Plan is a form used to document information regarding calming strategies that the person identifies as being helpful in avoiding a crisis. The plan also lists triggers that are identified that may signal or lead to agitation or distress.

(11)(12) Pro re nata (PRN) means an individualized order for the care of an individual person which is written after the person has been seen by the practitioner, which order sets parameters for attending staff to implement according to the circumstances set out in the order. A PRN order shall not be used as an emergency treatment order.

(12)(13) Protective medical devices mean a specific category of medical restraint that includes devices, or combinations of devices, to restrict movement for purposes of protection from falls or complications of physical care, such as geri-chairs, posey vests, mittens, belted wheelchairs, sheeting, and bed rails. The requirements for the use and documentation of use of these devices are for specific medical purposes rather than for behavioral control.

(13)(14) Recovery Plan may also be referred to as a “service plan” or “treatment plan.” A recovery plan is a written plan developed by the person and his or her recovery team to facilitate achievement of the person's recovery goals. This plan is based on assessment data, identifying the person’s clinical, rehabilitative and activity service needs, the strategy for meeting those needs, documented treatment goals and objectives, and documented progress in meeting specified goals and objectives.

(14)(15) Recovery Team may also be referred to as “service team” or “treatment team.” A recovery team is an assigned group of individuals with specific responsibilities identified on the recovery plan who support and facilitate a person’s recovery process. Team members may include the person, psychiatrist, guardian/guardian advocate, community case manager, family member, peer specialist and others as determined by the person’s needs and preferences.

(16) Restraint for behavior management purposes is defined in Section 394.455(28)(a), F.S. A drug used as a restraint is defined in Section 394.455(28)(b), F.S. Physically holding a person during a procedure to forcibly administer psychotropic medication is a physical restraint.

(17) Seclusion for behavior management purposes is defined in Section 394.455(29), F.S.

(15)(18) Seclusion and Restraint Oversight Committee is a group of staff members or volunteerspeople at an agency or facility that monitors the use of seclusion and restraint in aat the facility in order to assist in safely reducing the use of these practices. This committee is intended to assist in the reduction of seclusion and restraint use at the agency or facility. Members are selected by the administrator and Membership includes, but areis not limited to, the administrator or designee administrator/designee, medical director or a physician designated by the medical directorstaff, quality assurance staff, and a certified recovery specialistpeer specialist or advocate, if employed by the facility or otherwise available. If no certified recovery specialistsuch person is employed by the facility, a volunteer certified recovery specialistan external peer specialist or advocate may be selected by the administrator appointed.

(16)(19) Standing order means a broad protocol or delegation of medical authority that is generally applicable to a group of persons, hence not individualized. As limited by this chapter, it prohibits improper delegations of authority to staff that are not authorized by the facility, or not permitted by practice licensing laws, to independently make such medical decisions; such as decisions involving determination of need, medication, routes, dosages for psychotropic medication, or use of restraints or seclusion upon a person.

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.455, 394.455(1), 394.457, 394.4573(1)(b), 394.459(2), 394.4625, 394.4655, 394.467, 765.101, 765.401 FS. History–New 11-29-98, Amended 4-4-05, 1-8-07, 5-7-08,________.

65E-5.1302 Admissions to State Treatment Facilities.

(1) through (2) No change.

(3) If a person awaiting transfer to a state treatment facility improves to the degree that he or she no longer meets the criteria for involuntary placement or that such transfer is unnecessary, the receiving facility shall discharge the person as specified in Section 394.469, F.S.

Rulemaking Authority 394.457(5) FS. Law Implemented 394.4573(2), 394.469 FS. History–New 11-29-98, Amended 4-4-05, ________.

65E-5.1303 Discharge from Receiving and Treatment Facilities.

(1) through (3) No change.

(4) Receiving and treatment facilities shall have written discharge policies and procedures which shall contain:

(a) Agreements or protocols for transfer and transportation arrangements between facilities;

(b) Protocols for assuring that current medical and legal information, including day of discharge medication administered, is transferred before or with the person to another facility; and

(c) Policy and procedures which address continuity of services and access to necessary psychotropic medications.

(5) When a state mental health treatment facility has established an anticipated discharge date for discharge to the community which is more than seven days in advance of the person’s actual discharge, at least 7 days notice must be given to the community agency which has been assigned case management responsibility for the implementation of the person’s discharge plan. When an impending discharge is known 7 days or less prior to the discharge, the staff of the state mental health treatment facility shall give verbal and written notice of the impending discharge to the community case management agency within 1 working day after the decision to discharge is made. Recommended form CF-MH 7001, Jan. 98, “State Mental Health Facility Discharge Form,” which is incorporated by reference, may be used for this purpose.

(6) On the day of discharge from a state mental health treatment facility, the referring physician, or his or her designee, within state law and approved facility protocols and practice guidelines shall immediately notify the community aftercare provider or entity responsible for dispensing or administering medications. Recommended form CF-MH 7002, “Physician to Physician Transfer,” as referenced in subsection 65E-5.1302(2), F.A.C., may be used for this purpose.

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.4573(2), 394.459(11), 394.460, 394.4655, 394.468 FS. History–New 11-29-98, Amended 4-4-05,________.

65E-5.1304 Discharge Policies of Receiving and Treatment Facilities.

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(11) FS. History–New 11-29-98, Amended 4-4-05, Repealed________.

65E-5.1305 Discharge from a State Treatment Facility.

Rulemaking Authority 394.457(5) FS. Law Implemented 394.4573, 394.459(11), 394.468 FS. History–New 11-29-98, Amended 4-4-05, Repealed________.

65E-5.1703 Emergency Treatment Orders for the Administration of Psychotropic Medications.

(1) An emergency treatment order shall be consistent with the least restrictive treatment interventions, including the emergency administration of psychotropic medications or the emergency use of restraints or seclusion. Use of seclusion or restraint in an emergency situation is addressed in subsection 65E-5.180(7), Florida Administrative Code and is not addressed in this rule. This rule pertains only to the use of psychotropic medication in an emergency situation.

(a) The issuance of an emergency treatment order requires a physician’s review of the person’s condition for causal medical factors, such as insufficiency of psychotropic medication blood levels, as determined by drawing a blood sample; medication interactions with psychotropic or other medications; side effects or adverse reactions to medications; organic, disease or medication based metabolic imbalances or toxicity; or other biologically based or influenced symptoms.

(b) All emergency treatment orders may only be issuedwritten by a physician licensed under the authority of Chapter 458 or 459, F.S.

(c) The physician must review, integrate and address such metabolic imbalances in the issuance of an emergency treatment order.

(d) The use of an emergency treatment order must be consistent with the least restrictive treatment requirements, and for persons must include:,

1. aAbsent more appropriate interventions, an emergency treatment order is for immediate administration of rapid response psychotropic medications to a person to expeditiously treat symptoms, that if left untreated, present an immediate danger to the safety of the person or others.

2. Absent more appropriate medical interventions, an emergency treatment order for restraint or seclusion of a person to expeditiously treat symptoms that if left untreated, present an imminent danger to the safety of the person or others.

(d) An emergency treatment order, as used in this chapter, excludes the implementation of individualized behavior management programs as described and authorized in Rule 65E-5.1602, F.A.C., of this rule chapter.

(2) through (9) No change.

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(3), 394.4598, 394.463(2)(f), 458, 459 FS. History–New 11-29-98, Amended 4-4-05,________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Joe Anson
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: David E. Wilkins
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 10-29-2012
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: