59C-1.041. Hospital Inpatient Substance Abuse Services

(1) Agency Intent. It is the intent of the Agency to ensure the availability of hospital inpatient substance abuse services for children, adolescents and adults in need of these services regardless of their ability to pay. This rule regulates the establishment of new inpatient substance abuse hospitals, and specifies which services can be provided by licensed or approved providers of hospital inpatient substance abuse services.

(2) Definitions.

(a) “Adolescent.” A person age 14 through 17.

(b) “Adult.” A person age 18 and over.

(c) “Agency.” The Agency for Health Care Administration.

(d) “Approved Hospital Inpatient Substance Abuse Bed.” A proposed hospital inpatient substance abuse bed for which an exemption, notification, a certificate of need, a letter of intent to grant a certificate of need, a signed stipulated agreement, or a final order granting a certificate of need was issued, consistent with the provisions of paragraph 59C-1.008(2)(b), F.A.C., as of the most recent published deadline for Agency initial decisions prior to publication of the fixed need pool, as specified in paragraph 59C-1.008(1)(g), F.A.C.

(e) “Charity Care.” Is defined the same as in Section 409.911(1), F.S.

(f) “Child.” A person under the age of 14 years.

(g) “District.” A District of the Agency defined in Section 408.032(5), F.S.

(h) “Fixed Bed Need Pool.” The numerical hospital inpatient substance abuse bed need for adults for the applicable planning horizon, as established by the Agency in accordance with this rule and subsection 59C-1.008(2), F.A.C.

(i) “General Hospital.” Means any facility which meets the provisions of Section 395.002(12), F.S.

(j) “Hospital Inpatient Substance Abuse Bed.” A bed designated for the exclusive use of patients receiving hospital inpatient substance abuse services as defined by this rule.

(k) “Hospital Inpatient Substance Abuse Services.” Services provided under the direction of a professional trained and experienced in substance abuse services, including a psychiatrist, a physician certified by the American Society of Addiction Medicine, a physician subspecialty certified in Addiction Medicine by the American Osteopathic Association, a Certified Addictions Professional, a clinical psychologist, a clinical social worker (as defined in Section 491.003(2), F.S.) or a certified master social worker (as defined in Section 491.0145, F.S.) to persons whose sole diagnosis, or in the event of more than one diagnosis, the principal diagnosis is a substance abuse disorder defined in paragraph (2)(s) of this rule.

(l) “Planning Horizon.” The projected date by which a proposed hospital inpatient substance abuse service would be initiated. For purposes of this rule, the planning horizon for applications submitted between January 1 and June 30 is July of the year 5 years subsequent to the year the application is submitted; the planning horizon for applications submitted between July 1 and December 31 is January of the year 5 years subsequent to the year which follows the year the application is submitted.

(m) “Psychiatric Disorder.” For purposes of this rule, a psychiatric disorder is a mental illness as defined in Section 394.455(18), F.S., which requires inpatient hospitalization.

(n) “Separately Organized Unit.” A specific section, ward, wing, or floor with a separate nursing station designated exclusively for the care of hospital inpatient substance abuse services  patients.

(o) “Specialty Hospital.” A specialty hospital is as defined by subsection 395.002(28), F.S.

(p) “Substance Abuse.” The misuse or abuse of, or a dependence on alchohol, illicit drugs or prescription medications which requires inpatient hospitalization. A disorder coded in any sub-classification of categories 291, 292, 303, 304 or 305 in Axis I or Axis II consistent with the diagnostic categories defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), incorporated herein by reference; or equivalent codes in the following sub-classifications in the International Classification of Disease (ICD 9), incorporated herein by reference: category 291, 292, 303, 304 or 305.

(3) General Provisions.

(a) Admissions to Hospital Inpatient Substance Abuse Services. Admission to facilities with a certificate of need for hospital inpatient substance abuse services is limited to persons whose sole diagnosis, or in the event of more than one diagnosis, the principal diagnosis is a substance abuse disorder as defined in subsection (2).

(b) Service Location. The hospital inpatient substance abuse services regulated under this rule may be provided in a hospital licensed as a general hospital or licensed as a specialty hospital.

(c) Separate Regulation of Age Categories. The Agency regulates two types of hospital inpatient substance abuse services, those services which are used for substance abuse treatment of adults, and those services used for substance abuse treatment of children and adolescents. Certificate of need applications for the establishment of hospital inpatient substance abuse services for adults shall be reviewed separately from certificate of need applications for hospital inpatient substance abuse services for children and adolescents. A separate certificate of need shall be issued for each service.

(d) Separately Organized Units. Hospital inpatient substance abuse services for adults shall be provided in one or more separately organized units within a general hospital or specialty hospital. Hospital inpatient substance abuse services for children and adolescents shall be provided in one or more separately organized units within a general hospital or specialty hospital.

(e) Minimum Size of Specialty Hospitals. A specialty hospital providing hospital inpatient substance abuse services shall have a minimum total capacity of 40 beds, which may include beds used for hospital inpatient psychiatric services regulated under Rule 59C-1.040, F.A.C. The separately organized units for hospital inpatient substance abuse services for adults or for children and adolescents in specialty hospitals shall meet the minimum size requirements stated in subsection (5) of this rule.

(f) Conformance with the Criteria for Approval. A certificate of need for the establishment of new inpatient substance abuse hospitals shall not normally be approved unless the applicant meets the applicable review criteria in Section 408.035, F.S., and the standards and need determination criteria set forth in this rule.

(g) Required Services. Hospital inpatient substance abuse services whether provided directly by the hospital or under contract shall include, at a minimum, emergency screening services; treatment planning services; pharmacology, if appropriate; individual therapy; family therapy; discharge planning; referral services, including written referral agreements for educational and vocational services; and occupational and recreational therapies.

(h) Excluded Hospitals. Hospitals operated by the State of Florida are not regulated under this rule pursuant to Sections 408.036(3)(d), (r) and (s), F.S.

(4) Criteria for Determination of Need.

(a) Bed Need. A favorable need determination for proposed inpatient substance abuse hospitals for adults shall not normally be made unless a bed need exists according to the numeric need methodology in paragraph (4)(c) of this rule.

(b) Fixed Bed Need Pool. The future need for hospital inpatient substance abuse services for adults shall be determined twice a year and published by the Agency as a fixed bed need pool for the applicable planning horizon.

(c) Need Formula for Hospital Inpatient Substance Abuse Beds for Adults. The net bed need for hospital inpatient substance abuse beds for adults in each District shall be calculated in accordance with the following formula:

NNA = ((PDA/PA × PPA) / (365 × .75)) – LBA – ABA

where:

1. NNA equals the net need for hospital inpatient substance abuse beds for adults in a district.

2. PDA equals the number of inpatient days in hospital inpatient substance abuse beds for adults in a district for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the fixed bed need pool.

3. PA equals the estimated population age 18 or over in the district. For applications submitted between January 1 and June 30, PA is the population estimate for January of the preceding year; for applications submitted between July 1 and December 31, PA is the population estimate for July of the preceding year. The population estimate shall be the most recent estimate published by the Office of the Governor and available to the Agency at least 6 weeks prior to publication of the fixed bed need pool.

4. PPA equals the estimated population age 18 or over in the district for the applicable planning horizon. The population estimate shall be the most recent estimate published by the Office of the Governor and available to the Agency at least 6 weeks prior to publication of the fixed bed need pool.

5. .75 equals the desired average annual occupancy rate for hospital inpatient substance abuse beds for adults in the district.

6. LBA equals the district’s number of licensed hospital inpatient substance abuse beds for adults as of the most recent published deadline for Agency initial decisions prior to publication of the fixed bed need pool.

7. ABA equals the district’s number of approved hospital inpatient substance abuse beds for adults, as determined consistent with the provisions of subsection (2) of this rule.

(d) Need for Hospital Inpatient Substance Abuse Services for Children and Adolescents. The need for proposed hospital inpatient substance abuse services for children and adolescents shall be determined consistent with the following:

1. The Agency shall consider the need for hospital inpatient substance abuse services for children and adolescents within the context of licensed or approved hospital inpatient substance abuse services for children and adolescents and licensed non-hospital residential treatment programs for children and adolescents with substance abuse disorders. The applicant for hospital inpatient substance abuse services for children and adolescents shall provide documentation that the district’s licensed non-hospital residential treatment programs for children and adolescents with substance abuse disorders do not meet the need for the proposed service.

2. No additional hospital inpatient substance abuse beds for children and adolescents shall normally be approved in a district having one or more facilities with hospital inpatient substance abuse services for children and adolescents unless the average annual occupancy rate of all licensed hospital inpatient substance abuse beds for children and adolescents in the district equaled or exceeded 75 percent during the 12 month period ending 6 months prior to the application submission deadline.

(e) Preferences among competing applicants for hospital inpatient substance abuse services. In weighing and balancing statutory and rule review criteria, preference will be given to applicants who:

1. Provide Medicaid and charity care days as a percentage of their total patient days equal to or greater than the average percentage of Medicaid and charity care patient days of total patient days provided by other hospitals in the district, as determined by the Florida Center for Health Information and Policy Analysis hospital discharge data for the 12-month period ending six months prior to the beginning date of the quarter of the publication of the fixed bed need pool.

2. Propose to serve Medicaid-eligible persons.

3. Propose to serve substance-abusing pregnant and post-partum women regardless of their ability to pay.

4. Propose to serve individuals without regard to their ability to pay.

(f) Non-Competitive Applicants. The factors contained in paragraph (4)(e) shall also be considered in the review of a single non-competitive certificate of need application within the district.

(5) Unit Size. A separately organized unit for hospital inpatient substance abuse services for adults shall have a minimum of 10 beds. A separately organized unit for hospital inpatient substance abuse services for children and adolescents shall have a minimum of five beds.

(6) Access Standard. Hospital inpatient substance abuse services should be available within a maximum ground travel time of 45 minutes under average travel conditions for at least 90% percent of the district’s total population.

(7) Quality of Care.

(a) Compliance with Agency Standards. Hospital Inpatient Substance Abuse Services for Adults or for Children and Adolescents shall comply with the Agency standards for program licensure described in Chapter 59A-3, F.A.C. Applicants who include a statement in their certificate of need application that they will meet applicable Agency licensure standards are deemed to be in compliance with this provision.

(b) Hospital Inpatient Substance Abuse Services for Children. Facilities providing Hospital Inpatient Substance Abuse Services to children must have beds and common areas designated for children which cannot be used by adults. Adolescents may be treated in the units designated for children. Adolescents may only be treated in units designated for adult hospital inpatient substance abuse services if the admitting physician indicates that such placement is medically indicated, or for reasons of safety.

(c) Applicants proposing a new hospital inpatient substance abuse service shall state how they will comply with the provisions of hospital licensure as defined in Rule 59A-3.066, F.A.C.

(d) Continuity. Providers of hospital inpatient substance abuse services shall also provide outpatient or referral services, either directly or through written agreements with community outpatient substance abuse programs, such as local psychiatrists, other physicians trained in the treatment of psychiatric or substance abuse disorders, local psychologists, community mental health programs, or other local substance abuse outpatient programs.

(e) Screening Program. All facilities providing hospital inpatient substance abuse services shall have a screening program to assess the most appropriate treatment for the patient. Patients with a dual diagnosis of substance abuse, as defined in subsection (2), and a psychiatric disorder, as defined in subsection (2), shall be evaluated to determine the types of treatment needed, the appropriate treatment setting, and, if necessary, the appropriate sequence of treatment for the substance abuse and psychiatric disorders.

(8) Services Description. An applicant for an inpatient substance abuse hospital shall provide a detailed program description in its certificate of need application including:

(a) Age groups to be served.

(b) Specialty programs to be provided (e.g. alcoholism treatment programs, drug abuse treatment programs).

(c) Proposed staffing, including qualifications of the clinical director, a description of staffing appropriate for any specialty program, and a discussion of the training and experience requirements for all staff who will provide substance abuse services.

(d) Therapeutic approaches to be used.

(e) Expected sources of patient referrals.

(f) Expected average length of stay for the hospital inpatient substance abuse services discharges by age group.

(g) Projected number of hospital inpatient substance abuse services patient days by payer type, including Medicare, Medicaid, private insurance, self-pay and charity care patient days for the first 2 years of operation after completion of the proposed project.

(h) Admission policies of the facility with regard to charity care patients.

(9) Quarterly Reports. Facilities providing licensed hospital inpatient substance abuse services shall report to the Agency or its designee, within 45 days after the end of each calendar quarter, the number of hospital inpatient substance abuse services admissions and patient days by age groups (patients under age 18 years and adults).

Rulemaking Authority 408.034(3), (8), 408.15(8) FS. Law Implemented 408.035, 408.036(1)(b), (c), 408.039(4)(a) FS. History–New 1-1-77, Amended 11-1-77, 6-5-79, 4-24-80, 2-1-81, 4-1-82, 11-9-82, 2-14-83, 4-7-83, 6-9-83, 6-10-83, 12-12-83, 3-5-84, 5-14-84, 7-16-84, 8-30-84, 10-15-84, 12-25-84, 4-9-85, Formerly 10-5.11, Amended 6-19-86, 11-24-86, 1-25-87, 3-2-87, 3-12-87, 8-11-87, 8-7-88, 8-28-88, 9-12-88, 4-19-89, 10-19-89, 5-30-90, 7-11-90, 8-6-90, 10-10-90, 12-23-90, Formerly 10-5.011(1)(q), 10-5.041, Amended 8-24-93, 2-22-95, 6-23-16.