The purpose of this rulemaking is to expand the scope of Rule 65E-12.110, F.A.C., to include integrated adult crisis stabilization unit and addictions receiving facility services (in addition to children’s facilities), to update statutory references,...

DEPARTMENT OF CHILDREN AND FAMILY SERVICES
Mental Health Program

RULE NO.: RULE TITLE:
65E-12.110: Integrated Children's Crisis Stabilization Unit and Addictions Receiving Facility Demonstration Models
PURPOSE AND EFFECT: The purpose of this rulemaking is to expand the scope of Rule 65E-12.110, F.A.C., to include integrated adult crisis stabilization unit and addictions receiving facility services (in addition to children’s facilities), to update statutory references, to eliminate archaic language, and to modify certain provisions of the rule to enhance the quality of services in the facilities regulated by this rule.
SUMMARY: The proposed rulemaking would provide that integrated Crisis Stabilization Unit/Addictions Receiving Facilities (CSU/ARFs) may serve adults and children. The proposed rulemaking provides minimum standards for eligibility criteria for CSU/ARF service recipients, clinical procedures to be used in CSU/ARFs, staffing requirements, and operational, administrative, and financing requirements, including procedures for licensure and designation. With certain exceptions specified, CSU/ARFs would be subject to the requirements of Chapters 65E-12 and 65E-5, F.A.C. and exempt from the requirements of Chapter 65D-30, F.A.C. CSU/ARFs would be required to admit any individual who would otherwise be eligible for admission to a CSU under Chapter 397, F.S., or to an ARF under Chapter 394, F.S. CSU/ARFs would provide integrated CSU and ARF services based on the particular needs of each individual served.
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.
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: 394.4612 FS.
LAW IMPLEMENTED: 394.4612 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Joe Anson, Substance Abuse and Mental Health Program Office, Department of Children & Families, [phone] [e-mail]

THE FULL TEXT OF THE PROPOSED RULE IS:

(Substantial rewording of Rule 65E-12.110 follows. See Florida Administrative Code for present text.)

65E-12.110 Integrated Children’s Crisis Stabilization Unit and Addictions Receiving Facility Services Demonstration Models.

(1) General Provisions.

(a) All the requirements for licensure and operation as a Crisis Stabilization Unit (CSU) that are otherwise required by Chapters 65E-12 and 65E-5, F.A.C., shall apply, except as provided for in Section 394.4612, Section 394.499, F.S., and this rule.

(b) The requirements for licensure and operation as an addictions receiving facility (ARF) that are otherwise required by Chapter 65D-30, F.A.C., shall not apply except as provided for in Sections 394.4612 and 394.499, F.S., and this rule section.

(c) This rule section applies both to integrated adult Crisis Stabilization Unit (CSU) and addictions receiving facility (ARF) services (as described in Section 394.4612, F.S. and hereafter referred to as “adult CSU/ARFs” and to children’s Crisis Stabilization Unit (CSU) and addictions receiving facility (ARF) services, hereafter referred to as “children’s CSU/ARFs.”

(2) Eligibility Criteria

(a) Adult CSU/ARFs shall serve individuals 18 years of age and older who present with a serious and acute mental illness or substance abuse impairment, or with co-occurring mental illness and substance abuse disorders.

(b) Children’s CSU/ARFs shall serve minors under 18 years of age who present with a serious and acute mental illness or substance abuse impairment, or with co-occurring mental illness and substance abuse disorders.

(c) If an individual is admitted to a children’s CSU/ARF while under 18 years of age and attains the age of 18 years while receiving services at the facility, the facility may continue to provide services to the individual until the individual is discharged.

(d) CSU/ARFs shall admit any individual who would otherwise be eligible for admission to a CSU under Chapter 394, F.S. or to an ARF under Chapter 397, F.S.

(3) Clinical Procedures.

(a) CSU/ARFs shall provide integrated CSU and ARF services within the same facility, and shall provide services to each individual based upon their particular needs. This may include an emphasis on services that are typically provided in either an ARF or a CSU, as determined from the initial screening and assessment and subsequent screening of each individual.

(b) Commingling (or sharing of common space) among CSU/ARF service recipients may be permitted, regardless of the service recipients’ diagnoses, types of treatment, or reasons for admission.

(c) Service recipients requiring close medical observation, as determined by the medical staff, must be visible and readily accessible to nursing staff 24/7.

(d) The use of medication-assisted and methadone maintenance treatment for substance abuse in CSU/ARFs must meet the requirements of Rule 65D-30.014, F.A.C.

(e) Service recipients in a CSU/ARF must receive a physical examination within 24 hours of admission. This examination must meet the requirements of a physical health assessment as specified in subsection 65D-30.004(14), F.A.C., except that, with regard to service recipients who have been determined not to require substance abuse treatment, specific requirements of the examination may be waived in accordance with a medical protocol approved by the medical director.

(f) Service recipients in a CSU/ARF must receive a behavioral and psychosocial assessment meeting the requirements of paragraph 65E-12.107(2)(d) and subsection 65D-30.004(14), F.A.C., within 24 hours of admission.

(g) CSU/ARFs must provide all services required of CSUs (as specified in subsection 65E-12.107(5), F.A.C) and all services required of ARFs (as specified in subsection 65D-30.005(2), F.A.C.).

(h) A registered nurse shall ensure that emergency medical services are provided immediately in a CSU/ARF in accordance with the medical protocols established by the Medical Director. Such protocols shall include provisions to ensure that new arrivals are promptly assessed for symptoms of substance abuse intoxication and are given prompt medical care and attention. In addition, protocols shall be implemented to ensure that monitoring of psychiatric medication is provided, and that general health care needs are met.

(i) Development of a discharge plan shall commence upon admission. The plan shall include information on the need for continuation of prescribed psychotherapeutic medications and other prescribed medications, including opioid or other addiction treatment medications, and continuing care appointments for treatment and support services, including medication and case management, and shall be based upon the particular needs of the individual. If the discharge is delayed, the CSU/ARF shall notify the outpatient or continuing care service provider and shall document continued service planning. With the express and informed consent of the individual receiving services, discharge planning shall include input from the individual’s support system, including, but not limited to, family members and friends.

(j) Prescriptions for psychotropic medications shall be provided to each adult upon discharge, and to the legal guardian of each minor upon discharge to cover the intervening days until the first scheduled outpatient appointment. Discharge planning shall address the availability of and access to prescription medication in the community.

(k) The Medical Director shall develop protocols specifying the circumstances under which blood and urine samples shall be taken for laboratory testing, including drug screening.

(4) Staffing Requirements.

(a) Staff shall meet the training requirements of Rule 65E-5.330 and subsection 65D-30.004(31), F.A.C., as a prerequisite to providing services.

(b) Within the training requirements of Rule 65E-5.330 and subsection 65D-30.004(31), F.A.C., staff shall receive training from qualified professionals in substance abuse, as defined in Section 397.311, F.S., that includes the etiology and characteristics of substance abuse, common street drugs and means of use, motivational stages, and principles of recovery and relapse.

(c) A CSU/ARF shall have a Medical Director licensed under Chapter 458 or 459, F.S., who is responsible for overseeing all medical services delivered at the facility.

(d) The staff of a CSU/ARF shall include a qualified professional specializing in substance abuse. The qualified professional must be a physician licensed under Chapter 458 or 459, F.S., or a practitioner licensed under Chapter 490 or 491, F.S., or certified through a certification process recognized by the Department of Children and Families (hereafter referred to as “the Department”) as provided in Sections 397.311 and 397.416, F.S. Individuals who are certified are permitted to serve in the capacity of a qualified professional, but only within the scope of their certification. A qualified professional shall be available on-call 24 hours per day, seven days per week. A qualified professional shall be on-site daily for a minimum of 40 hours per week total. The provider’s operating procedures shall include a description of those circumstances requiring the qualified professional to be on-site.

(e) Emergency screeners shall meet the requirements of subsections 65D-30.005(7) and 65E-5.400(5), F.A.C.

(f) CSU/ARFs shall meet the staff and supervision requirements of subsections 65D-30.005(12)-(13), F.A.C.

(g) CSU/ARFs shall comply with subsection 65D-30.004(33), F.A.C., which limits the tasks that may be performed by certain types of staff members.

(5) Operational, Administrative, and Financing Requirements.

(a) Licensure and Designation. A facility may operate as a CSU/ARF if it meets the following requirements:

1. The facility is licensed as a CSU by the Agency for Health Care Administration (hereafter referred to as the “Agency”) under Chapter 394, F.S. and Chapter 65E-12, F.A.C.;

2. The facility is designated as a Baker Act receiving facility by the Department under Chapter 394, F.S., and Chapter 65E-5, F.A.C.;

3. The facility is licensed as a detoxification facility by the Department under Chapter 397, F.S. and Chapter 65D-30, F.A.C.; and

4. The facility is designated as an ARF by the Department under Chapter 397, F.S. and Chapter 65D-30, F.A.C.

(b) Unit Operating Policies and Procedures. Uniform policies and procedures and forms that provide for the integrated operation of CSU/ARF services shall be developed and utilized. This shall include policies and procedures in accordance with the provisions set forth in Rules 65E-12.105, 65E-12.106, and 65E-12.107, F.A.C. These procedures shall include provisions that address use of the Baker Act and the Marchman Act in accordance with the individual’s diagnosis. The unit’s operating policies and procedures shall be subject to the approval of the organization’s Medical Director and advisory governing board.

(c) CSU/ARFs shall develop policies and procedures for reporting to the Department critical incidents within 24 hours of their discovery. Critical incidents shall include any death, serious injury or illness, any event involving recent non-admission or discharge, a felony crime, fire, natural or other disaster, epidemic, escape, riot, elopement, sexual harassment, sexual battery, medication errors, violations of crucial procedures, and actions resulting in physical injury or any situation which may evoke public reaction or media coverage.

(d) CSU/ARFs shall report each seclusion and restraint event to the Department. This reporting shall be done electronically using the Department’s web-based application either directly via the data input screens or indirectly via the File Transfer Protocol batch process. The required reporting elements are: Provider tax identification number; Person’s social security number and identification number; date and time the seclusion or restraint event was initiated; discipline of the person ordering the seclusion or restraint; discipline of the person implementing the seclusion or restraint; reason seclusion or restraint was initiated; type of restraint used; whether significant injuries were sustained by the person; and date and time seclusion or restraint was terminated. Facilities shall report seclusion and restraint events on a monthly basis. Events that result in death or significant injury either to a staff member or person shall be reported to the Department’s web based system in accordance with Department operating procedures.

(e) In those cases where an individual receiving services from a CSU/ARF needs to be transported to other services, the provider shall arrange for such transportation.

(f) CSU/ARFs that house both men and women must provide separate bedrooms for each gender.

(g) When a CSU/ARF releases an involuntary client held under the Marchman Act, notice shall be given to the court.

(h) Each CSU/ARF shall ensure that information in case records and any other identifying information for individuals reflecting a substance abuse diagnosis be maintained in accordance with 42 Code of Federal Regulations, Part 2. The Department and the Agency shall have access to confidential records, as needed, to conduct monitoring visits, surveys, complaint investigations, and other required site visits.

(i) In those instances where case records are maintained electronically, a staff identifier code shall be acceptable in lieu of a signature. Documentation within case records shall not be deleted. Amendments or marked through changes shall be initialed and dated by the individual making such changes.

(j) A CSU/ARF shall develop a uniform case record system regarding the content and format of case records.

(k) Each CSU/ARF shall develop a written Universal Infection Control plan which shall apply to all staff, volunteers, and to all individuals receiving services, and shall be reviewed and approved by the Medical Director. The CSU/ARF shall conduct screening and a risk assessment for infectious diseases for each individual who is determined to be substance abuse impaired, as required by Rules 65D-30.004 and 65E-5.180, F.A.C. All infection control activities shall be documented.

(6) Investigation of Complaints

(a) Each CSU/ARF shall develop a written policy and procedure regarding complaints as required by subsection 65E-5.180(6), F.A.C. This policy must be posted conspicuously in an area of the facility routinely used by all service recipients.

(b) Complaints received by the Department or by the Agency may be jointly investigated.

Rulemaking Specific Authority 394.4612, 394.499 FS. Law Implemented 394.4612, 394.499 FS. History–New 8-28-03, Amended________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Joe Anson
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: David E. Wilkins, Secretary
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: September 28, 2011
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: March 5, 2010