Amending to add covered community substance abuse and mental health services.

 

DEPARTMENT OF CHILDREN AND FAMILIES

Mental Health Program

RULE NOS.:RULE TITLES:

65E-14.001Applicability

65E-14.021Schedule of Covered Services

PURPOSE AND EFFECT: Amending to add covered community substance abuse and mental health services.

SUMMARY: The amendments accomplish the following: 1) Adds a definition for “plan of care” and increases the value of equipment; 2) Adds Care Coordination, Community Action Treatment (CAT), HIV Early Intervention Services, Respite Services Level II, and Room and Board with Supervision Level IV as covered services; and 3) Provides description, program, measurement standard, and data elements for new covered services.

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.

A SERC has not been prepared.

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 Department used a checklist to conduct an economic analysis and determine if there is an adverse impact or regulatory costs associated with this rule that exceeds the criteria in section 120.541(2)(a), F.S. Based upon this analysis, the Department has determined that the proposed rule is not expected to require legislative ratification.

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: 394.74, 394.78(1), (5), 394.9082(3), 397.321(5), 402.73

LAW IMPLEMENTED: 394.74, 394.74(2)(b), (3)(d), (e), (4), 394.77, 394.78(1), (5), 394.9082, 397.321(10), 397.481, 402.73(1)

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: Elizabeth Floyd. Elizabeth can be reached at [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

65E-14.001 Applicability.

(1) This chapter applies to all Substance Abuse and Mental Health (SAMH)-Funded Entities as defined in paragraph (2)(s) (2)(r), of this rule, when providing services using community substance abuse and mental health funds appropriated by the Legislature to the Department of Children and Families (Department) through the Community Substance Abuse and Mental Health Services budget entity.

(2) Definitions.

(a) through (c) No change.

(d) “Audit” means a single or program-specific audit in accordance with 2 C.F.R. §§200.0-.521, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, (January 1, 2014), http://www.flrules.org/Gateway/reference.asp?No=Ref-06630, herein incorporated by reference, as specified in subsection 65E-14.003(1), F.A.C., and Section 215.97, F.S. Copies of this incorporated document may be obtained from the Office of Substance Abuse and Mental Health, 1317 Winewood Blvd., Building 6, Tallahassee, Florida 32399-0700, and are also available at https://www.federalregister.gov/a/2013-30465.

(e) through (f) No change. 

(g) “Equipment” means fixtures and other tangible personal property of a non-consumable nonconsumable and nonexpendable nature, the value of which is $5,000 $1,000 or more and the normal expected life of which is one year or more;, and hardback-covered bound books that are circulated to students or the general public, the value or cost of which is $25 or more, and hardback-covered bound books, the value or cost of which is $250 or more; and. For the purposes of this chapter, “equipment” also includes intangible data processing applications and/or computer software, regardless of its value. The value of donated equipment shall be based upon the item’s market value at the time of donation. 

(h) through (l) No change. 

(m) “Plan of care” means a plan developed by the service provider and the person served which delineates goals for the person served and the services to be provided to meet those goals. This includes, but is not limited to, recovery plans, service plans, treatment plans, and case management plans. 

(m) through (r) are redesignated (n) through (s)

(t)(s) “Second Party Payer” or “Responsible Party” means any person legally responsible for the financial support of the individual receiving services, and may include parents of a minor, individual; a spouse, regardless of the age of either party; a guardian,; representative payee or trustee in a fiduciary capacity for handling benefit payments, trusts and estates established or received for the financial support of the individual served.

(u)(t) “Service Provider” means any agency or entity, as defined in Section 394.455(44) or 397.311(42), F.S., providing substance abuse or mental health services, programs or activities.

(u) through (x) are redesignated (v) through (y)

Rulemaking Authority 394.74, 394.78(1), 394.9082(3), 397.321(5) FS. Law Implemented 394.74, 394.77, 394.9082, 397.481 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.01, Amended 7-29-96, Formerly 10E-14.001, Amended 7-1-03, 12-14-03, 1-2-05, 7-27-14, 4-27-16. Amended _______________.

 

65E-14.021 Schedule of Covered Services.

This rule provides guidelines and requirements applicable to service providers under direct contract with the Department department or service providers under subcontracts with a Managing Entity.

(1) Unless specifically authorized otherwise in advance by the Department department, service providers shall only use the following Substance Abuse and Mental Health (SAMH) Covered Services to report contracted or subcontracted substance abuse and mental health services provided to adults or children.

(a) Aftercare,;

(b) Assessment,;

(c) Care Coordination,

(d)(c) Case Management,;

(e) Community Action Treatment (CAT),

(f)(d) Comprehensive Community Service Team,;

(g)(e) Crisis Stabilization,;

(h)(f) Crisis Support/Emergency,;

(i)(g) Day Care,;

(j)(h) Day Treatment,;

(k)(i) Drop-In/Self Help Centers,;

(l)(j) Florida Assertive Community Treatment (FACT) Team,;

(m) HIV Early Intervention Services,

(n)(k) Incidental Expenses,;

(o)(l) Information and Referral,;

(p)(m) In-Home and Onsite,;

(q)(n) Inpatient,;

(r)(o) Intensive Case Management,;

(s)(p) Intervention,;

(t)(q) Medical Services,;

(u)(r) Medication-Assisted Treatment,;

(v)(s) Mental Health Clubhouse Services,;

(w)(t) Outpatient,;

(x)(u) Outreach,;

(y)(v) Prevention – Indicated,;

(z)(w) Prevention – Selective,;

(aa)(x) Prevention – Universal Direct,;

(bb)(y) Prevention – Universal Indirect,;

(cc)(z) Recovery Support,;

(dd)(aa) Residential Level I,;

(ee)(bb) Residential Level II,;

(ff)(cc) Residential Level III,;

(gg) Residential Level IV,

(hh)(ee) Respite Services,;

(ii) Respite Services Level II,

(jj)(ff) Room and Board with Supervision Level I,;

(kk)(gg) Room and Board with Supervision Level II,;

(ll)(hh) Room and Board with Supervision Level III,;

(mm) Room and Board with Supervision Level IV,

(nn)(ii) Short-term Residential Treatment,;

(oo)(jj) Substance Abuse Inpatient Detoxification,;

(pp)(kk) Substance Abuse Outpatient Detoxification,;

(qq)(ll) Supported Employment,;

(rr)(mm) Supportive Housing/Living,;

(ss)(nn) Treatment Alternatives for Safer Communities (TASC),; and,

(tt)(oo) Any other SAMH Covered Services the department may establish pursuant to subsection (2), of this rule, to ensure adequate provision of service.

(2) No change.

(3) Measurement Standards for Covered Services.

(a) To account for services provided pursuant to contracts with SAMH-Funded Entities, the following common measurement definitions shall apply to each SAMH Covered Service as specified in subsection (4), of this rule:

1. Direct Staff Hour.

a. through b. No change.

c. Covered Services that are measured by this standard shall be reported on the basis of utilization, except for the following SAMH Covered Services, which shall be paid on the basis of availability.

(I) Paragraph (4)(h)(f), Crisis Support/Emergency,

(II) Paragraph (4)(o)(l), Information and Referral, and,

(III) Paragraph (4)(pp)(kk), Substance Abuse Outpatient Detoxification.

2. No change.

3. Day.

a. No change.

b. Covered Services that are measured by this standard shall be reported on the basis of utilization, except for the following:

(I) Paragraph (4)(g)(e), Crisis Stabilization,

(II) Paragraph (4)(nn)(ii), Short-term Residential Treatment,; and,

(III) Paragraph (4)(oo)(jj), Substance Abuse Inpatient Detoxification.

4. No change.

(b) through (c) No change.

(d) Definition of Hour.

1. through 2. No change.

3. For the Case Management Covered Service defined in paragraph (4)(d)(c), of this rule, if the time interval required by Medicaid is different than described above, a service provider may use the Medicaid time interval instead.

(e) No change.

(4) The descriptions, applicable programs, measurements standards, and data elements for SAMH Covered Services are as follows:

(a) Aftercare.

1. Description – Aftercare activities occur after a treatment level of care is completed and include activities such as supportive counseling, life skills training, and relapse prevention for individuals with individual participation in daily activity functions that were adversely affected by mental illness or substance use disorders to assist in their ongoing recovery. abuse impairments. Relapse prevention issues are important in assisting the individual’s recognition of triggers and warning signs of regression. Aftercare services help individuals, families, and pro-social support systems reinforce a healthy living environment.

2. through 4. No change.

(b) Assessment.

1. Description – This Covered Service includes the systematic collection and integrated review of individual-specific data, such as examinations and evaluations. This data is gathered, analyzed, monitored and documented to develop the person’s individualized plan of care treatment and to monitor recovery. Assessment specifically includes efforts to identify the person’s key medical and psychological needs, competency to consent to treatment, history of mental illness or substance use and indicators of co-occurring conditions, as well as clinically significant neurological deficits, traumatic brain injury, organicity, physical disability, developmental disability, need for assistive devices, and physical or sexual abuse, and or trauma.

2. through 4. No change.

(c) Care Coordination.

1. Description – Care Coordination is a time-limited service that assists individuals with behavioral health conditions who are not effectively engaged with case management or other behavioral health services and supports for a successful transition to appropriate levels of care. Once engagement in the necessary community-based services is verified, care coordination services are terminated.

2. Programs – Community Mental Health and Community Substance Abuse.

3. Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1. of this rule.

4. Data Elements:

a. Service Documentation – Activity Log:

(I) Covered Service,

(II) Staff name and identification number,

(III)Recipient name and identification number,

(IV) Service date,

(V) Duration,

(VI) Service (specify), and

(VII) Program.

b. Audit Documentation – Recipient Service Chart:

(I) Recipient name and identification number,

(II) Staff name and identification number,

(III) Service date,

(IV) Duration, and

(V) Service (specify).

(d)(c) No Change.

(e) Community Action Treatment (CAT).

1. Description – This Covered Service, pursuant to section 394.495, F.S., provides community-based services to children ages 11 to 21 with a mental health disorder (including those with a co-occurring substance use diagnosis) who meet certain accompanying eligibility criteria identified by the statute. Children younger than 11 may be served if they display two or more of the aforementioned eligibility criteria. The team is available on nights, weekends, and holidays. Allowable services may include one or any combination of the following activities:

a. Aftercare,

b. Assessment,

c. Care Coordination,

d. Case Management,

e. Crisis Support / Emergency,

f. Information and Referral,

g. In-Home and On-Site Services,

h. Intensive Case Management,

i. Intervention – Individual and Group,

j. Medical Services,

k. Outpatient – Individual and Group,

l. Outreach,

m. Recovery Support – Individual and Group,

n. Supported Employment, and

o. Supported Housing / Living,

2. Programs – Community Mental Health.

3. Measurement Standard: Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1., of this rule.

4. Data Elements:

a. Service Documentation – Activity Log:

(I) Staff name and identification number,

(II) Recipient name and identification number,

(III) Service date,

(IV) Duration,

(V) Service (specify), and

(VI) Program.

b. Audit Documentation – Recipient Service Chart:

(I) Recipient name and identification number,

(II) Staff name and identification number,

(III)Service date,

(IV) Duration, and

(V) Service (specify).

(f)(d) Comprehensive Community Service Team.

1. Description – This Covered Service is a bundled service package designed to provide short-term assistance and guide individuals to rebuild in rebuilding skills in identified roles in their environment through the engagement of natural supports, treatment services, and assistance of multiple agencies when indicated. Services provided under Comprehensive Community Service Teams may not be simultaneously reported to another Covered Service. Allowable bundled activities include the following Covered Services as defined in subsection (4), of this rule:

a. through b. No change.

c. Care Coordination,

c. through m. are redesignated d. through n.

2. through 4. No change.

(g)(e) No change.

(h)(f) Crisis Support/Emergency.

1. Description – This non-residential care is generally available twenty-four hours per day, seven 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, mobile response, crisis telephone or telehealth crisis support, and emergency walk-in walkin.

2. through 4. No change.

(i)(g) Day Care.

1. Description – Day care services, in a non-residential group setting, provide for the care of children of persons who are participating in mental health or substance use treatment abuse services. In a residential setting, day care services provide for the residential and care-related costs of a child living with a parent receiving residential services. This covered service must be provided in conjunction with another Covered Service provided to a person 18 years of age or older.

2. through 4. No change.

(j)(h) Day Treatment.

1. Description – Day Treatment services provide a structured schedule of non-residential interventions services for four 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. Activities for substance abuse programs emphasize rehabilitation, treatment, activities of daily living, and education services, using multidisciplinary teams to provide integrated programs of academic, therapeutic, and family services. For mental health programs, day treatment services must be provided for four or more consecutive hours per day. Substance abuse programs must follow the standards set forth in Rules 65D-30.0081 and 65D-30.009, F.A.C.

2. through 4. No change.

(k)(i) Drop-in/Self-Help Centers.

1. Description – These community centers, such as drop-in centers or recovery community organizations, are intended to provide a range of opportunities for persons with or a history of mental health and substance use conditions severe and persistent mental illness to independently develop, operate, and participate in social, recreational, self-help, harm reduction, and networking activities. This covered service may not be provided to a person less than 18 years old.

2. Programs – Community Mental Health and Community Substance Abuse.

3. through 4. No change.

(l)(j) Florida Assertive Community Treatment (FACT) Team.

1. Description – A FACT team is comprised of slots for participants with a serious severe and persistent mental illness. Participants are enrolled on a weekly basis. For a provider to identify themselves as a FACT team, the provider must demonstrate adherence to assertive community treatment principles. FACT Teams provide non-residential services that are available twenty-four hours per day, seven days per week. Rehabilitative, support and therapeutic services are provided in the community, by a multidisciplinary team. This covered service may not be provided to a person less than 18 years old.

2. No change.

3. Measurement Standard – The total value of a service provider’s FACT team contract divided by the number of contracted slots establishing the annual cost per participant. The annual cost per participant may be divided by 365 days per year to establish the daily enrollment cost. Number of Enrolled Participants, notwithstanding the requirements of paragraph (3)(a), of this rule.

4. Data Elements:

a. Enrollment Documentation:

(I) Date and weekly number of enrolled participants,

(II) through (IV) No change.

b. No change.

5. Reimbursement for this Covered Service shall be based upon weekly enrollment costs according to the following formula.

a. The total value of a service provider’s FACT team contract shall be divided by the contracted number of slots to establish the annual cost per participant.

b. The annual cost per participant shall be divided by 52 weeks per year to establish the weekly enrollment cost.

(m) HIV Early Intervention Services.

1. Description - This Covered Service is a bundled service package to provide Human Immunodeficiency Virus (HIV) Early Intervention Services in accordance with 65D-30.004, F.A.C. Allowable HIV Early Intervention Services may include one or any combination of the following activities:

a. Pretest counseling,

b. Posttest counseling,

c. Tests to confirm the presence of HIV,

d. Tests to diagnose the extent of the deficiency in the immune system,

e. Tests to provide information on appropriate therapeutic measures for preventing and treating the deterioration of the immune system and conditions arising from HIV, including tests for hepatitis C (when provided to individuals with HIV),

f. Therapeutic measures for preventing and treating the deterioration of the immune system and conditions arising from HIV, and

g. Linkages to diagnostic tests, therapeutic measures, and HIV specific support services.

2. Programs – Community Substance Abuse

3. Measurement Standard: Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1., of this rule.

4. Data Elements:

a. Service Documentation – Activity Log:

(I) Staff name and identification number,

(II) Recipient name and identification number,

(III) Service date,

(IV) Duration,

(V) Service (specify), and

(VI) Program.

b. Audit Documentation – Recipient Service Chart:

(I) Recipient name and identification number,

(II) Staff name and identification number,

(III)Service date,

(IV) Duration, and

(V) Service (specify).

(n)(k) Incidental Expenses.

1. Description – This Covered Service reports temporary expenses incurred to facilitate continuing treatment and community stabilization when no other resources are available. All incidental expenses shall be authorized by the Managing Entity. Allowable purchases under uses of this Covered Service includes include: transportation, childcare, housing assistance clothing, educational services, vocational services, medical care, housing subsidies, pharmaceuticals and other incidentals as approved by the Department department or Managing Entity.

2. through 3. No change.

4. Data Elements:

a. No change.

b. Audit Documentation – Recipient Service Chart:

(I) through (IV) No change.

(V) Associated treatment plan of care goal,; and,

(VI) No change.

(o)(l) Information and Referral.

1. Description – These services maintain information about resources in the community, link people who need assistance with appropriate service providers, and provide information about agencies and organizations that offer services. The information and referral process is comprised of involves: being readily available for contact by the individual,; assisting the individual with determining which resources are needed,; providing referral to appropriate resources,; and following up to ensure the individual’s needs have been met, where appropriate.

2. through 4. No change.

(p)(m) In-Home and On-Site.

1. Description – Therapeutic services and supports, including early childhood mental health consultation, are rendered for individuals and their families in non-provider settings such as nursing homes, assisted living facilities, residences, schools school, detention centers, commitment settings, foster homes, daycare centers, and other community settings.

2. through 4. No change.

(q)(n) Inpatient.

1. Description – Inpatient services are provided in psychiatric units within hospitals licensed as general hospitals and psychiatric hospitals under Chapter 395, F.S., as general hospitals and psychiatric specialty hospitals. They are designed to provide intensive treatment and stabilization to persons exhibiting violent behaviors that may result in harm to self or others due to, suicidal behaviors, and other severe disturbances due to substance abuse or mental illness or co-occurring mental illness and substance use disorder.

2. through 3. No change.

4. Data Elements:

a. No change.

b. Audit Documentation – Recipient Service Chart:

(I) through (II) No change.

(III) Clinical diagnosis, and

(IV) No change.

(r)(o) Intensive Case Management.

1. Description – These services are typically offered to persons who are being discharged from an acute care setting, and are in need of more professional care, and have contingency needs to remain in a less restrictive setting. The services include the same components as case management as described in sub-sub-paragraph (4)(d)1., of this rule, but are provided at a higher intensity and frequency, and with lower caseloads per case manager sufficient to meet the needs of the individuals in treatment. Case management services consist of activities aimed at assessing recipient needs, planning services, linking the service system to a recipient, coordinating the various system components, monitoring service delivery, and evaluating the effect of services received. These services are typically offered to persons who are being discharged from a hospital or crisis stabilization unit who are in need of more professional care and who will have contingency needs to remain in a less restrictive setting.

2. Programs – Community Mental Health and Community Substance Abuse.

3. through 4. No change.

(s)(p) Intervention.

1. Description – Intervention services focus on reducing risk factors generally associated with the progression of substance misuse 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. These services are targeted toward individuals and families. This covered service shall include clinical supervision provided to a service provider’s personnel by a professional qualified by degree, licensure, certification, or specialized training in the implementation of this service.

2. through 4. No change.

(t)(q) Medical Services.

1. Description – Medical services provide primary psychiatric care, therapy, and medication administration provided by an individual licensed under the state of Florida to provide the specific service rendered. Medical services are designed to improve the functioning or prevent further deterioration of persons with mental health or substance abuse problems, including psychiatric mental status assessment. For adults with mental illness, Medical medical services are usually provided on a regular schedule, with arrangements for non-scheduled visits during times of increased stress or crisis.

2. through 4. No change.

(u)(r) Medication-Assisted Treatment.

1. Description – This Covered Service provides for the delivery of medications for the treatment of substance use or abuse disorders which are prescribed by a licensed health care professional. Services must be based upon a clinical assessment, and treatment and support services must be available for and offered to individuals receiving medications to support their ongoing recovery provided in conjunction with substance abuse treatment.

2. through 4. No change.

(v)(s) Mental Health Clubhouse Services.

1. Description – Structured, evidence-based services designed to both strengthen and/or regain the individual’s interpersonal skills, provide psycho-social support therapy toward rehabilitation, develop the environmental supports necessary to help the individual thrive in the community and meet employment and other life goals, and promote recovery from mental illness. Services are typically provided in a community-based program with trained staff and members working as teams to address the individual’s life goals and to perform the tasks necessary for the operations of the program. The emphasis is on a holistic approach focusing on the individual’s strengths and abilities while challenging the individual to pursue those life goals. This service would include, but not be limited to, clubhouses certified under the International Center for Clubhouse Development. This covered service may not be provided to a person less than 18 years old.

2. through 4. No change.

(w)(t) Outpatient.

1. Description – Outpatient services provide clinical interventions a therapeutic environment, which is designed to improve the functioning or prevent further deterioration of persons with mental health and/or substance use disorders 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 provided by a SAMH-Funded Entity. This covered service shall include clinical supervision provided to a service provider’s personnel by a professional qualified by degree, licensure, certification, or specialized training in the implementation of this service.

2. through 4. No change.

(x)(u) Outreach.

1. Description – Outreach services are provided through a formal program to both individuals and the community. Community services include education, identification, and linkage with high-risk groups. Outreach services for individuals are designed to: encourage, educate, and engage prospective individuals who show an indication of substance misuse abuse and mental health problems or needs. Individual enrollment is not included in Outreach services.

2. through 4. No change.

(y)(v) Prevention ‒ Indicated.

1. Description – Indicated prevention services are provided to at-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing mental health disorders or substance use disorders. Target recipients of indicated prevention services are at-risk individuals who do not meet clinical criteria for mental health or substance use abuse disorders. Indicated prevention services are designed to preclude, forestall, or impede the development of mental health or substance use abuse disorders. These services shall address the following specific prevention strategies, as defined in Rule 65D-30.013, F.A.C.: education, alternative and problem identification and referral services.

2. through 4. No change.

(z)(w) Prevention – Selective.

1. Description – Selective prevention services are provided to a population subgroup whose risk of developing mental health or substance use abuse disorders is higher than average. Target recipients of selective prevention services do not meet clinical criteria for mental health or substance use abuse disorders. Selective prevention services are designed to preclude, forestall, or impede the development of mental health or substance use abuse disorders. These services shall address the following specific prevention strategies, as defined in Rule 65D-30.013, F.A.C.: information dissemination, education, alternatives, and problem identification and referral services.

2. through 4. No change.

(aa)(x) Prevention – Universal Direct.

1. Description – Universal direct prevention services are provided to the general public or a whole population that has not been identified on the basis of individual risk. These services are designed to preclude, forestall, or impede the development of mental health or substance use abuse disorders. Universal direct services directly serve an identifiable group of participants who have not been identified on the basis of individual risk. This includes interventions involving interpersonal and ongoing or repeated contact such as curricula, programs, and classes. These services shall address the following specific prevention strategies, as defined in Rule 65D-30.013, F.A.C.: information dissemination, education, alternatives, or problem identification and referral services.

2. through 4. No change.

(bb)(y) Prevention – Universal Indirect.

1. Description – Universal indirect prevention services are provided to the general public or a whole population that has not been identified on the basis of individual risk. These services are designed to preclude, forestall, or impede the development of mental health or substance use disorders. Universal indirect services support population-based programs and environmental strategies such as changing laws and policies. These services can include programs and policies implemented by coalitions. These services can also include meetings and events related to the design and implementation of components of the strategic prevention framework, including needs assessments, logic models, and comprehensive community action plans. These services shall address the following specific prevention strategies, as defined in Rule 65D-30.013, F.A.C.: information dissemination, education, community-based processes, and environmental strategies.

2. through 4. No change.

(cc)(z) Recovery Support.

1. Description – This Covered Service is comprised of nonclinical activities that assist individuals and families in recovering from substance use and mental health conditions. Activities include social support, linkage to and coordination among service providers, life skills training, recovery planning, coaching, education on mental illness and substance use disorders, and other supports that facilitate increasing recovery capital and wellness contributing to an improved quality of life. Recovery capital is the personal, family, social, community resources and natural supports that promote recovery. These activities may be provided prior to, during, and after treatment. These services are designed to support and coach an adult or child and family to regain or develop skills to live, work and learn successfully in the community. Services include substance abuse or mental health education, assistance with coordination of services as needed, skills training, and coaching. This Covered Service shall include clinical supervision provided to a service provider’s personnel by a professional qualified by degree, licensure, certification, or specialized training in the implementation of this service, or by a certified peer specialist who has at least 2 years of fill-time experience as a peer specialist at a licensed behavioral health organization. This Covered Service must be provided by a Certified Recovery Peer Specialist pursuant to section 397.417, F.S. For Adult Mental Health and Children’s Mental Health Programs, these services are provided by a Certified Family, Veteran, or Recovery Peer Specialist. For Adult and Children’s Substance Abuse programs, these services may be provided by a certified Peer Recovery Specialist or trained paraprofessional staff subject to supervision by a Qualified Professional as defined in Rule 65D-30.002, F.A.C. These services exclude twelve-step programs such as Alcoholics Anonymous and Narcotics Anonymous.

2. through 4. No change.

(dd)(aa) Residential Level I.

1. Description – These licensed services provide a structured, live-in, non-hospital setting with supervision on a twenty-four hours per day, seven days per week basis. A nurse is on duty in these facilities at all times. For adult mental health, Residential Treatment Facilities Level IA and IB, as defined in Rule 65E-4.016, F.A.C., are reported under this Covered Service. 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 hours per day, seven 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 stabilization setting. support unit setting, including residential treatment centers. Medicaid Residential Treatment Centers, as defined in Rule 65E-9.002, F.A.C., and Residential Treatment Centers are reported under this Covered Service. On-call medical care shall 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.

2. through 4. No change.

(ee)(bb) Residential Level II.

1. Description – Level II facilities are licensed, structured rehabilitation-oriented group facilities that have twenty-four hours per day, seven days per week, supervision. Level II facilities house persons who have significant deficits in independent living skills and need extensive support and supervision. For adults with a mental illness, Residential Treatment Facilities Level II, as defined in Rule 65E-4.016, F.A.C., are reported under this Covered Service. For children with serious emotional disturbances, Level II services provide are programs specifically designed for the purpose of providing intensive therapeutic behavioral and treatment interventions. Therapeutic Group Home, Specialized Therapeutic Foster Homes Home – Level II, and Therapeutic Foster Home – Level 2 are reported under this Covered Service. For substance use treatment abuse, Level II services provide a range of assessment, treatment, rehabilitation, and ancillary services in a less intensive therapeutic environment with an emphasis on rehabilitation, and may include formal school and adult educational programs.

2. through 4. No change.

(ff)(cc) Residential Level III.

1. Description – These licensed facilities provide twenty-four hours per day, seven days per week supervised residential alternatives to persons who have developed a moderate functional capacity for independent living. For adults with a mental illness, Residential Treatment Facilities Level III, as defined in Rule 65E-4.016, F.A.C., are reported under this Covered Service. For children with serious emotional disturbances, Level III services are specifically designed to provide sparse therapeutic behavioral and treatment interventions. Therapeutic Group Home, Specialized Therapeutic Foster Home – Level I, and Therapeutic Foster Home – Level 1 are reported under this Covered Service. For adults with serious mental illness, this Covered Service consists of supervised apartments. For substance use treatment abuse, Level III provides a range of assessment, rehabilitation, treatment and ancillary services on a long-term, continuing care basis where, depending upon the characteristics of the individuals served, the emphasis is on rehabilitation or treatment.

2. through 4. No change.

(gg)(dd) Residential Level IV.

1. Description – This type of facility may have less than twenty-four hours per day, seven days per week on-premise supervision. It is primarily a support service and, as such, treatment services are not included in this Covered Service, although such treatment services may be provided as needed through other Covered Services. Level IV includes satellite apartments, satellite group homes, and therapeutic foster homes. For adults with a mental illness, Residential Treatment Facilities Level IV, as defined in paragraph 65E-4.016, F.A.C., are reported under this Covered Service.  For children with serious emotional disturbances, Level IV services are the least intensive and restrictive level of residential care provided in group or foster home settings, therapeutic foster homes, and group care. Regular therapeutic foster care can be provided either through Residential Level IV “Day of Care: Therapeutic Foster Home” or by billing in-home/non-provider setting for a child in a foster home.

2. through 4. No change.

(hh)(ee) Respite Services Level I.

1. Description – Respite care services support are designed to sustain the family or other primary care giver by providing time-limited, temporary relief from the ongoing responsibility of care giving. Respite Services Level I are billed as a direct staff hour when the duration of the services is less than ten hours.

2. through 3. No change.

4. Data Elements:

a. Service Documentation – Service Ticket:

(I) through (VI)  No change.

(VII) Respite service type, Service (specify); and,

(VIII) Program.

b. No change.

(ii) Respite Services Level II.

1. Description – Respite care services support the family or other primary care giver by providing time-limited, temporary relief from the ongoing responsibility of care giving. Respite Services Level II are billed as a day rate when the duration of the services is for ten hours or more.

2. Programs – Community Mental Health and Community Substance Abuse.

3. Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II), of this rule.

4. Data Elements:

a. Service Documentation – Census Log:

(I) Covered Service,

(II) Program,

(III) Recipient name and identification,

(IV) Clinical diagnosis,

(V) Service date, and

(VI) Respite service type.

b. Audit Documentation – Recipient Service Chart:

(I) Covered Service,

(II) Recipient name and identification number, and,

(III) Service date.

(jj)(ff) Room and Board with Supervision Level I.

1. Description – This Covered Service solely provides for room and board with supervision on a twenty-four hours per day, seven days per week basis. It corresponds to Residential Level I as defined in paragraph (4)(dd) (4)(aa), of this rule. This Covered Service is not applicable for provider facilities which meet the definition of an Institute for Mental Disease as defined by Title 42 CFR, Part 435.1010.

2. through 4. No change.

(kk)(gg) Room and Board with Supervision Level II.

1. Description – This Covered Service solely provides for room and board with supervision on a twenty-four hours per day, seven days per week basis. It corresponds to Residential Level II as defined in paragraph (4)(ee) (4)(bb),  of this rule. This Covered Service is not applicable for provider facilities which meet the definition of an Institute for Mental Disease as defined by Title 42 CFR, Part 435.1010.

2. through 4. No change.

(ll)(hh) Room and Board with Supervision Level III.

1. Description – This Covered Service solely provides for room and board with supervision on a twenty-four hours per day, seven days per week basis. It corresponds to Residential Level III as defined in paragraph (4)(ff) (4)(cc), of this rule. This Covered Service is not applicable for provider facilities which meet the definition of an Institute for Mental Disease as defined by Title 42 CFR, part 435.1010.

2. through 4. No change.

(mm) Room and Board with Supervision Level IV.

1. Description – This Covered Service solely provides for room and board with supervision on a twenty-four hours per day, seven days per week basis. It corresponds to Respite Level II as defined in paragraph (4)(ii), of this rule.

2. Programs – Community Mental Health and Community Substance Abuse.

3. Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II), of this rule.

4. Data Elements:

a. Service Documentation – Census Log:

(I) Covered Service,

(II) Program,

(III) Recipient name and identification,

(IV) Clinical diagnosis,

(V) Service date, and

(VI) Residential type.

b. Audit Documentation – Recipient Service Chart:

(I) Covered Service,

(II) Recipient name and identification number, and

(III) Service date.

(nn)(ii) Short-term Residential Treatment.

1. Description – These individualized, stabilizing acute and immediately sub-acute care services provide short and intermediate duration intensive mental health residential and habilitative services on a twenty-four hours per day, seven days per week basis, as provided for in Rule Chapter 65E-12, F.A.C. These services shall meet the needs of individuals who are experiencing an acute or immediately sub-acute crisis and who, in the absence of a suitable alternative, would require hospitalization. This covered service may not be provided to a person less than 18 years old.

2. through 4. No change.

(oo)(jj) Substance Abuse Inpatient Detoxification.

1. Description – These programs utilize medical and clinical procedures to assist adults, children, and adolescents with substance use disorders abuse problems in their efforts to withdraw from physical the physiological and psychological effects of substance use abuse. Residential detoxification and addiction receiving facilities provide emergency screening, evaluation, short-term stabilization, and treatment in a medically supervised secure environment.

2. through 4. No change.

(pp)(kk) Substance Abuse Outpatient Detoxification.

1. Description – These services utilize medication or a psychosocial counseling regimen that assists recipients in their efforts to withdraw from the physiological and psychological effects of the abuse of addictive substances.

2. through 4. No change. 

(qq)(ll) Supported Employment.

1. Description – Supported employment assist individuals with gaining competitive integrated employment.  All individuals enrolled in one of the Department’s priority populations and interested in work are eligible for these services. Evidence-based supported employment is a team-based approach that focuses on the full range of community jobs that match the job seeker’s strengths and preferences. Job supports are individualized and provided as long as desired and needed. Individuals are assisted in making job changes to promote career advancement. services are evidence-based community-based employment services in an integrated work setting which provides regular contact with non-disabled co-workers or the public. A job coach provides longer-term, ongoing support for as long as it is needed to enable the recipient to maintain employment.

2. through 4. No change.

(rr)(mm) Supportive Housing/Living.

1. Description – Supported housing/living is an evidence-based approach to assist persons with substance use abuse and mental illness in the selection of permanent housing of their choice. These services also provide the necessary services and supports to transition into independent community living and assure continued successful living in the community and transitioning into the community. For children with mental health challenges problems, supported living services are a process which assist assists adolescents in selecting and maintaining housing arrangements and provides services, such as training in independent living skills, to assure successful transition to independent living or with roommates in the community. Services include training in independent living skills. For substance use treatment abuse, services provide for the housing placement and monitoring of recipients who are participating in non-residential services,; recipients who have completed or are completing substance use abuse treatment,; and those recipients who need assistance and support in independent or supervised living within a “live-in” environment.

2. through 4. No change.

(ss)(nn) Treatment Alternatives for Safer Communities (TASC).

1. Description – TASC provides for identification, screening, court liaison, referral and tracking of persons in the criminal justice system with a history of substance use abuse or addiction.

2. through 4. No change.

(5) No change.

(6) Setting Rates.

(a) Negotiated Rates.

1. through 2. No change.

3. When proposing projected rates on the Agency Capacity Report, the service provider shall use the number of units derived using the following minimum productivity and utilization standards:

a. Direct Staff Hour – Annualized Standard Units: 1,252 hours per FTE; Standard Percentage: 60.19 percent.

(I) Exceptions:

(II) For paragraph (4)(h)(f), Crisis Support/Emergency, and paragraph (4)(o)(l), Information and Referral – Annualized Standard Units: 2,080 hours per FTE; Standard Percentage: 100 percent.

(III) For paragraph (4)(l)(j), FACT – Annualized Standard Units: 1,788 hours per FTE; Standard Percentage: 85.96 percent.

(IV) For paragraph (4)(v)(s), Mental Health Clubhouse – Annualized Standard Units: 1,768 hours per FTE; Standard Percentage: 85 percent.

(V) For paragraph (4)(i)(g), Day care; paragraph (4)(j)(h), Day Treatment; paragraph (4)(y)(v), Prevention – Indicated; and paragraph (4)(pp)(kk), Substance Abuse Outpatient Detoxification – Annualized Standard Units to be established through negotiation between the department or Managing Entity and the service provider; Standard Percentage: 90 percent.

b. Non-Direct Staff Hour – Annualized Standard Units: 1,430 hours per FTE; Standard Percentage: 68.75 percent, except for paragraph (4)(k)(i). Drop-in/Self help Centers – Annualized Standard Units: To be established through negotiation between the department or Managing Entity and the service provider; Standard Percentage: 100 percent.

c. Day – Annualized Standard Units: 365 Days or 366 Days during Leap Year; Standard Percentage: 100 percent, except paragraphs (4)(dd) – (gg)(aa)-(dd). Residential I-IV; paragraphs(4)(jj) – (mm)(ff)-(hh), Room and Board with Supervision I-III Annualized Standard Units: 365 Days; Standard Percentage: 85 percent.

d. Dosage – Annualized Standard Units: To be established through negotiation between the department or Managing Entity and the service provider; Standard Percentage: 100 percent.

4. Nothing herein shall preclude the department or Managing Entity from using audited data on actual expenditures to analyze the projected rates submitted by a SAMH-Funded Entity.

(b) No change.

(7) No change.

(8) All forms incorporated by reference in subsection (5), of this rule, may be obtained from the Office of Substance Abuse and Mental Health, 1317 Winewood Blvd., Building 6, Tallahassee, Florida 32399-0700.

Rulemaking Authority 394.78(1), (5), 394.9082(3), 397.321(5), 402.73 FS. Law Implemented 394.74(2)(b), (3)(d), (e), (4), 394.77, 394.78(1), (5), 394.9082, 397.321(10), 402.73(1) FS. History–New 7-1-03, Amended 12-14-03, 1-2-05, 7-27-14, 6-28-15, 4-27-16. Amended________________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: William Hardin, Heather Allman

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Shevaun Harris

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 15, 2022

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: September 7, 2022