Current through Reg. 50, No. 187; September 24, 2024
(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.
New 1-17-01, Amended
8-31-03.
