The Department intends to amend rules 65D-30.002, .004, .0031, .0046, and .0081, F.A.C., to conform with statutory changes.

 

DEPARTMENT OF CHILDREN AND FAMILIES

Substance Abuse Program

RULE NOS.:RULE TITLES:

65D-30.002Definitions

65D-30.0031Certifications and Recognitions Required by Statute

65D-30.004Common Licensing Standards

65D-30.0046Staff Training, Qualifications, and Scope of Practice

65D-30.0081Standards for Day or Night Treatment with Community Housing

PURPOSE AND EFFECT: The Department intends to amend rules 65D-30.002, .004, .0031, .0046, and .0081, F.A.C., to conform with statutory changes.

SUMMARY: The amendments accomplish the following: 1) Remove unnecessary definitions; 2) Establish procedure and incorporate a form for requests for exemption from disqualification; 3) Set forth requirements for Department recognition as a certifying organization for peer specialists; 4) Delineate the scope of practice for staff; 5) Clarify that day or night treatment with community housing is intended for individuals who are at least 18 years of age.

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.

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: 397.321(5), FS.

LAW IMPLEMENTED: 397.311, 397.321, 397.4014, 397.403, 397.410, 397.4103, 397.4113, 397.487, 397.4871, 397.4872, 397.4873, FS.

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: Jodi Abramowitz. Jodi can be reached at [phone] or [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

65D-30.002 Definitions.

(1) through (17) No change.

(18) “Component” or “Service Component” as defined in subsection 397.311(43) 397.311(42), F.S.

(a) through (l) No change.

(19) through (39) No change.

(40) “Medication Administration Record” or “MAR” means the chart maintained for each individual which records the medication information required by this rule chapter. Other information or documents pertinent to medication administration may be attached to the MAR.

(41) through (44) are renumbered (40) through (43) No change.

(45) “Medication Administration Record” or “MAR” means the chart maintained for each individual which records the medication administered to an individual as required by this rule chapter. Other information or documents pertinent to medication administration may be attached to the MAR.

(44)(46) No change.

(47) “Medication Error” means medication that is administered or dispensed to an individual in a dose that is higher or lower, with greater or lesser frequency, or that is the wrong medication than that which is prescribed under a physician’s order.

(48) through (54) are renumbered (45) through (51) No change.

(52) “Peer specialist” as defined in subsection 397.311(30), F.S.

(55) through (67) are renumbered (53) through (65) No change.

(66)(68) “Qualified Professional” as defined in subsection 397.311(35) 397.311(34), F.S.

(67)(69) No change.

(68) “Recovery residence” as defined in subsection 397.311(38), F.S.

(70) through (76) are renumbered (69) through (75) No change.

(76)(77) “Stabilization” as defined in subsection 397.311(46) 397.311(45), F.S.

(78) “Substantial Compliance” means an applicant for a new license that is in the initial stages of developing services, has demonstrated the ability to implement the requirements of these rules through operating procedures, and is thereby eligible for a probationary license.

(79) through (84) are renumbered (77) through (82) No change.

(83)(85) “Treatment Plan” as defined in subsection 397.311(50) 397.311(49), F.S.

(86) through (89) are renumbered (84) through (87) No change.

Rulemaking Authority 397.321(5) FS. Law Implemented 397.311, 397.321(1), 397.410 FS. History–New 5-25-00, Amended 4-3-03, 12-12-05, 8-29-19,______.

 

65D-30.004 Common Licensing Standards.

(1) through (3) No change.

(4) Personnel Policies. Personnel policies shall clearly address recruitment and selection of prospective employees, promotion and termination of staff, code of ethical conduct, sexual harassment, confidentiality of individual records, attendance and leave, employee grievance, non-discrimination, abuse reporting procedures, and the orientation of staff to the agency’s universal infection control procedures. The code of ethical conduct shall prohibit employees and volunteers from engaging in sexual activity with individuals receiving services for a minimum of two (2) years after the last professional contact with the individual. Providers shall also have a drug-free workplace policy for employees and prospective employees.

(a) No change.

(b) Screening of Staff. All owners, chief financial officers, chief executive officers, and clinical supervisors of service providers are subject to level 2 background screening and local background screening as provided under chapters 435 and 397, F.S. All service provider personnel, and volunteers who have direct contact with children receiving services or with adults with intellectual disabilities receiving services are subject to level 2 background screening as provided under chapter 435, and section 397.4073, F.S. In addition, individuals shall be re-screened within five (5) years from the date of their last screening and shall include a local background screening. Re-screening shall include a level 2 screening in accordance with chapter 435, F.S. Service provider personnel who request an exemption from disqualification must submit the request within 30 days after being notified of the disqualification. If five (5) years or more have elapsed since the most recent disqualifying offense, service provider personnel may work with adults who have substance use disorders under the supervision of a qualified professional until the Department makes a final determination regarding the request for an exemption from disqualification. (Personnel operating directly with local correctional agency or authority, Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections or the Department of Management Services are exempt from the requirements in this paragraph, unless they have direct contact with unmarried inmates under the age of 18 or with inmates who are intellectually disabled.)

(c) Exemptions from disqualification. Except as provided in section 397.4872(2), F.S., the Department will consider exemptions to staff disqualification or administrator ineligibility to work in substance use disorder treatment programs, facilities, or in programs or facilities that treat co-occurring substance use and mental health disorders.

1. Staff and administrators who request an exemption from disqualification must submit the request within 30 days after being notified of the disqualification.

2.  Staff and administrators who choose to request an exemption from disqualification shall do so by submitting a Request for Exemption form, CF 708, Mar 2020, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXX and https://www.myflfamilies.com/programs/backgroundscreening/docs/Exemption-Packet.pdf.

(d)(c) No change.

(5) No change.

(6) Medical Director. This requirement applies to addictions receiving facilities, detoxification, intensive inpatient treatment, residential treatment, and methadone and medication-assisted treatment for opioid addiction. Providers shall designate a medical director who shall oversee all medical services. The medical director’s responsibilities shall be clearly described.

(a) through (b) No change.

(c) The Department shall utilize the following methodology for determining the maximum number of individuals a medical director may serve pursuant to subparagraph 397.410(1)(c)5., F.S.:

Component	Average Length of Stay (LOS) in Days	Total Service Time over LOS	Work Days	Work Days per LOS	Hours worked per LOS (Work Days x Work Days per LOS)	Calculation (Time in LOS/Total Service Time)	Total Case Load
Inpatient Detoxification	4 days	1.0 hour*	8 hours	4 days	32 hours	32 /1 hour	32 individuals
Outpatient Detoxification	5 days	1.2 hours*	8 hours	5 days	40 hours	40/1.2 hours	33 individuals
Residential Level I	19 days	1 hour**	8 hours	15 days	120 hours	120/1 hour	120 individuals
Residential Level II	41 days	1.75 hours**	8 hours	30 days	240 hours	240/1.75	137 individuals
Residential Level III	54 days	2.25 hours**	8 hours	40 days	320 hours	320/2.25	142 individuals
Residential Level IV	42 days	1.75 hours**	8 hours	30 days	240 hours	240/1.75	137 individuals
Methadone Medication-Assisted Treatment for Opioid Use Disorder Medication and Methadone Maintenance	1,030 days	3.25 hours***	8 hours	709 days	5,672 hours	5,672/3.25	1,745 individuals

*Service Times: New Patient Visit (30 minutes), Daily Follow-up (10 minutes)

**Service Times: New Patient Visit (30 minutes), Weekly Follow-up (15 minutes)

***Service Times: New Patient Visit (30 minutes), Quarterly Follow-up (15 minutes)

(d) A medical director may not serve in that capacity for more than a maximum of the indicated number of individuals for the treatment types listed below:

1. through 6. No change.

7. Methadone medication-assisted treatment for opioid use disorder Medication and methadone maintenance treatment – a cumulative total of 1,745 individuals at any given time.

(e) through (h) No change.

(7) Medical Services.

(a) No change.

(b) The medical protocols shall also include:

1. The manner in which certain medical functions may be delegated to Advanced Practice Registered Nurses Nurse Practitioners and Physician’s Assistants in those instances where these practitioners are utilized as part of the clinical staff;

2. through 4. No change.

(c) through (e) No change.

(8) through (22) No change.

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321, 397.4014, 397.4073, 397.4075, 397.410, 397.4103, 397.4113, 397.4872 FS. History–New 5-25-00, Amended 4-3-03, 12-12-05, 8-29-19,____.

 

65D-30.0031 Certifications and Recognitions Required by Statute.

(1) No change.

(2) Department Recognition of Credentialing Entities.

(a) through (b) No change.

(c) The Department shall recognize one (1) or more credentialing entities as a certifying organization for peer specialists, in accordance with section 397.417, F.S. A list of Department recognized credentialing organizations for peer specialists can be found at the following link: http://www.myflfamilies.com/service-programs/_____________. An organization that desires recognition by the Department as a certifying organization for peer specialists shall request such approval in writing from the Department. Organizations seeking approval must demonstrate compliance with the following nationally recognized standards for developing and administering professional certification programs to certify peer specialists:

1. Core competencies required for certification of an individual as a peer specialist that include:

a. Advocacy;

b. Mentoring;

c. Recovery support;

d. Cultural and linguistic competence;

e. Motivational interviewing;

f. Vicarious trauma/Self-care;

g. Professional responsibility; and

h. Group facilitation skills;

2. Certification guidelines and requirements, including training requirements;

3. Ability to screen applicants;

4. Capacity to administer exams for certification at proctored test-taking sites, including policies for special accommodations in compliance with the Americans with Disabilities Act;

5. Established code of ethics;

6. Policies and procedures for investigation of complaints and corrective action against a certified peer specialist, which may include suspension and revocation of certification, and appeals;

7. Procedures for continuing education requirements for, and a process for, biennial certification renewal; and

8. Publicly available fee schedule and payment process for costs associated with certification, exam, recertification, and continuing education units.

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321(6), (15), 397.403, 397.417, 397.4871 FS. History–New 8-29-19, Amended_____.

 

65D-30.0046 Staff Training, Qualifications, and Scope of Practice.

(1) through (2) No change.

(3) Scope of Practice for all staff. All staff must provide services within the scope of their professional licensure or certification, training and competence in accordance with applicable clinical protocols.

(4) Scope of Practice for staff who are not licensed or certified as qualified professionals, and who provide services specific to substance use.

(a) This staff is comprised of:

1. Bachelor’s or master’s degree level practitioners. Practitioners must hold a degree from an accredited university or college with a major in counseling, social work, psychology, nursing, rehabilitation, special education, health education, or a related human services field;

2. Registered interns for marriage and family therapy, clinical social work, and mental health counseling; and

3. Certified addiction counselors who are certified by the Florida Certification Board.

(b)  The staff listed in subsection (4)(a) must work directly under the supervision of a qualified professional.

(c) When providing services specific to substance use, the staff listed in subsection (4)(a) are limited to the following tasks, unless otherwise specified in this rule:

1. Screening;

2. Psychosocial assessment;

3. Treatment planning;

4. Referral and linkage;

5. Service coordination;

6. Consultation;

7. Continuing assessment and treatment plan reviews;

8. Recovery support services;

9. Crisis intervention;

10. Individual, family, and community education;

11. Documentation of progress;

12.Any other tasks permitted in these rules and appropriate to that licensable component; and

13. Counseling, except therapy;

(d) Therapy, including individual, family, and group therapy, may only be provided by master’s degree level practitioners and registered interns.

(5)  Scope of Practice for staff who are peer specialists, and who provide services specific to substance use disorder treatment.

(a) Peer specialists providing Department funded peer support services shall be certified by a Department recognized credentialing organization for peer specialists.

(b)  Peer specialists shall work under the supervision of a qualified professional or a certified peer specialist with a minimum of three (3) years of experience providing recovery support services to individuals with substance use disorders.

(c)  Peer specialists are allowed one year from the date of their employment to obtain certification.

(d)  Peer specialists may provide the following services: 

1. Referral and linkage;

2. Service coordination;

3. Recovery support services;

4. Facilitation of recovery group meetings, excluding twelve-step meetings and therapeutic or clinical group counseling sessions;

5. Non-clinical crisis support;

6. Individual, family, and community education

7. Outreach;

8. Recovery goal setting and planning assistance;

9. Advocacy;

10. Documentation of recovery plan progress; and

11. Participation in treatment team planning and process

(3) Scope of Practice. Staff not licensed under chapter 458, 459, 464, 490 or 491, F.S., providing services specific to substance use are limited to the following tasks unless otherwise specified in this rule:

(a) Screening;

(b) Psychosocial assessment;

(c) Treatment planning;

(d) Referral;

(e) Service coordination;

(f) Consultation;

(g) Continuing assessment and treatment plan reviews;

(h) Recovery support services;

(i) Crisis intervention;

(j) Individual, family, and community education;

(k) Documentation of progress;

(l) Any other tasks permitted in these rules and appropriate to that licensable component; and

(m) Counseling, including;

1. Individual counseling;

2. Group counseling; and

3. Counseling with families, couples, and significant others.

(4) Staff Qualifications. Staff must provide services within the scope of their professional licensure certification; or training and competence in applicable clinical protocols.

(a) The scope of practice limitations listed in subsection (3) apply to the following unlicensed staff who must work directly under the supervision of a qualified professional:

1. Bachelor’s or master’s degree level practitioners. Practitioners must hold a degree from an accredited university or college with a major in counseling, social work, psychology, nursing, rehabilitation, special education, health education, or a related human services field;

2. Registered marriage and family therapy, clinical social work, and mental health counseling interns;

3. Certified master’s degree level addiction professionals who are certified by the Florida Certification Board;

4. Certified addictions professionals who are certified by the Florida Certification Board;

5. Certified addiction counselors who are certified by the Florida Certification Board.

(b) Certified recovery peer specialists and specialist or certified recovery support specialists who are certified by the Florida Certification Board may provide all services listed in subsection (3) of this rule, except counseling listed in paragraph (3)(l), under the supervision of a qualified professional or a certified recovery peer specialist with a minimum of three (3) years of experience providing recovery support services to individuals with substance use disorders. Recovery support specialists and recovery peer specialists are allowed one year from the date of their employment to obtain certification through the Florida Certification Board.

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321, 397.410 FS. History–New 8-29-19, Amended____.

 

65D-30.0081 Standards for Day or Night Treatment with Community Housing.

In addition to rule 65D-30.004, F.A.C., the following standards apply to day or night treatment with community housing.

(1) Day or Night Treatment with Community Housing is provided on a nonresidential basis at least five (5) hours each day and at least 25 hours each week and is intended for individuals who are at least 18 years of age and who can benefit from living independently in peer community housing while undergoing treatment. Day or night treatment with community housing is appropriate for individuals who do not require structured, 24-hours-a-day, 7-days-a-week residential treatment. The housing must be provided and managed by the licensed service provider, including room and board and any ancillary services needed, such as supervision, transportation, and meals. Activities for day or night treatment with community housing programs emphasize rehabilitation and treatment services using multidisciplinary teams to provide integration of therapeutic and family services. This component allows individuals to live in a supportive, community housing location while participating in treatment. Treatment shall not take place in the housing where the individuals live, and that the housing is utilized solely for the purpose of assisting individuals in making a transition to independent living. Individuals who are considered appropriate for this level of care:

(a) through (f) No change.

(2) through (8) No change.

Rulemaking Authority 397.321(5) FS. Law Implemented 397.311(26), 397.321, 397.4014, 397.410, 397.487, 397.4873, FS. History–New 12-12-05, Amended 8-29-19,_____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Chris Weller

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Chad Poppell

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 9, 2020

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: October 30, 2019