65E-11.003. Scope of Behavioral Health Services

(1) Children eligible for behavioral health services are those children that are Title XXI eligible-enrolled in the Florida KidCare Program and which are at least five (5) years of age and not yet nineteen (19) years of age.

(2) Providers of Behavioral Health Services shall adopt Section 394.491, F.S., and the legislative intent and purpose described in Chapter 397, F.S., as guiding principles in the delivery of services and supports to children with mental health and substance dependence disorders.

(3) Enrolled children shall be provided any of the medically necessary behavioral health services that are available to Medicaid eligible children under:

(a) Florida’s Medicaid benefit package for Community Mental Health, Inpatient and Outpatient Hospitals. Notwithstanding paragraph 65E-11.003(3)(a), F.A.C., a Provider of Behavioral Health Services shall not be liable for more than 10 inpatient days per contract year.

(b) Targeted Case Management; and,

(c) Physician and Pharmaceutical services.

(4) Notwithstanding subsection 65E-11.003(3), F.A.C., above, enrolled children are eligible for up to 30 days of medically necessary residential care.

(5) Notwithstanding subsection 65E-11.003(3), F.A.C., above, a crisis stabilization unit licensed under Chapter 394, F.S., or addictions receiving facility licensed under Chapter 397, F.S., is deemed to be an acceptable alternative to the inpatient care provision so long as it represents a clinically appropriate level of care for the child.

(6) Notwithstanding subsection 65E-11.003(3), F.A.C., above, Alternative Services shall be provided to enrolled children when deemed necessary to meet the objectives outlined in a child’s treatment plan and shall be provided in the most integrated setting appropriate to the needs of the enrolled child.

(a) Alternative Services shall be approved so long as they are related to the child’s treatment services plan. Documentation of approved Alternative Services shall include the name of the district Behavioral Health Network Coordinator with signature and shall contain the following elements:

1. District identifier,

2. Provider name,

3. Provider Federal Identification number (FID),

4. Description of Alternative Service,

5. Definition of Alternative Service,

6. Unit type; and,

7. Unit cost.

(b) To track the provision of Pharmaceutical and approved Alternative Services, documentation shall contain the following elements:

1. County in which service was provided,

2. Provider Federal Identification number (FID),

3. Client social security number,

4. Alternative Service provided,

5. Name of medication, strength, and schedule if applicable,

6. Units; and,

7. Unit cost.

(7) The Lead Agency shall include within its behavioral health care network at a minimum, a psychiatric hospital licensed under Chapter 395, F.S., a crisis stabilization unit licensed under Chapter 394, F.S., and an addiction receiving facility, licensed under Chapter 397, F.S., to which an enrolled child is to be sent.

(8) Coordination with Children’s Medical Services and the Department. The name and supporting credentials for the candidate for the behavioral health liaison position shall be submitted by the Lead Agency or Provider of Behavioral Health Services to the district Alcohol, Drug Abuse, and Mental Health Program Office and the Children’s Medical Services area office for approval prior to the liaison assuming duties.

(9) If neither the district Alcohol, Drug Abuse, and Mental Health Program Office nor the Children’s Medical Services area office disapproves the candidate within ten (10) working days after the submission is received, the candidate will be deemed approved.

(10) The Behavioral Health Liaison shall be a licensed professional as defined in Chapter 490 or 491, F.S., or a certified professional as defined in Chapter 397, F.S., and shall:

(a) Have a minimum of three years experience working with children with Serious Emotional Disturbances and their families;

(b) Be knowledgeable of mental health and substance-related diagnosis and treatment; and,

(c) Have demonstrated ability to interact in a medical environment as determined by professional references.

(11) In order to coordinate care in an efficient manner, the Behavioral Health Liaison shall be accessible and shall serve as the coordinator of care across agency and program lines. The liaison shall conduct targeted outreach to include:

(a) Regular contacts with all Florida Healthy Kids’ local outreach projects and coordinating committees;

(b) Health maintenance organizations or other licensed insurers;

(c) Exceptional education programs, school nurses, school social workers, and area schools in order to facilitate their referrals and answer questions;

(d) Children’s Medical Services area offices;

(e) Substance-related and mental health providers serving children within the district where the Behavioral Health Liaison is employed;

(f) Local child advocacy agencies and organizations such as Healthy Start, Early Childhood Services, and Healthy Families;

(g) Serve as the principal liaison to the department’s designated Behavioral Health Specialty Care Coordinator;

(h) Provide ongoing training to the local Children’s Medical Services staff on identification and intervention with children who exhibit behavioral health problems as a result of their mental or substance-related disorder and be available for consultation regarding general behavioral health care issues;

(i) Participate in joint treatment plan staffings as required by the Children’s Medical Services Area Office;

(j) Be located within the local Children’s Medical Services area office for a portion of a Full Time Equivalent (FTE) staff. The portion of the FTE shall be determined by the district Alcohol, Drug Abuse, and Mental Health Program Office;

(k) Share and communicate information between the Behavioral Health Specialty Care Network, Children’s Medical Services Network, the child’s primary care doctor and parents or legal guardians;

(l) Accept and process referrals that result from outreach activities, including assisting families with the preparation, submission, and completion of the KidCare application;

(m) Discuss behavioral health screening or assessment results with families, especially those in the process of completing the KidCare application;

(n) Provide each enrolled family with culturally-competent training regarding the behavioral health services benefits; the nature and extent of the child and family’s respective rights; what constitutes emergency, urgent and routine care; and where to go to get questions answered and grievances resolved;

(o) Complete the Behavioral Health Network Screening and Eligibility Tracking form, March 1, 2002 version hereby incorporated by reference. The Behavioral Health Network Screening and Eligibility Tracking form, March 1, 2002, may be obtained from the district Alcohol, Drug Abuse, and Mental Health Program Office. In addition, complete the Behavioral Health Network Reverification and Request for Disenrollment form, March 1, 2002, version hereby incorporated by reference. The Behavioral Health Network Reverification and Request for Disenrollment form may be obtained from the district Alcohol, Drug Abuse, and Mental Health Program Office. Upon completion, the Behavioral Health Liaison shall submit a copy of the Behavioral Health Network Screening and Eligibility Tracking form and the Behavioral Health Network Reverification and Request for Disenrollment form(s) to the Children’s Medical Services area office and the district Alcohol, Drug Abuse, and Mental Health Program Office.

(12) Providers of Behavioral Health Services shall cooperate with the district Alcohol, Drug Abuse, and Mental Health Program Office and the Children’s Medical Services area office to establish procedures for referral to and clinical interaction with any integrated care system established by Children’s Medical Services.

(13) A parent or guardian of an enrolled child shall be allowed to change his direct service practitioner(s) within the Lead Agency’s Behavioral Health Network as well as participate in decision-making regarding care. Once begun, the Lead Agency or Provider of Behavioral Health Services shall be responsible for services without interruption so long as the child remains Title XXI eligible as described in Section 409.814, F.S.

Rulemaking Authority 409.8135(6) FS. Law Implemented 409.8135 FS. History–New 1-17-01, Amended 8-31-03.