65E-11.005. Behavioral Health Services Standards

(1) Lead Agencies shall adopt and distribute to their network members and subcontracted Providers of Behavioral Health Services, clinical practice guidelines and practice parameters for providing behavioral health services to enrolled children and their families that are based on the service standards and clinical guidelines described in this rule and Rule 65E-11.006, F.A.C.

(a) The clinical practice guidelines and practice parameters, shall be in writing and available to the department upon request and shall be based on national behavioral health standards developed by the American Academy of Child and Adolescent Psychiatry, or the American Managed Behavioral HealthCare Association, or the treatment improvement protocols developed by the Federal Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA), or on behavioral health standards reviewed and accepted by national accrediting bodies such as the Rehabilitation Accreditation Commission (CARF), or the National Committee for Quality Assurance (NCQA), or the Council on Accreditation (COA), or the Joint Commission on Accreditation of Health Care Organizations (JCAHCO), or based on any combination of the standards developed by the organizations described in this chapter.

(b) A Deemed Status. A Provider of Behavioral Health Services that becomes unconditionally accredited to provide behavioral health services either through The Joint Commission on Accreditation of Healthcare Organizations, or the Commission on Accreditation of Rehabilitation Facilities, or the Council on Accreditation, shall be deemed to have complied with all minimal clinical practice guidelines, practice parameters, and credentialing standards required by this rule for so long as the accreditation is maintained in good standing. Notwithstanding this requirement, Providers of Behavioral Health Services who provide services for the treatment and prevention of substance dependence shall have met the minimum standards for licensure as set forth in Chapter 397, F.S.

(2) In addition to the practice guidelines described in Rule 65E-11.007, F.A.C., Lead Agencies and Providers of Behavioral Health Services that do not meet the criteria for deemed status as defined in this chapter, shall develop behavioral health services standards that address the following:

(a) Standards for accessibility, availability, referral, and triage;

(b) Standards for credentialing, recredentialing and reappointment of behavioral health providers;

(c) Standards for credentialing shall be no less restrictive than those staffing and direct services standards found in the Community Mental Health Coverage and Limitation Handbook, version July 2000, herein incorporated by reference as if fully set out here. A copy of the Community Mental Health Coverage and Limitation Handbook can be obtained from the district Agency for Health Care Administration Program Office.

(d) Standards to establish a uniform protocol for assessing and confirming qualifications and competencies of licensed behavioral health providers including those licensed behavioral health providers that are subcontracted to provide behavioral health services. Said protocol shall be submitted to the department for review and shall address:

1. Criteria for and the primary source of verification of each behavioral health provider’s current license, education, relevant training, board certification, and experience,

2. Solicitation of reference checks from professional peers regarding each behavioral health provider’s competence and past practice,

3. Standards to ensure clinical evaluation, and treatment records review and confidentiality that are consistent with statutes and rules of the department,

4. Standards for the enrolled child’s rights and responsibilities that are consistent with Sections 397.501 and 394.459, F.S.,

5. Standards for managing the enrolled child and his or her family’s complaints and appeals,

6. Standards for subcontracting with Providers of Behavioral Health Services,

7. Standards to assess and ensure the enrolled child and his or her family’s satisfaction with services, and knowledge of grievance and appeals procedures,

8. Standards to ensure that enrolled children and their families are given information necessary for them to be informed about services for which they are eligible,

9. Care Planning Standards that includes significant child and family participation,

10. Treatment Services Standards that assure children and their families have access to a broad array of flexible, community-based services and supports,

11. Discharge Planning Standards that describe procedures to effect transfer to a different service, a more appropriate level of care, and to an out-of-network provider on behalf of the child and his family:

a. When a child completes the prescribed behavioral health services treatment outlined in the treatment plan and is discharged from the service,

b. When a child is placed in an emergency status and is transferred to an out-of-network provider,

c. When a child’s episode of emergency behavioral care treatment with an out-of-network provider is completed and the child is ready to be transferred back to the Provider of Behavioral Health Services,

d. When a child does not complete the prescribed behavioral health services treatment outlined in his or her treatment plan and is transferred to an out-of-network provider.

(3) Providers of Behavioral Health Services providing treatment for substance-related disorders shall follow the Florida Supplement to the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders, Second Edition (ASAM PPC-2) Revised July 1, 1998 criteria as a clinical placement guide, hereby incorporated by reference as if fully set out here. A copy of the ASAM PPC-2 can be obtained from the district Alcohol, Drug Abuse, and Mental Health Program Office.

(4) Lead Agencies shall not offer their network members and subcontracted Providers of Behavioral Health Services, financial incentives for limiting the number of referrals, tests, and services based on the cost of said referrals, tests, and services.

(5) Providers of Behavioral Health Services shall not prohibit their behavioral health services providers from discussing with the child and his family the full range of treatment options.

(6) Providers of Behavioral Health Services shall have demonstrated experience in the diagnosis and treatment of children with serious mental or serious substance-related disorders, as appropriate to the child’s presenting condition.

Rulemaking Authority 409.8135(6) FS. Law Implemented 409.8135 FS. History–New 1-17-01.