The purpose of the amendments is to make improvements and corrections to the substance abuse and mental health contracting system and financial rule, based upon input from departmental staff.

Substance Abuse and Mental Health Programs

RULE NOS.: RULE TITLES:

65E-14.003 Audits of Contractors Participating in the Substance Abuse and Mental Health Programs

65E-14.017 Cost Principles

65E-14.021 Unit Cost Method of Payment

65E-14.022 Data Requirements

PURPOSE AND EFFECT: The purpose of the amendments is to make improvements and corrections to the substance abuse and mental health contracting system and financial rule, based upon input from departmental staff.

SUBJECT AREA TO BE ADDRESSED: Amendments are made to Chapter 65E-14, F.A.C. to: update the contact person, update a reference as how the method of depreciation is followed; add language allowing the department to pursue alternative methods of payment pursuant to Section 394.74(2)(b), F.S., add a clarification as to how the Mental Health Clubhouse staff hours shall be paid; add language pertaining to how Day-Night services are to be provided to resolve a conflict with paragraph 65D-30.002(16)(e), F.A.C.; add language to the Crisis Support/Emergency, Intervention services and Outpatient services descriptions that allows the maximum rate to be paid for these services during a Governor’s Emergency Declaration for natural or man-made disasters; add a clarification to the description of the Prevention/Intervention-Day services cost center that includes in the cost center children and adolescents in non-school based programs or the Florida Youth Initiative Program; add Intensive Inpatient Services to the Residential Level 1 cost center and the maximum rate to be paid for these services ; add Aftercare and Intervention services to the list of services eligible for special rates for group treatment and the unit of measure for those; add a new section on alternative method of payment for use under conditions of a Governor’s Emergency Declaration for natural or man-made disasters;  delete the provision for units billed to cost centers paid on the basis of utilization; add an updated form for the Monthly Request for Non-TANF Payment and add an updated Worksheet for Request for Payment.

SPECIFIC AUTHORITY: 394.78(1), 397.321(5) FS.

LAW IMPLEMENTED: 216.181(16) FS., 394.66(9), (12) FS., 394.74(2)(b), (3)(d), (e), (4) FS., 394.77 FS., 394.78(1), (6) FS., 397.321(10) FS., 402.73(7) FS.

A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: March 31, 2006, 10:00 a.m. – 12:00 Noon

PLACE:  1317 Winewood Blvd., Building 6, Conference Room A, Tallahassee, Florida

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULES IS: Amy Johnson, Senior Management Analyst Supervisor, Department of Children and Families, 1317 Winewood Blvd., Building 6, Room 233,  [phone], e-mail: [e-mail].

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

65E-14.003 Audits of Contracts Participating in the Substance Abuse and Mental Health Programs.

(1) through (4) No change.

(5) The following special audit schedule and documents are hereby incorporated by reference, copies of which may be obtained from the Mental Health Substance Abuse Program Office, Attn.: PDMH PDSA, 1317 Winewood Blvd., Buiding 6, Tallahassee, Florida 32399-0700.

(a) through (e) No change.

Specific Authority 394.74, 394.77, 394.78(1), (3), 397.321(5) FS. Law Implemented 394.74, 394.66(9), 394.76(5), 394.77, 394.78(3,) 397.481 FS. History–New  2-23-83, Amended 2-25-85, Formerly 10E-14.03, Amended 7-29-96, Formerly 10E-14.003, Amended 7-1-03, 12-14-03, ________.

 

65E-14.017 Cost Principles.

(1) through (4)(i)  No change.

4. Where depreciation method is followed, the period of useful service, useful life established in accordance with guidelines as published by the American Hospital Association, Revised 2004 Edition 1973 Edition  of the “Estimated Useful Lives of Depreciable Hospital Assets”  Chart of Accounts for Hospitals, “Estimated Useful Life of Land Improvements, Buildings and Fixed Equipment.” The method of depreciation used to assign the cost of an asset, or group of assets, to accounting periods shall reflect the pattern of consumption of the asset during its useful life. In the absence of clear evidence indicating that the expected consumption of the asset will be significantly greater in the early portions of its useful life than in the later portions, the straight-line method shall be presumed to be the appropriate method. Depreciation methods once used shall not be changed unless approved in advance by the department. When the depreciation method is introduced for application to assets previously subject to a use allowance, the combination of use allowances and depreciation applicable to such assets must not exceed the total acquisition cost of the assets. When the depreciation method is used for buildings, a building’s shell may be segregated from each building component, for example, plumbing system, heating, and air conditioning system, etcetera, and each item depreciated over its estimated useful life; or the entire building, that is, the shell and all components, may be treated as a single asset and depreciated over a single useful life.

5. through (ss). No change.

Specific Authority 394.78(1), 397.321 (5) FS. Law Implemented 394.74, 394.77, 394.78 (1), 397.481 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.17, Amended 7-29-96, Formerly 10E-14.017, Amended 9-17-97, 7-1-03,________.

 

65E-14.019 Methods of Paying for Services.

(1) through (3) No change.

(4) Nothing in subsection (1) or (2) shall be construed to preclude the department from utilizing alternative methods of contracting pursuant to Section 394.74(2)(b), F.S.  Additional services may also be negotiated between the provider and the department through a properly executed contract document.

(5)(4) The Reference Guide for State Expenditures (updated January 2005) is hereby incorporated by reference, copies of which may be obtained from the Mental Health Substance Abuse Program Office, ATTN: PDMH PDSA, 1317 Winewood Blvd., Building 6, Tallahassee, Florida 32399-0700.

Specific Authority 394.74(2), 394.76(4), 394.78(1), (6), 397.321(5) FS. Law Implemented 394.66(9), (12), 394.74(2), 394.76(4), 394.78(1), (6) FS. History–New 7-1-03, Amended 12-14-03, ________.

 

65E-14.020 Cost Reimbursement Method of Payment.

(1) through (3). No change.

(4) The following forms are hereby incorporated by reference, copies of which may be obtained from the Mental Health Substance Abuse Program Office, ATTN.: PDMH PDSA, 1317 Winewood Blvd,., Building 6, Tallahassee, Florida 32399-0700

(a) through (c) No change.

Specific Authority 394.78(1), (6), 397.321(5) FS. Law Implemented 394.66(9), 394.74(2)(c), (3)(d), (4), 394.78(1), (6), 397.321(10) FS. History–New 7-1-03, Amended 12-14-03,_________.

 

65E-14.021  Unit Cost Method of Payment.

(1) through (5)(a)9. No change.

10. Clubhouse Staff Hour. This unit of measure represents an hour of staff time in which one or more persons (Clubhouse members) are being provided with a service or activity within the Clubhouse or away from the Clubhouse. It may also include staff time spent on behalf of members away from the facility, such as, developing employment prospects or exploring housing alternatives. Staff time spent in travel on behalf of Clubhouse members or activities may also be included. Clubhouse staff hours shall be paid on the basis of utilization.

(b) through (7) (d) No change.

(e) Crisis Support/Emergency.

1. Description – These non-residential care services are generally available twenty-four (24) hours per day, seven (7) days per week, or some other specific time period, to intervene in a crisis or provide emergency care. Examples include: mobile crisis, crisis support, crisis/emergency screening, crisis telephone, and emergency walk-in. During the period of time covered by a Governor’s Emergency Declaration, and in the counties so named in that declaration, the rate for Crisis Support/Emergency services may be paid at the maximum allowable under Chapter 65E-14, F.A.C.

2. through (7) (f). No change.

(g) Day-Night

1.  Description – Day-Night services provide a structured schedule of non-residential services for four (4) or more consecutive hours per day. Activities for children and adult mental health programs are designed to assist individuals to attain skills and behaviors needed to function successfully in living, learning, work, and social environments. Generally, a person receives three (3) or more services a week. Activities for substance abuse programs emphasize rehabilitation, treatment, and education services, using multidisciplinary teams to provide integrated programs of academic, therapeutic, and family services.  For substance abuse services the minimal hours of service required on a weekly basis for this cost center are specified in Chapter 65D-30, F.A.C., Licensure Standards for Substance Abuse Services.

2. through (7) (n) No change.

(o) Intervention

1. Description – Intervention services focus on reducing risk factors generally associated with the progression of substance abuse and mental health problems. Intervention is accomplished through early identification of persons at risk, performing basic individual assessments, and providing supportive services, which emphasize short-term counseling and referral. The services are targeted toward individuals and families. During a period of time covered by a Governor’s Emergency Declaration for natural or man-made disasters, and in the counties so named in that declaration, the rate for Intervention services may be paid at the maximum allowable under Chapter 65E-14, F.A.C.

2. through (7) (r)  No change.

(s) Outpatient.

1. Description – Outpatient services provide a therapeutic environment, which is designed to improve the functioning or prevent further deterioration of persons with mental health and/or substance abuse problems. 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 group size limitations applicable to the Medicaid program shall apply to all Outpatient services funded through a state substance abuse and mental health program contract.    During a period of time covered by a Governor’s Emergency Declaration for natural or man-made disasters, and in the counties so named in that declaration, the rate for Outpatient services may be paid at the maximum allowable under Chapter 65E-14, F.A.C.

2. through (7) (v) No change.

(w) Prevention/Intervention – Day.

1. Description – This cost center includes school-based day services for children and adolescents for four (4) or more consecutive hours per day. For children with mental health problems, these services include school-based mental health services for children who have been identified by the school as having, or are at risk of developing, mental health problems. Services are individualized and may be provided in a self-contained classroom, a regular classroom, or as a component of a full service school. For children and adolescents with substance abuse problems, it includes Alpha and Beta targeted prevention programs serving students in grades 4-6 and 6-8, respectively, who are identified as at risk for alcohol or other drug abuse. These services consist of multiple, structured contacts over time to specific individuals or groups identified as having behavioral, biological or environmental at-risk characteristics. These programs promote skills building and reduce the risk of establishing patterns of use. Services are provided through community provider agencies in partnership with county school boards. Counselors provide individual, group, and family counseling, and school personnel implement an intensive education program. This cost center also includes children and  adolescents who are at risk of substance abuse problems and receive targeted prevention services in non-school based programs or through the Florida Youth Initiative Program.

2. through (7) (w) No change.

(x) Residential Level I

1.  Description – These licensed services provide a structured, live-in, non-hospital setting with supervision on a twenty-four (24) hour, seven (7) days per week basis.  A nurse is on duty in these facilities at all times.  For adult mental health, these services include group homes.  Group homes are for longer-term residents.  These facilities offer nursing supervision provided by, at a minimum, licensed practical nurses on a twenty-four (24) hours a day, seven (7) days per week basis.  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 support unit setting, including residential treatment centers.  Medicaid Residential Treatment Centers in a non-hospital or a non-crisis support unit setting, including residential treatment centers.  Medicaid Residential Treatment Centers (MRTC) and Residential Treatment Centers (RTC) are reported under this cost center.  On-call medical care must be available for substance abuse programs.  Level 1 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.  Substance Abuse Intensive Inpatient services may also be provided under this cost center.  Services include an increased medical overlay and increased frequency and intensity of contact.  Payment for these services may not exceed the Maximum Unit Cost Rate plus fifteen percent (15%).

2 through (7)(kk).  No change.

(8) through (9)(c) No change.

(d) Special Rates for Group Treatment. The state rate for group treatment for Aftercare, Intervention, and Outpatient Services is equal to 25 percent of the state rate for individual Aftercare, Intervention, and Outpatient Services.  Services for group rates shall be paid on the basis of a contact hour.

(10) through (10)(b)2. No change.

3.  Funding Flexibility for Individual Cost Centers.

a.  Except for cost centers designated pursuant to sub-subparagraph 3.c. below, a contractor may invoice and be paid up to 15 percent more than the non-Temporary Assistance to Needy Families (TANF) funding amount specified in the contract for an individual cost center within a program; however, a contractor may not invoice and be paid more than the aggregate non-TANF funding amount provided in the contract for all cost centers within the program, but not across programs.  The department may combine cost centers into groups within a program, and the aggregate amount of payment that may not be exceeded is the total contract amount associated with the cost centers within each group, but not across groups.

b.  The substance abuse and mental health program supervisors in the district or region may increase from 15 percent up to  30 percent the amount contractor may exceed the total non-TANF funding specified in the contract for an individual cost center within a program and may further specify that funding may be added to that cost center but not subtracted from that cost center.

c.  The state Directors of the Substance Abuse and Mental Health Programs may identify specific cost centers where the non-TANF funding flexibility specified in sub-subparagraphs a. and b. above shall not exist.  In each such cost center, payment for units of service shall not exceed the contracted amount, and the contracted funds are restricted to payment for units of service in only that cost center.  The substance abuse and mental health program supervisors in a district or region, upon a finding in the District or Regional /Substance Abuse and Mental Health Plan that an extraordinary need exists to provide a precise number of service units in a particular cost center, may add that cost center to those identified by the state Program Directors.

d.  When entering into a contract with a particular contractor, the substance abuse and mental health program supervisors in a district or region may deny non-TANF flexibility for all cost centers if the contractor is currently under a corrective action plan or has failed to implement a corrective action plan pursuant to Rule 65-29.001, F.A.C., or if the substance abuse and mental health program supervisors in a district or region present a justification to and obtains the approval of state Directors of the Substance Abuse and Mental Health Programs.

3.  Aggregate Invoice Amounts

a.  With non-TANF funds, the contractor may invoice and be paid an amount for any individual cost center specified for non-TANF funding in the contract not to exceed the total amount of non-TANF funds provided in the contract for all such cost centers within a program or group of cost centers within a program; however, the aggregate amount invoiced and paid for all such cost centers shall also not exceed the total amount of non-TANF funds provided in the contract for the program or for the group of cost centers.

3.e.b. With TANF funds, the contractor may invoice and be paid an amount for any individual cost center specified for TANF funding in the contract not to exceed the total amount of TANF funds provided in the contract for all such cost centers within a program or group of cost centers within a program; however, the aggregate amount invoiced and paid for all such cost centers shall also not exceed the total amount of TANF funds provided in the contract for the program or for the group of cost centers.  The contract shall specify the unit cost rate for each cost center contracted for TANF funding, which shall be the same rate as for non-TANF funding, but the contract shall not specify the number of TANF units or the amount of TANF funding for individual cost centers.

4.  Alternative Method of Payment for Use Under Conditions of a Governor’s Emergency Declaration for Natural or Man-Made Disasters.

a. During a period of time covered by a Governor’s Emergency Declaration for natural or man-made disasters, and in the counties so named in that declaration, the department may use an alternate method of payment to continue the provision of substance abuse and mental health services in adversely affected counties.

b. The department’s alternate method of payment may, if funds are available, release a prorated monthly share of the contract in the amount of one-twelfth (1/12) of the total annual dollar amount in lieu of the method of payment specified in the contract, based upon a written request from the contractor in the named disaster declaration county.

c. The contractor shall reconcile the total number of service units invoiced provided during the term of the contract with the total service units contracted by the department in the contractor’s final request for payment before the close of the current state fiscal year.

d. During a period of time covered by a Governor’s Emergency Declaration for natural or man-made disasters, and in the counties so named in that declaration, the rate for Intervention, Crisis Support and Outpatient services may be paid at the maximum allowable by Chapter 65E-14, F.A.C.

5. 4. Financial Penalties. 

The department shall apply the provisions of Rule 65-29.001, F.A.C., if a contractor fails to comply with a department-approved corrective action plan in response to a finding of unacceptable performance, nonperformance, or noncompliance to the terms and conditions of a contract.

6. 5. Deducting Units Paid for by Other Sources of Funds.  When preparing a request for payment for services provided, the contractor shall:

a through c No change.

7.6. Submission of Request for Payment.

a. No change.

b.c. For cost centers paid on the basis of availability, the year-to-date number of units reported on a request for payment or any associated worksheet shall not exceed the prorated share of contracted units.b.  For cost centers paid for on the basis of utilization, the year-to-date number of units of service reported on a request for payment or any associated worksheet shall not exceed the total number of units reported and accepted in the department’s data system pursuant to Rule 65E-14.022, F.A.C.  for those same cost centers, the year-to-date number of units of service reported on the request for payment or any associated worksheet as billable to Medicaid shall be no fewer than the number reported and accepted in the department’s data system, and the year-top-date number of units reported on the request for payment as provided to Temporary Assistance to Needy Families(TANF) clients and billed to the department shall not exceed the number reported and accepted in the department’s data system.  If the department, through no fault of the contractor, is unable to validate compliance with this requirement within 10 days of receipt of the request for payment, the processing of the contractor’s request for payment shall not be delayed further.

(c) through (d) No change.

(11) The following forms are hereby incorporated by reference, copies of which may be obtained from the Mental Health Substance Abuse Program Office, ATTN: PDMH SA, 1317 Winewood Blvd., Building 6, Tallahassee, Florida 32399-0700.

(a) through (e) No change.

(f) CF-MH 1047, Jul Nov 2005 2003 Monthly request for Non-TANF  Payment/Advance, consisting of a two page form and three pages of instructions.

(g) through (j) No change.

Specific Authority 394.78(1),(6), 397.321(5) FS.  Law Implemented 216.181(16), 394.66(9), (12), 394.74(2)(b), (3)(d), (e), (4), 394.77, 394.78(1), (6) 397.321(10), 402.73(7) FS. History–New 7-1-03, Amended 12-14-03, 1-2-05,_________

 

65E-14.022 Data Requirements

The following document is hereby incorporated by reference, copies of which may be obtained from the Mental Health Substance Abuse Program Office, ATTN.: PDSA, 1317 Winewood Blvd., Building 6, Tallahassee, Florida 32399-0700:

CFP 155-2, Oct 2004 Mental Health and Substance Abuse Measurement and Data Pamphlet, 7th 6th Edition Version 1 consisting of 267 141 pages.

Specific Authority 394.78(1), (6), 397.321(5) FS. Law Implemented 216.181(16), 394.66(9), (12), 384.74(2)(b), (3)(d), (e), (4), 394.78(1), (6), 397(10), 402.73(7) FS. History–New 7-1-03, Amended 12-14-03, 1-2-05,___________