Behavioral Health Community Support Services  

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    AGENCY FOR HEALTH CARE ADMINISTRATION

    Medicaid

    RULE NO.:RULE TITLE:

    59G-4.031Behavioral Health Community Support 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. 44 No. 218, November 7, 2018 issue of the Florida Administrative Register.

    The Florida Medicaid Behavioral Health Community Support Services Coverage Policy has been changed as follows:

    Section 1.0, Introduction,  now reads:

    Florida Medicaid provides behavioral health community support services to promote recovery from behavioral health disorders or cognitive symptoms by improving the ability of recipients to strengthen or regain skills necessary to function successfully.

    Subsection 1.1, through Subsection 1.4, No Change.

    Section 2.0, Eligible Recipient

    Subsection 2.1, General Criteria, No Change.

    Subection 2.2 Who Can Receive now reads:

    Florida Medicaid recipients requiring medically necessary behavioral health community support services that have a mental health diagnosis and exhibit the following symptoms:

             Addictive behavior

             Behavioral or cognitive

             Clinical conditions severe enough to cause significant impairment in day-to-day functioning

             Psychiatric

    Subsection 2.3, Coinsurance and Copayments, No Change.

    Section 3.0, Eligible Provider

    Subsection 3.1, General Criteria, No Change.

    Subsection 3.2, Who Can Provide now reads:

    All providers that deliver behavioral health support and rehabilitative services must be either employed or contracted with a community behavioral health agency. Psychosocial rehabilitation and clubhouse services must be rendered by one of the following:

             Bachelor’s level practitioners

             Certified addictions professionals

             Certified behavioral health technicians

             Certified psychiatric rehabilitation practitioners

             Certified recovery peer specialists

             Certified recovery support specialists

             Master’s level certified addictions professionals

             Practitioners licensed in accordance with Chapters 490 or 491, F.S. and working within their scope of practice

             Substance abuse technicians - Substance abuse technicians can only deliver psychosocial rehabilitation services

    Section 4.0, Coverage Information

    Subsection 4.1, General Criteria, No Change.

    Subsection 4.2, Specific Criteria now reads:

    Florida Medicaid covers up to 1,920 units per recipient, per fiscal year of behavioral health community support services. The combined totals of units for both services per recipient, per fiscal year cannot exceed 1,920. Units of psychosocial rehabilitation services count against units of clubhouse services and vice versa.

    4.2.1 Psychosocial Rehabilitation Services

    Psychosocial rehabilitation services restore a recipient’s skills and abilities necessary for independent living through the following activities:

          Development and maintenance of necessary daily living skills

          Food planning and preparation

          Money management

          Maintenance of the living environment

          Training in appropriate use of community services

    Psychosocial rehabilitation services combines daily medication use, independent living and social skills training, housing services, pre-vocational and transitional employment rehabilitation training, social support, and network enhancement to recipients and their families. Psychosocial rehabilitation services must assist the recipient with the following:

          Eliminating or compensating for functional deficits and interpersonal and environmental barriers

          Restoring social skills for independent living and life management

    Psychosocial rehabilitation services can include the following to facilitate cognitive and socialization skill necessary for functioning in a work environment and maintaining independence:

          On-the-job training and support

          Job development on behalf of the recipient

          Job matching

          Work readiness assessments

    Psychosocial rehabilitation services must concentrate on the amelioration of symptoms and restoring functional capabilities. They can be provided in a facility, home, or community setting. Psychosocial rehabilitation services can be delivered to groups that do not exceed 12.

     

    4.2.2 Clubhouse Services

    Clubhouse services provide structured, community-based services delivered in a group setting that utilize behavioral, cognitive, or supportive interventions to improve a recipient’s potential for establishing and maintaining social relationships and obtaining occupational or educational achievements. Clubhouse services consist of social, educational, pre-vocational and transitional employment rehabilitation utilized to assist the recipient with the following:

          Eliminating functional, interpersonal, and environmental barriers

          Facilitating cognitive and socialization skills necessary for functioning in a work environment

          Restoring social skills for independent living and effective life management

    Clubhouses services are rehabilitative and utilize a wellness model to restore independent living skills. They must be delivered in a group setting that cannot exceed 12. Florida Medicaid recipients must be at least 16 years old to receive Clubhouse services.

    Section 4.3, Early and Periodic Screening, Diagnosis, and Treatment, No Change.

    Section 5.0, Exclusion

    Subsection 5.1, General Non-Covered Criteria, No Change.

     

     

    Section 5.2, Specific Non-Covered Criteria now reads:

    Florida Medicaid does not cover the following as part of this service benefit:

          Babysitting or child care services

          Case management

          Services provided to a recipient on the day of admission into the Statewide Inpatient

          Psychiatric Program

          Services rendered to individuals residing in an institution for mental diseases

          Services rendered to institutionalized individuals, as defined in 42 CFR 435.1009

          Transportation

          Travel time

    6.0 Documentation

    6.1, General Criteria, No Change.

    6.2, Specific Criteria, now reads:

    Providers must maintain the following in the recipient’s file:

          Daily progress notes that list each service and activity provided

          Record of a mental health diagnosis from a licensed practitioner

    Section 7.0 Authorization through Section 8.0, Reimbursement, No Change.

Document Information

Related Rules: (1)
59G-4.031.