Behavioral Health Community Support Services

 

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.