Florida Administrative Code
65 - DEPARTMENT OF CHILDREN AND FAMILIES
65E - Mental Health Program
Chapter 65E-14 - COMMUNITY SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES - FINANCIAL RULES
Section 65E-14.021 - Schedule of Covered Services
Universal Citation: FL Admin Code R 65E-14.021
Current through Reg. 50, No. 187; September 24, 2024
This rule provides guidelines and requirements applicable to service providers under direct contract with the Department or service providers under subcontracts with a Managing Entity.
(1) Unless specifically authorized otherwise in advance by the Department, service providers shall only use the following Substance Abuse and Mental Health (SAMH) Covered Services to report contracted or subcontracted substance abuse and mental health services.
(a) Aftercare,
(b) Assessment,
(c) Care Coordination,
(d) Case Management,
(e) Community Action Treatment (CAT),
(f) Comprehensive Community
Service Team,
(g) Crisis
Stabilization,
(h) Crisis
Support/Emergency,
(i) Day Care,
(j) Day Treatment,
(k) Drop-In/Self Help Centers,
(l) Florida Assertive Community Treatment
(FACT) Team,
(m) HIV Early
Intervention Services,
(n)
Incidental Expenses,
(o)
Information and Referral,
(p)
In-Home and Onsite,
(q) Inpatient,
(r) Intensive Case Management,
(s) Intervention,
(t) Medical Services,
(u) Medication-Assisted Treatment,
(v) Mental Health Clubhouse Services,
(w) Outpatient,
(x) Outreach,
(y) Prevention - Indicated,
(z) Prevention - Selective,
(aa) Prevention - Universal Direct,
(bb) Prevention - Universal
Indirect,
(cc) Recovery Support,
(dd) Residential Level I,
(ee) Residential Level II,
(ff) Residential Level III,
(gg) Residential Level IV,
(hh) Respite Services,
(ii) Room and Board with Supervision Level
I,
(jj) Room and Board with
Supervision Level II,
(kk) Room and
Board with Supervision Level III,
(ll) Room and Board with Supervision Level
IV,
(mm) Short-term Residential
Treatment,
(nn) Substance Abuse
Inpatient Detoxification,
(oo)
Substance Abuse Outpatient Detoxification,
(pp) Supported Employment,
(qq) Supportive Housing/Living,
(rr) Treatment Accountability for Safer
Communities (TASC), and
(ss) Any
other SAMH Covered Services the department may establish pursuant to subsection
(2) of this rule, to ensure adequate provision of service.
(2) The department may establish additional SAMH Covered Services for statewide use as necessary to ensure the adequate provision of services to individuals. At a minimum, the department shall notify affected parties of the department's intended action and provide an opportunity to comment at least 30 days prior to the establishment of a temporary SAMH Covered Service.
(3) Measurement Standards for Covered Services.
(a)
Measurement standards document the amount of service delivery, regardless of
the method of payment for the service provided pursuant to contracts with
SAMH-Funded Entities. The following common measurement definitions shall apply
to each SAMH Covered Service as specified in subsection (4) of this rule:
1. Direct Staff Hour.
a. This measure equals the actual time a
staff person:
(I) Is available at the work
site to perform assigned tasks, or
(II) Spends in face-to-face or direct
telephone contact with an individual receiving services or a collateral contact
where the contact is documented in the individual's service record,
or
(III) Spends on activities
directly associated with an individual receiving services, including case
staffings and travel time if the travel is integral to a Covered Service
allowable under this rule.
b. This measure may also include telephone
contact with parents or teachers and actual time spent in a courtroom or
juvenile detention facility on behalf of a child or adult.
c. Covered Services that are measured by this
standard shall be reported on the basis of utilization, except for the
following SAMH Covered Services, which shall be paid on the basis of
availability.
(I) Paragraph (4)(h), Crisis
Support/Emergency,
(II) Paragraph
(4)(o), Information and Referral; and,
(III) Paragraph (4)(oo), Substance Abuse
Outpatient Detoxification.
2. Non-Direct Staff Hour.
a. This measure indicates the time spent on
activities that cannot be directly associated with an individual or group of
individuals receiving services, but are integral to the program and described
in the program description. This includes preparation for services and travel
time, if travel is integral to a Covered Service allowable under this
rule.
b. Covered Services that are
measured by this standard shall be reported on the basis of utilization, except
paragraph (4)(i), Drop-in/Self Help Centers, which shall be reported on the
basis of availability.
3.
Day.
a. This measure is determined by one of
the following:
(I) The service provider's
capacity to provide an actual bed for a period of twenty-four hours to
individuals eligible for SAMH-funded services, or
(II) A day in which an individual receiving
services is physically present at the midnight census, including the day the
individual is admitted and excluding the day the individual is
discharged.
b. Covered
Services that are measured by this standard shall be reported on the basis of
utilization, except for the following:
(I)
Paragraph (4)(g), Crisis Stabilization,
(II) Paragraph (4)(mm), Short-term
Residential Treatment; and,
(III)
Paragraph (4)(nn), Substance Abuse Inpatient
Detoxification.
4. Dosage.
a. This measure equals one dose of clinically
prescribed medication received by an individual participating in programs under
the Medication-Assisted Treatment Covered Service.
b. Dosage shall be reported on the basis of
utilization.
(b) Covered Services reported on the basis of
utilization require the service to be provided to or on behalf of an eligible
individual, or by the commitment of actual direct or non-direct staff
hours.
(c) Covered Services
reported on the basis of availability require the service to be available for
use, regardless of whether the service is actually used by an individual.
Availability shall not include staff time spent serving a Medicaid eligible
individual for a Medicaid eligible service, or staff time spent in another
program or Covered Service other than the specific availability-based service
in which they are listed on the duty roster.
(d) Definition of Hour.
1. Hourly units of measure are based upon the
actual time spent providing services to or on behalf of an individual or
individuals, rounded to the nearest fifteen-minute interval. The cumulative,
rounded number of minutes shall be divided by sixty to derive the number of
hourly units.
2. When intermittent
services are provided to or on behalf of a specific individual during a single
calendar day, the actual cumulative time spent providing the service during
that day shall be rounded to the nearest fifteen-minute interval.
3. For the Case Management Covered Service
defined in paragraph (4)(d) of this rule, if the time interval required by
Medicaid is different than described above, a service provider may use the
Medicaid time interval instead.
(e) Covered Services measured in terms of
hours or days:
1. Shall not include the time
direct service delivery staff are:
a. Absent
from the work place, or
b.
Attending training or orientation, unless the training or orientation is
specifically required in contracts or subcontracts.
2. Shall include time direct service delivery
staff spend administering individual functional assessments and individual
satisfaction surveys.
(4) The descriptions, applicable programs, measurements standards, and data elements for SAMH Covered Services are as follows:
(a) Aftercare.
1. Description - Aftercare activities occur
after a treatment level of care is completed and include activities such as
supportive counseling, life skills training, and relapse prevention for
individuals with mental illness or substance use disorders to assist in their
ongoing recovery. Aftercare services help individuals, families, and pro-social
support systems reinforce a healthy living environment.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1.a.(III) of this rule.
4.
Data Elements:
a. Service Documentation -
Activity Log:
(I) Covered Service,
(II) Staff name and identification number,
(III) Recipient name and
identification number,
(IV) Service
date,
(V) Duration,
(VI) Service (specify),
(VII) Group Indicator; and,
(VIII) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Recipient name and identification
number,
(II) Staff name and
identification number,
(III)
Service date,
(IV) Duration; and,
(V) Service
(specify).
(b) Assessment.
1. Description - This Covered Service
includes the systematic collection and integrated review of individual-specific
data, such as examinations and evaluations. This data is gathered, analyzed,
monitored and documented to develop the person's individualized plan of care
and to monitor recovery. Assessment specifically includes efforts to identify
the person's key medical and psychological needs, competency to consent to
treatment, history of mental illness or substance use and indicators of
co-occurring conditions, as well as clinically significant neurological
deficits, traumatic brain injury, organicity, physical disability,
developmental disability, need for assistive devices, physical or sexual abuse,
and trauma.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard - Direct Staff Hour,
as defined in sub-sub-subparagraph (3)(a)1.a.(II) of this rule.
4. Data Elements:
a. Service Documentation - Service Ticket:
(I) Recipient name and identification number,
(II) Staff name and identification
number,
(III) Service date,
(IV) Duration,
(V) Covered Service,
(VI) Service (specify); and,
(VII) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Recipient name and identification
number,
(II) Staff name and
identification number,
(III)
Service date,
(IV) Duration; and,
(V) Service
(specify).
(c) Care Coordination.
1. Description - Care Coordination is a
time-limited service that assists individuals with behavioral health conditions
who are not effectively engaged with case management or other behavioral health
services and supports for a successful transition to appropriate levels of
care. Once engagement in the necessary community-based services is verified,
care coordination services are terminated.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1. of this rule.
4. Data
Elements:
a. Service Documentation - Activity
Log:
(I) Covered Service,
(II) Staff name and identification number,
(III) Recipient name and
identification number,
(IV) Service
date,
(V) Duration,
(VI) Service (specify), and
(VII) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Recipient name and identification
number,
(II) Staff name and
identification number,
(III)
Service date,
(IV) Duration,
and
(V) Service
(specify).
(d) Case Management.
1. Description - Case management services
consist of activities that identify the recipient's needs, plan services, link
the service system with the person, coordinate the various system components,
monitor service delivery, and evaluate the effect of the services received.
This covered service shall include clinical supervision provided to a service
provider's personnel by a professional qualified by degree, licensure,
certification, or specialized training in the implementation of this
service.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard - Direct Staff Hour,
as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
4. Data Elements:
a. Service Documentation - Activity Log:
(I) Covered Service,
(II) Staff name and identification number,
(III) Recipient name and
identification number,
(IV) Service
date,
(V) Duration,
(VI) Service (specify); and,
(VII) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Recipient name and identification
number,
(II) Staff name and
identification number,
(III)
Service date,
(IV) Duration; and,
(V) Service
(specify).
(e) Community Action Treatment (CAT).
1. Description - This Covered Service,
pursuant to section 394.495, F.S., provides
community-based services to children ages 11 to 21 with a mental health
disorder (including those with a co-occurring substance use diagnosis) who meet
certain accompanying eligibility criteria identified by the statute. Children
younger than 11 may be served if they display two or more of the aforementioned
eligibility criteria. The team is available on nights, weekends, and holidays.
Allowable services may include one or any combination of the following
activities:
a. Aftercare,
b. Assessment,
c. Care Coordination,
d. Case Management,
e. Crisis Support / Emergency,
f. Information and Referral,
g. In-Home and On-Site Services,
h. Intensive Case Management,
i. Intervention - Individual and Group,
j. Medical Services,
k. Outpatient - Individual and Group,
l. Outreach,
m. Recovery Support - Individual and Group,
n. Supported Employment,
and
o. Supported Housing / Living,
2. Programs - Community
Mental Health.
3. Measurement
Standard: Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1.a.(III), of this rule.
4.
Data Elements:
a. Service Documentation -
Activity Log:
(I) Staff name and
identification number,
(II)
Recipient name and identification number,
(III) Service date,
(IV) Duration,
(V) Service (specify), and
(VI) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Recipient name and identification
number,
(II) Staff name and
identification number,
(III)
Service date,
(IV) Duration,
and
(V) Service
(specify).
(f) Comprehensive Community Service Team.
1. Description - This Covered Service is a
bundled service package designed to provide short-term assistance and guide
individuals to rebuild skills in identified roles in their environment through
the engagement of natural supports, treatment services, and assistance of
multiple agencies when indicated. Services provided under Comprehensive
Community Service Teams may not be simultaneously reported to another Covered
Service. Allowable bundled activities include the following Covered Services as
defined in subsection (4) of this rule:
a.
Aftercare,
b. Assessment,
c. Care Coordination,
d. Case Management,
e. Information and Referral,
f. In-home/Onsite,
g. Intensive Case Management,
h. Intervention,
i. Outpatient,
j. Outreach,
k. Prevention - Indicated,
l. Recovery Support,
m. Supported Employment; and,
n. Supported Housing.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1.a.(III) of this rule.
4.
Data Elements:
a. Service Documentation -
Service Ticket:
(I) Staff name and
identification number,
(II) Service
date,
(III) Duration,
(IV) Covered Service provided; and,
(V) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Staff name and identification
number,
(II) Service
date,
(III) Duration;
and,
(IV) Covered Service
provided.
(g) Crisis Stabilization.
1. Description - These acute care services,
offered twenty-four hours per day, seven days per week, provide brief,
intensive mental health residential treatment services. These services meet the
needs of individuals who are experiencing an acute crisis and who, in the
absence of a suitable alternative, would require hospitalization.
2. Programs - Community Mental
Health.
3. Measurement Standard
-Day, as defined in sub-sub-subparagraph (3)(a)3.a.(I) of this rule.
4. Data Elements:
a. Service Documentation - Number of licensed
bed-days.
b. Audit Documentation -
License:
(I) Beginning date,
(II) Ending date; and,
(III) Number of
beds.
(h) Crisis Support/Emergency.
1. Description - This non-residential care is
generally available twenty-four hours per day, seven days per week, or some
other specific time period, to intervene in a crisis or provide emergency care.
Examples include: crisis/emergency screening, mobile response, telephone or
telehealth crisis support, and emergency walk-in.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1.a.(I) of this rule.
4. Data
Elements:
a. Service Documentation - Duty
Roster:
(I) Staff name and identification
number,
(II) Date,
(III) Hours on Duty - Beginning and ending
time,
(IV) Covered Service,
(V) Program; and,
(VI) Signature of Clinical
Director.
b. Audit
Documentation - Time Sheet:
(I) Staff name and
identification number,
(II) Date,
(III) Hours worked - Beginning and
ending time,
(IV) Program,
(V) Covered Service; and,
(VI) Signature of
Supervisor.
(i) Day Care.
1. Description - Day care services, in a
non-residential group setting, provide for the care of children of persons who
are participating in mental health or substance use treatment services. In a
residential setting, day care services provide for the residential and
care-related costs of a child living with a parent receiving residential
services. This covered service must be provided in conjunction with another
Covered Service provided to a person 18 years of age or older.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard -Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1.a.(II) of this rule, reimbursing a maximum of four hours in a calendar
day.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Recipient (Parent) name and
identification number and child's date of birth; and,
(IV) Service date.
b. Audit Documentation - Recipient Service
Chart:
(I) Covered Service,
(II) Recipient (Parent) name and
identification number and child's date of birth; and,
(III) Service
date.
(j) Day Treatment.
1. Description - Day Treatment services
provide a structured schedule of non-residential interventions to assist
individuals to attain skills and behaviors needed to function successfully in
living, learning, work, and social environments. Activities emphasize
rehabilitation, treatment, activities of daily living, and education services,
using multidisciplinary teams to provide integrated programs of academic,
therapeutic, and family services. For mental health programs, day treatment
services must be provided for four or more consecutive hours per day. Substance
abuse programs must follow the standards set forth in Rules
65D-30.0081 and
65D-30.009, F.A.C.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard -Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1.a.(II) of this rule, reimbursing a maximum of four hours in a calendar
day.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Recipient name and identification
number; and,
(IV) Service
date.
b. Audit
Documentation - Recipient Service Chart:
(I)
Covered Service,
(II) Recipient
name and identification number; and,
(III) Service
date.
(k) Drop-in/Self-Help Centers.
1. Description - These community centers,
such as drop-in centers or recovery community organizations, provide a range of
opportunities for persons with or a history of mental health and substance use
conditions to independently develop, operate, and participate in social,
recreational, self-help, harm reduction, and networking activities. This
covered service may not be provided to a person less than 18 years
old.
2. Programs - Community Mental
Health and Community Substance Abuse.
3. Measurement Standard - Non-direct staff
hour as defined in subparagraph (3)(a)2. of this rule.
4. Data Elements:
a. Service Documentation:
(I) Number of Days,
(II) Time Sheet; and,
(III) Staff name and identification
number.
b. Audit
Documentation:
(I) Time Sheet; and,
(II) Staff name and identification
number.
(l) Florida Assertive Community Treatment
(FACT) Team.
1. Description - A FACT team is
comprised of slots for participants with a serious mental illness. For a
provider to identify themselves as a FACT team, the provider must demonstrate
adherence to assertive community treatment principles. FACT Teams provide
non-residential services that are available twenty-four hours per day, seven
days per week. Rehabilitative, support and therapeutic services are provided in
the community, by a multidisciplinary team. This covered service may not be
provided to a person less than 18 years old.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Number of Enrolled Participants, notwithstanding the
requirements of paragraph (3)(a) of this rule.
4. Data Elements:
a. Enrollment Documentation:
(I) Date and number of enrolled participants,
(II) Services provided for
participant,
(III) Program; and,
(IV) Staff identification and
signature.
b. Audit
Documentation - Time Sheet:
(I) Staff name
and identification number,
(II)
Date,
(III) Hours worked -
Beginning and ending time,
(IV)
Program,
(V) Covered Service; and,
(VI) Signature of
Supervisor.
5.
Reimbursement for this Covered Service shall be based upon the total value of a
service provider's FACT team contract divided by the number of contracted slots
establishing the annual cost per participant. The annual cost per participant
may be divided by 365 days per year to establish the daily enrollment
cost.
(m) HIV Early
Intervention Services.
1. Description - This
Covered Service is a bundled service package to provide Human Immunodeficiency
Virus (HIV) Early Intervention Services in accordance with
65D-30.004, F.A.C. Allowable HIV
Early Intervention Services may include one or any combination of the following
activities:
a. Pretest counseling,
b. Posttest counseling,
c. Tests to confirm the presence of
HIV,
d. Tests to diagnose the
extent of the deficiency in the immune system,
e. Tests to provide information on
appropriate therapeutic measures for preventing and treating the deterioration
of the immune system and conditions arising from HIV, including tests for
hepatitis C (when provided to individuals with HIV),
f. Therapeutic measures for preventing and
treating the deterioration of the immune system and conditions arising from
HIV, and
g. Linkages to diagnostic
tests, therapeutic measures, and HIV specific support
services.
2. Programs -
Community Substance Abuse
3.
Measurement Standard: Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1., of this rule.
4. Data
Elements:
a. Service Documentation - Activity
Log:
(I) Staff name and identification
number,
(II) Recipient name and
identification number,
(III)
Service date,
(IV) Duration,
(V) Service (specify),
and
(VI)
Program.
b. Audit
Documentation - Recipient Service Chart:
(I)
Recipient name and identification number,
(II) Staff name and identification number,
(III) Service date,
(IV) Duration, and
(V) Service
(specify).
(n) Incidental Expenses.
1. Description - This Covered Service reports
temporary expenses incurred to facilitate continuing treatment and community
stabilization when no other resources are available. All incidental expenses
shall be authorized by the Managing Entity. Allowable purchases under this
Covered Service includes: transportation, childcare, housing assistance
clothing, educational services, vocational services, medical care, housing
subsidies, pharmaceuticals and other incidentals as approved by the Department
or Managing Entity.
2. Programs -
Community Mental Health and Community Substance Abuse.
3. Measurement Standard - Cumulative
allowable expenses reported in actual dollars expended, notwithstanding the
requirements of paragraph (3)(a) of this rule.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Recipient name and identification,
(IV) Receipt for incurred
incidental costs,
(V) Authorization
from the department or appropriate managing entity; and,
(VI) Invoice date.
b. Audit Documentation - Recipient Service
Chart:
(I) Covered Service,
(II) Recipient name and identification
number,
(III) Invoice
date,
(IV) Receipt for incurred
incidental costs,
(V) Associated
plan of care goal, and
(VI)
Authorization documentation.
(o) Information and Referral.
1. Description - These services maintain
information about resources in the community, link people who need assistance
with appropriate service providers, and provide information about agencies and
organizations that offer services. The information and referral process is
comprised of: being readily available for contact by the individual, assisting
the individual with determining which resources are needed, providing referral
to appropriate resources, and following up to ensure the individual's needs
have been met, where appropriate.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1.a.(I) of this rule.
4. Data
Elements:
a. Service Documentation - Duty
Roster:
(I) Staff name and identification
number,
(II) Date,
(III) Hours on Duty - Beginning and ending
time,
(IV) Covered Service,
(V) Program; and,
(VI) Signature of Clinical
Director.
b. Audit
Documentation - Time Sheet:
(I) Staff name and
identification number,
(II) Date,
(III) Hours worked - Beginning and
ending time,
(IV) Program,
(V) Covered Service; and,
(VI) Signature of
Supervisor.
(p) In-Home and On-Site.
1. Description - Therapeutic services and
supports, including early childhood mental health consultation, are rendered
for individuals and their families in non-provider settings such as nursing
homes, assisted living facilities, residences, schools, detention centers,
commitment settings, foster homes, daycare centers, and other community
settings.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard - Direct Staff Hour,
as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
4. Data Elements:
a. Service Documentation - Activity Log:
(I) Covered Service,
(II) Staff name and identification number,
(III) Recipient name and
identification number,
(IV) Service
date,
(V) Duration,
(VI) Service (specify); and,
(VII) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Recipient name and identification
number,
(II) Staff name and
identification number,
(III)
Service date,
(IV) Duration; and,
(V) Service
(specify).
(q) Inpatient.
1. Description - Inpatient services provided
in psychiatric units within hospitals licensed as general hospitals and
psychiatric hospitals under Chapter 395, F.S. They provide intensive treatment
and stabilization to persons exhibiting behaviors that may result in harm to
self or others due to mental illness or co-occurring mental illness and
substance use disorder.
2. Programs
- Community Mental Health.
3.
Measurement Standard - Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II)
of this rule.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Name of hospital,
(II) Recipient name and identification
number,
(III) Clinical diagnosis,
(IV) Service date; and,
(V) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Name of hospital,
(II) Recipient name and identification
number,
(III) Clinical diagnosis,
(IV) Service
date.
(r) Intensive Case Management.
1. Description - These services are typically
offered to persons who are being discharged from an acute care setting, and
need more professional care, and have contingency needs to remain in a less
restrictive setting. The services include the same components as case
management as described in subparagraph (4)(d)1., of this rule, but are
provided at a higher intensity and frequency, and with lower caseloads per case
manager sufficient to meet the needs of the individuals in treatment.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1.a.(III) of this rule.
4.
Data Elements:
a. Service Documentation -
Activity Log:
(I) Covered Service,
(II) Staff name and identification number,
(III) Recipient name and
identification number,
(IV) Service
date,
(V) Duration,
(VI) Service (specify); and,
(VII) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Recipient name and identification
number,
(II) Staff name and
identification number,
(III)
Service date,
(IV) Duration; and,
(V) Service
(specify).
(s) Intervention.
1. Description - Intervention services focus
on reducing risk factors generally associated with the progression of substance
misuse and mental health problems. Intervention is accomplished through early
identification of persons at risk, performing basic individual assessments, and
providing supportive services, which emphasize short-term counseling and
referral. These services are targeted toward individuals and families. This
covered service shall include clinical supervision provided to a service
provider's personnel by a professional qualified by degree, licensure,
certification, or specialized training in the implementation of this
service.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard -Direct Staff Hour,
as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
4. Data Elements:
a. Service Documentation - Activity Log:
(I) Covered Service,
(II) Staff name and identification number,
(III) Recipient name and
identification number,
(IV) Service
date,
(V) Duration,
(VI) Service (specify),
(VII) Group Indicator; and,
(VIII) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Recipient name and identification
number,
(II) Staff name and
identification number,
(III)
Service date,
(IV) Duration; and,
(V) Service
(specify).
(t) Medical Services.
1. Description - Medical services provide
primary psychiatric care, therapy, and medication administration provided by an
individual licensed under the state of Florida to provide the specific service
rendered. Medical services improve the functioning or prevent further
deterioration of persons with mental health or substance abuse problems,
including mental status assessment. Medical services are usually provided on a
regular schedule, with arrangements for non-scheduled visits during times of
increased stress or crisis.
2.
Programs - Community Mental Health and Community Substance Abuse.
3. Measurement Standard -Direct Staff Hour,
as defined in sub-sub-subparagraph (3)(a)1.a.(I) of this rule.
4. Data Elements:
a. Service Documentation - Service Ticket:
(I) Recipient name and identification number
or, if non-recipient, participant's name, address, and relation to recipient,
(II) Staff name and identification
number,
(III) Service date,
(IV) Duration,
(V) Clinical diagnosis,
(VI) Covered Service,
(VII) Service (specify),
(VIII) Group Indicator; and,
(IX) Program.
b. Audit Documentation - Recipient Service or
Non-Recipient Chart:
(I) Recipient name and
identification number or if non-recipient, participant's name, address, and
relation to recipient,
(II) Staff
name and identification number,
(III) Service date,
(IV) Duration; and,
(V) Service
(specify).
(u) Medication-Assisted Treatment.
1. Description - This Covered Service
provides for the delivery of medications for the treatment of substance use
disorders which are prescribed by a licensed health care professional. Services
must be based upon a clinical assessment, and treatment and support services
must be available for and offered to individuals receiving medications to
support their ongoing recovery.
2.
Programs - Community Substance Abuse.
3. Measurement Standard - Dosage, as defined
in sub-subparagraph (3)(a)4.a. of this rule.
4. Data Elements:
a. Service Documentation - Medication
Administration Record:
(I) Recipient name and
identification number,
(II) Dosage
date,
(III) Prescribed dosage,
(IV) Clinical diagnosis,
(V) Covered Service,
(VI) Service (specify); and,
(VII) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Individual name and identification
number,
(II) Dosage date,
(III) Dosage received; and,
(IV) Covered
Service.
(v) Mental Health Clubhouse Services.
1. Description - Structured, evidence-based
services both strengthen and/or regain the individual's interpersonal skills,
provide psycho-social support, develop the environmental supports necessary to
help the individual thrive in the community and meet employment and other life
goals, and promote recovery from mental illness. Services are typically
provided in a community-based program with trained staff and members working as
teams to address the individual's life goals and to perform the tasks necessary
for the operations of the program. The emphasis is on a holistic approach
focusing on the individual's strengths and abilities while challenging the
individual to pursue those life goals. This service would include, but not be
limited to, clubhouses certified under the International Center for Clubhouse
Development. This covered service may not be provided to a person less than 18
years old.
2. Programs - Community
Mental Health.
3. Measurement
Standard -Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III)
of this rule.
4. Data Elements:
a. Service Documentation - Duty Roster:
(I) Staff name and identification number,
(II) Date,
(III) Hours on Duty - Beginning and ending
time,
(IV) Covered Service,
(V) Program; and,
(VI) Signature of Program
Manager.
b. Audit
Documentation.
(I) Staff name and
identification number,
(II) Date,
(III) Hours worked - Beginning and
ending time,
(IV) Program,
(V) Covered Service,
(VI) Clubhouse Schedule,
(VII) Daily consumer sign-in sheet with date;
and,
(VIII) Signature of Program
Manager.
(w) Outpatient.
1. Description - Outpatient services provide
clinical interventions to improve the functioning or prevent further
deterioration of persons with mental health and/or substance abuse use
disorders. These services are usually provided on a regularly scheduled basis
by appointment, with arrangements made for non-scheduled visits during times of
increased stress or crisis. Outpatient services may be provided to an
individual or in a group setting. The maximum number of individuals allowed in
a group session is 15. This covered service shall include clinical supervision
provided to a service provider's personnel by a professional qualified by
degree, licensure, certification, or specialized training in the implementation
of this service.
2. Programs -
Community Mental Health and Community Substance Abuse.
3. Measurement Standard - Direct Staff Hour,
as defined in sub-sub-subparagraph (3)(a)1.a.(II) of this rule.
4. Data Elements:
a. Service Documentation - Service Ticket:
(I) Recipient name and identification number
or, if non-recipient, participant's name, address, and relation to recipient,
(II) Staff name and identification
number,
(III) Service date,
(IV) Duration,
(V) Covered Service,
(VI) Service (specify),
(VII) Clinical Diagnosis,
(VIII) Group Indicator; and,
(IX) Program.
b. Audit Documentation - Recipient Service or
Non-Recipient Chart:
(I) Recipient name and
identification number or, if non-recipient, participant's name, address, and
relation to recipient,
(II) Staff
name and identification number,
(III) Service date,
(IV) Clinical diagnosis,
(V) Duration; and,
(VI) Service
(specify).
(x) Outreach.
1. Description - Outreach services are
provided through a formal program to both individuals and the community.
Community services include education, identification, and linkage with
high-risk groups. Outreach services for individuals: encourage, educate, and
engage prospective individuals who show an indication of substance misuse and
mental health problems or needs. Individual enrollment is not included in
Outreach services.
2. Programs -
Community Mental Health and Community Substance Abuse.
3. Measurement Standard - Non-Direct Staff
Hour, as defined in subparagraph (3)(a)2. of this rule.
4. Data Elements:
a. Service Documentation - Time Sheet:
(I) Staff name and identification number,
(II) Description of activity,
including time to plan and prepare,
(III) Duration,
(IV) Activity date,
(V) Program; and,
(VI) Covered Service.
b. Audit Documentation:
(I) Activity list,
(II) Duration; and,
(III) Supervisor's staff
schedule.
(y) Prevention - Indicated.
1. Description - Indicated prevention
services are provided to at-risk individuals who are identified as having
minimal but detectable signs or symptoms foreshadowing mental health or
substance use disorders. Target recipients of indicated prevention services are
at-risk individuals who do not meet clinical criteria for mental health or
substance use disorders. Indicated prevention services preclude, forestall, or
impede the development of mental health or substance use disorders. These
services shall address the following specific prevention strategies, as defined
in rule 65D-30.013, F.A.C.: education,
alternative and problem identification and referral services.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1.a.(II) of this rule, measured at a maximum of eight hours per calendar
day.
4. Data Elements:
a. Service Documentation - Time Sheet:
(I) Staff name,
(II) Staff identifier number,
(III) Name of Program,
(IV) Activity Name,
(V) Activity Description,
(VI) Program Group Identifier,
(VII) Activity Date,
(VIII) Activity duration,
(IX) Specific Prevention Strategy provided,
(X) Participant name and
identification number,
(XI) Number
of participants served; and,
(XII)
Staff time, including separate planning, preparation and travel time
details.
b. Audit
documentation:
(I) Attendances records with
date,
(II) Program Material; and,
(III) Activity name from the
program manual.
(z) Prevention - Selective.
1. Description - Selective prevention
services are provided to a population subgroup whose risk of developing mental
health or substance use disorders is higher than average. Target recipients of
selective prevention services do not meet clinical criteria for mental health
or substance use disorders. Selective prevention services preclude, forestall,
or impede the development of mental health or substance use disorders. These
services shall address the following specific prevention strategies, as defined
in Rule 65D-30.013, F.A.C.: information
dissemination, education, alternatives, and problem identification and referral
services.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard - Non-Direct Staff
Hour, as defined in subparagraph (3)(a)2. of this rule.
4. Data Elements:
a. Service Documentation - Time Sheet:
(I) Covered Service,
(II) No change,
(III) Program name and program group
identifier,
(IV) Description of
activity, including time to plan and prepare,
(V) Duration,
(VI) Activity Date,
(VII) Specific Prevention Strategy provided,
(VIII) Number served; and,
(IX) Staff time, including
separate planning, preparation and travel time details.
b. Audit Documentation:
(I) Attendance records with date,
(II) Program Material; and,
(III) Activity name from the program
manual.
(aa) Prevention - Universal Direct.
1. Description - Universal direct prevention
services are provided to the general public or a whole population that has not
been identified on the basis of individual risk. These services preclude,
forestall, or impede the development of mental health or substance use
disorders. Universal direct services directly serve an identifiable group of
participants who have not been identified on the basis of individual risk. This
includes interventions involving interpersonal and ongoing or repeated contact
such as curricula, programs, and classes. These services shall address the
following specific prevention strategies, as defined in rule
65D-30.013, F.A.C.: information
dissemination, education, alternatives, or problem identification and referral
services.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard - Non-Direct Staff
Hour, as defined in subparagraph (3)(a)2. of this rule.
4. Data Elements:
a. Service Documentation - Time Sheet:
(I) Staff name and identification
number,
(II) Program name and
program group identifier,
(III)
Description of activity, including time to plan and prepare,
(IV) Duration,
(V) Activity Date,
(VI) Specific Prevention Strategy provided,
(VII) Number served; and,
(VIII) Staff time, including
separate planning, preparation and travel time details.
b. Audit Documentation:
(I) Attendance records with date,
(II) Program Material; and,
(III) Activity name from the program
manual.
(bb) Prevention - Universal Indirect.
1. Description - Universal indirect
prevention services are provided to the general public or a whole population
that has not been identified on the basis of individual risk. These services
preclude, forestall, or impede the development of mental health or substance
use disorders. Universal indirect services support population-based programs
and environmental strategies such as changing laws and policies. These services
can include programs and policies implemented by coalitions. These services can
also include meetings and events related to the design and implementation of
components of the strategic prevention framework, including needs assessments,
logic models, and comprehensive community action plans. These services shall
address the following specific prevention strategies, as defined in Rule
65D-30.013, F.A.C.: information
dissemination, education, community-based processes, and environmental
strategies.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard - Non-Direct Staff
Hour, as defined in subparagraph (3)(a)2. of this rule.
4. Data Elements:
a. Service Documentation - Time Sheet:
(I) Staff name and identification
number,
(II) Description of
activity, including time to plan and prepare,
(III) Duration,
(IV) Activity Date,
(V) Specific Prevention Strategy provided, as
defined in rule 65D-30.013, F.A.C.,
(VI) Number of attendees,
(VII) Staff time including separate planning,
preparation and travel time details; and,
(VII) For media campaigns, identify the
campaign name, number of buys, days and times, and copies of media
content.
b. Audit
Documentation:
(I) Meeting minutes with date,
(II) Meetings materials; and,
(III) Agenda with
date.
(cc) Recovery Support.
1. Description - This Covered Service is
comprised of nonclinical activities that assist individuals and families in
recovering from substance use and mental health conditions. Activities include
social support, linkage to and coordination among service providers, life
skills training, recovery planning, coaching, education on mental illness and
substance use disorders, assisting individuals using digital therapeutics
approved by the United States Food and Drug Administration, and other supports
that facilitate increasing recovery capital and wellness contributing to an
improved quality of life. Recovery capital is the personal, family, social,
community resources and natural supports that promote recovery. These
activities may be provided prior to, during, and after treatment. These
services support and coach an adult or child and family to regain or develop
skills to live, work and learn successfully in the community. This Covered
Service shall include supervision provided to a service provider's personnel by
a professional qualified by degree, licensure, certification, or specialized
training in the implementation of this service, or by a certified peer
specialist who has at least 2 years of fill-time experience as a peer
specialist at a licensed behavioral health organization. This Covered Service
must be provided by a Certified Recovery Peer Specialist pursuant to Section
397.417, F.S. These services
exclude twelve-step programs such as Alcoholics Anonymous and Narcotics
Anonymous.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard - Direct Staff Hour,
as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
4. Data Elements:
a. Service Documentation - Activity Log:
(I) Covered Service,
(II) Staff name and identification number,
(III) Recipient name and
identification number,
(IV) Service
date,
(V) Duration,
(VI) Service (specify),
(VII) Clinical diagnosis,
(VIII) Group Indicator; and,
(IX) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Recipient name and identification
number,
(II) Staff name and
identification number,
(III)
Service date,
(IV) Duration; and,
(V) Service
(specify).
(dd) Residential Level I.
1. Description - These licensed services
provide a structured, live-in, non-hospital setting with supervision on a
twenty-four hours per day, seven days per week basis. For adult mental health,
Residential Treatment Facilities Level IA and IB, as defined in Rule
65E-4.016, F.A.C., are reported
under this Covered Service. For children with serious emotional disturbances,
Level 1 services are the most intensive and restrictive level of residential
therapeutic intervention provided in a non-hospital or non-crisis stabilization
setting. Residential Treatment Centers, as defined in Rule
65E-9.002, F.A.C. are reported
under this Covered Service. For substance use treatment, Residential Level 1,
as defined in Rule 65D-30.007, F.A.C., provides a
range of assessment, treatment, rehabilitation, and ancillary services in an
intensive therapeutic environment, with an emphasis on treatment, and may
include formal school and adult education programs.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard -Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II) of
this rule.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Clinical diagnosis,
(IV) Documentation of medications, if
applicable,
(V) Recipient name and
identification number,
(VI) Service
date; and,
(VII) Residential
type.
b. Audit
Documentation - Recipient Service Chart:
(I)
Covered Service,
(II) Recipient
name and identification number; and,
(III) Service
date.
(ee) Residential Level II.
1. Description - Level II facilities are
licensed, structured rehabilitation-oriented group facilities that have
twenty-four hours per day, seven days per week, supervision. Level II
facilities house persons who have significant deficits in independent living
skills and need extensive support and supervision. For adults with a mental
illness, Residential Treatment Facilities Level II, as defined in Rule
65E-4.016, F.A.C., are reported
under this Covered Service. For children with serious emotional disturbances,
Level II services provide intensive therapeutic behavioral and treatment
interventions. Therapeutic Foster Homes are reported under this Covered
Service. For substance use treatment, Level II, as defined in Rule
65D-30.007, F.A.C., services
provide a range of assessment, treatment, rehabilitation, and ancillary
services in a less intensive therapeutic environment with an emphasis on
rehabilitation and may include formal school and adult educational
programs.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard - Day, as defined in
sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Clinical diagnosis,
(IV) Recipient name and identification
number,
(V) Service date; and,
(VI) Residential
type.
b. Audit
Documentation - Recipient Service Chart:
(I)
Covered Service,
(II) Recipient
name and identification number; and,
(III) Service
date.
(ff) Residential Level III.
1. Description - These licensed facilities
provide twenty-four hours per day, seven days per week supervised residential
alternatives to persons who have developed a moderate functional capacity for
independent living. For adults with a mental illness, Residential Treatment
Facilities Level III, as defined in Rule
65E-4.016, F.A.C., are reported
under this Covered Service. For substance use treatment, Level III, as defined
in Rule 65D-30.007, F.A.C., provides a
range of assessment, rehabilitation, treatment and ancillary services on a
long-term, continuing care basis where, depending upon the characteristics of
the individuals served, the emphasis is on rehabilitation or
treatment.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard - Day, as defined in
sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Cost center,
(II) Program,
(III) Recipient name and identification
number,
(IV) Clinical diagnosis,
(V) Service date; and,
(VI) Residential type.
b. Audit Documentation - Recipient Service
Chart:
(I) Cost center,
(II) Recipient name and identification
number; and,
(III) Service
date.
(gg) Residential Level IV.
1. Description - This type of facility may
have less than twenty-four hours per day, seven days per week on-premise
supervision. It is primarily a support service and, as such, treatment services
are not included in this Covered Service, although such treatment services may
be provided as needed through other Covered Services. Level IV includes
satellite apartments, satellite group homes, and therapeutic foster homes. For
adults with a mental illness, Residential Treatment Facilities Level IV, as
defined in paragraph 65E-4.016, F.A.C., are reported
under this Covered Service. For substance use treatment, Level IV, as defined
in Rule 65D-30.007, F.A.C., provides a
range of assessment, rehabilitation, treatment, and ancillary services on a
long-term, continuing care basis where, depending upon the characteristics of
the individuals served, the emphasis is on rehabilitation or
treatment.
2. Programs - Community
Mental Health and Community Substance Abuse.
3. Measurement Standard - Day, as defined in
sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Recipient name and identification
number,
(IV) Clinical diagnosis,
(V) Service date; and,
(VI) Residential type.
b. Audit Documentation - Recipient Service
Chart:
(I) Cost center,
(II) Recipient name and identification
number; and,
(III) Service
date.
(hh) Respite Services.
1. Description - Respite care services
support the family or other primary care giver by providing time-limited,
temporary relief, including overnight stays, from the ongoing responsibility of
care giving.
2. Programs -
Community Mental Health and Community Substance Abuse.
3. Measurement Standard -Direct Staff Hour,
as defined in sub-sub-subparagraph (3)(a)1.a.(II) of this rule.
4. Data Elements:
a. Service Documentation - Service Ticket:
(I) Recipient name and identification number,
(II) Staff name and identification
number,
(III) Service date,
(IV) Clinical Diagnosis of client,
(V) Duration,
(VI) Covered Service,
(VII) Respite service type, and,
(VIII) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Covered Service,
(II) Recipient name and identification
number; and,
(III) Service
date.
(ii) Room and Board with Supervision Level I.
1. Description - This Covered Service solely
provides for room and board with supervision on a twenty-four hours per day,
seven days per week basis. It corresponds to Residential Level I as defined in
paragraph (4)(dd) of this rule.
2.
Programs - Community Mental Health and Community Substance Abuse.
3. Measurement Standard - Day, as defined in
sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Recipient name and identification,
(IV) Clinical diagnosis,
(V) Service date; and,
(VI) Residential type.
b. Audit Documentation - Recipient Service
Chart:
(I) Covered Service,
(II) Recipient name and identification
number; and,
(III) Service
date.
(jj) Room and Board with Supervision Level
II.
1. Description - This Covered Service
solely provides for room and board with supervision on a twenty-four hours per
day, seven days per week basis. It corresponds to Residential Level II as
defined in paragraph (4)(ee) of this rule. This Covered Service is not
applicable for provider facilities which meet the definition of an Institute
for Mental Disease as defined by Title 42 CFR, Part 435.1010.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II)
of this rule.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Recipient name and identification,
(IV) Clinical diagnosis,
(V) Service date; and,
(VI) Residential type.
b. Audit Documentation - Recipient Service
Chart:
(I) Covered Service,
(II) Recipient name and identification
number; and,
(III) Service
date.
(kk) Room and Board with Supervision Level
III.
1. Description - This Covered Service
solely provides for room and board with supervision on a twenty-four hours per
day, seven days per week basis. It corresponds to Residential Level III as
defined in paragraph (4)(ff) of this rule.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II)
of this rule.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Recipient name and identification,
(IV) Clinical diagnosis,
(V) Service date; and,
(VI) Residential type.
b. Audit Documentation - Recipient Service
Chart:
(I) Covered Service,
(II) Recipient name and identification
number; and,
(III) Service
date.
(ll) Room and Board with Supervision Level
IV.
1. Description - This Covered Service
solely provides for room and board with supervision on a twenty-four hours per
day, seven days per week basis. It corresponds to Respite Services as defined
in this rule.
2. Programs -
Community Mental Health and Community Substance Abuse.
3. Measurement Standard - Day, as defined in
sub-sub-subparagraph (3)(a)3.a.(II), of this rule.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Recipient name and identification,
(IV) Clinical diagnosis,
(V) Service date, and
(VI) Residential type.
b. Audit Documentation - Recipient Service
Chart:
(I) Covered Service,
(II) Recipient name and identification
number, and
(III) Service
date.
(mm) Short-term Residential Treatment.
1. Description - These individualized,
stabilizing acute and immediately sub-acute care services provide short and
intermediate duration intensive mental health residential services on a
twenty-four hours per day, seven days per week basis, as provided for in Rule
Chapter 65E-12, F.A.C. These services shall meet the needs of individuals who
are experiencing an acute or immediately sub-acute crisis and who, in the
absence of a suitable alternative, would require hospitalization.
2. Programs - Community Mental
Health.
3. Measurement Standard
-Day, as defined in sub-sub-subparagraph (3)(a)3.a.(I) of this rule.
4. Data Elements:
a. Service Documentation:
(I) Number of licensed days; and,
(II) Clinical diagnoses of
clients.
b. Audit
Documentation - License:
(I) Beginning date,
(II) Ending date; and,
(III) Number of
beds.
(nn) Substance Abuse Inpatient
Detoxification.
1. Description - These
programs utilize medical and clinical procedures to assist adults, and
adolescents with substance use disorders in their efforts to withdraw from the
physical effects of substance use. Residential detoxification and addiction
receiving facilities provide emergency screening, evaluation, short-term
stabilization, and treatment in a medically supervised.
2. Programs - Community Substance
Abuse.
3. Measurement Standard
-Day, as defined in sub-sub-subparagraph (3)(a)3.a.(I) of this rule.
4. Data Elements:
a. Service Documentation:
(I) Number of Days; and,
(II) Clinical diagnoses and age of
clients.
b. Audit
Documentation - License:
(I) Beginning date,
(II) Age of clients,
(III) Documentation of children's Crisis
Stabilization Unit license, if applicable,
(IV) Ending date; and,
(V) Number of
beds.
(oo) Substance Abuse Outpatient
Detoxification.
1. Description - These
services utilize medication or a psychosocial counseling regimen that assists
recipients in their efforts to withdraw from the physiological and
psychological effects of of addictive substances.
2. Programs - Community Substance
Abuse.
3. Measurement Standard -
Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(I) of this
rule, to a maximum of four hours in a calendar day.
4. Data Elements:
a. Service Documentation - Census Log:
(I) Covered Service,
(II) Program,
(III) Recipient name and identification,
(IV) Clinical diagnosis,
(V) Service date; and,
(VI) Residential type.
b. Audit Documentation - Recipient Service
Chart:
(I) Covered Service,
(II) Recipient name and identification
number,
(III) Service date and
duration; and,
(IV) Staff name and
identification number.
(pp) Supported Employment.
1. Description - Supported employment is an
evidence-based approach that assists individuals with gaining competitive
integrated employment. Supported employment can be a team-based approach and
focuses on the full range of community jobs that match the job seeker's
strengths and preferences. Job supports are individualized and include: job
development, job placement, and long-term job coaching.
2. Programs - Community Mental Health and
Community Substance Abuse.
3.
Measurement Standard - Direct Staff Hour, as defined in sub-sub-subparagraph
(3)(a)1.a.(III) of this rule.
4.
Data Elements:
a. Service Documentation - Time
Sheet:
(I) Covered Service,
(II) Staff name and identification number,
(III) Recipient name and
identification number,
(IV)
Clinical diagnosis,
(V) Service
date,
(VI) Duration; and,
(VII) Service
(specify).
b. Audit
Documentation - Recipient Service Chart:
(I)
Recipient name and identification number,
(II) Staff name and identification number,
(III) Service date,
(IV) Duration; and,
(VI) Service
(specify).
(qq) Supportive Housing/Living.
1. Description - Supported housing/living is
an evidence-based approach to assist persons with substance use and mental
illness in the selection of permanent housing of their choice. These services
also provide the necessary supports to transition into independent community
living and assure continued successful living in the community. For children
with mental health challenges, supported living services are a process which
assist adolescents in selecting and maintaining housing arrangements and
provides services, such as training in independent living skills, to assure
successful transition to independent living or with roommates in the community.
For substance use treatment, services provide for the housing and monitoring of
recipients who are participating in non-residential services, recipients who
have completed or are completing substance use treatment, and those recipients
who need assistance and support in independent or supervised living within a
"live-in" environment.
2. Programs
- Community Mental Health and Community Substance Abuse.
3. Measurement Standard -Direct Staff Hour,
as defined in sub-sub-subparagraph (3)(a)1.a.(II) of this rule.
4. Data Elements:
a. Service Documentation - Time Sheet:
(I) Covered Service,
(II) Staff name and identification number,
(III) Recipient name and
identification number,
(IV)
Clinical diagnosis,
(V) Service
date,
(VI) Duration; and,
(VII) Service
(specify).
b. Audit
Documentation - Recipient Service Chart:
(I)
Recipient name and identification number,
(II) Staff name and identification number,
(III) Service date,
(IV) Duration; and,
(V) Service
(specify).
(rr) Treatment Accountability for Safer
Communities (TASC).
1. Description - TASC
provides for identification, screening, court liaison, referral and tracking of
persons in the criminal justice system with a history of substance use or
addiction.
2. Programs - Community
Substance Abuse.
3. Measurement
Standard -Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(II)
of this rule.
4. Data Elements:
a. Service Documentation - Time Sheet:
(I) Covered Service,
(II) Staff name and identification number,
(III) Recipient name and
identification number,
(IV) Service
date,
(V) Duration,
(VI) Clinical Diagnosis,
(VII) Service (specify); and,
(VIII) Program.
b. Audit Documentation - Recipient Service
Chart:
(I) Recipient name and identification
number,
(II) Staff name and
identification number,
(III)
Service date,
(IV) Duration;
and,
(V) Service
(specify).
(5) Budgeting and Accounting for Revenues and Expenditures.
(a) The SAMH-Funded Entity shall
budget and account for revenues and expenditures in the SAMH Covered Services
for substance abuse and mental health services.
(b) The SAMH-Funded Entity shall develop a
written plan for allocating direct and indirect costs to Covered Services which
complies with the cost principles established in Rule
65E-14.017, F.A.C. The entity's
chief financial officer or equivalent shall assert that the cost plan is
reasonable and complies with these cost principles.
(c) Revenue shall be accounted for in the
Covered Service where it is generated. If it is not possible to determine the
Covered Service where revenue is generated, the revenue shall be allocated to
Covered Services pursuant to a written methodology, maintained by the provider,
in accordance with Generally Accepted Accounting Principles.
(d) Managing Entity Required Fiscal Reports.
Each Managing Entity shall submit the CF-MH 1042, July 2014, SAMH Projected
Operating and Capital Budget,
https://www.flrules.org/Gateway/reference.asp?No=Ref-04192,
hereby incorporated by reference, to the department.
(e) Service Provider Required Fiscal Reports.
1. All service providers shall prepare and
submit the following proposed fiscal reports to the department or Managing
Entity, as appropriate, for approval prior to the start of the contract or
subcontract period:
a. CF-MH 1042, July 2014,
SAMH Projected Operating and Capital Budget,
https://www.flrules.org/Gateway/reference.asp?No=Ref-04192,
as incorporated by paragraph (5)(d) of this rule.
b. CF-MH 1043, July 2014, Agency Capacity
Report, https://www.flrules.org/Gateway/reference.asp?No=Ref-04193,
hereby incorporated by reference.
c. CF-MH 1045, Oct 2015,
http://www.flrules.org/Gateway/reference.asp?No=Ref-06538,
Program Description, hereby incorporated by reference.
(I) A service provider shall give the
department or Managing Entity, as appropriate, notification ten calendar days
in advance of the end of any quarter in which a change in the Program
Description occurs, except changes that pertain to primary referral sources,
average length of client participation, or staffing levels by type of service
delivery position.
(II) A service
provider shall give the department or Managing Entity, as appropriate,
notification ten calendar days in advance prior to any changes to the Program
Description pertaining to service capacity, admissions and discharge criteria,
or service location.
2. If a service provider proposes different
rate methodologies or rates for each program applicable to a Covered Service
the fiscal reports in sub-subparagraphs (5)(e)1.a. through c. of this rule,
shall display information separately for each program. If the entity proposes
the same rate methodologies and rate for every program applicable to a Covered
Service; these reports may combine the information for all programs for that
Covered Service.
3. Once a contract
or subcontract has been signed, the service provider shall submit a final
version of the reports specified in sub-subparagraphs (5)(e)1.a. through c. of
this rule.
(6) Setting Rates.
(a) Negotiated Rates.
1. The department or Managing Entity and a
service provider shall negotiate rate methodologies and rates that are based on
projected expenditures and number of units of service to be furnished during
the contract or subcontract period using the fiscal reports required in
sub-subparagraphs (5)(e)1.a. through c. of this rule.
2. Negotiations shall take into account the
rates paid to the service provider for the most recent completed state fiscal
year. The service provider shall submit a budget narrative explaining any major
changes in projected expenditures from the previous year, including any
proposed changes to the quality or quantity of service to be
provided.
3. When proposing
projected rates on the Agency Capacity Report, the service provider shall use
the number of units derived using the following minimum productivity and
utilization standards:
a. Direct Staff Hour -
Annualized Standard Units: 1, 252 hours per FTE; Standard Percentage: 60.19
percent.
(I) Exceptions:
(II) For paragraph (4)(h), Crisis
Support/Emergency, and paragraph (4)(o), Information and Referral - Annualized
Standard Units: 2, 080 hours per FTE; Standard Percentage: 100
percent.
(III) For paragraph
(4)(l), FACT - Annualized Standard Units: 1, 788 hours per FTE; Standard
Percentage: 85.96 percent.
(IV) For
paragraph (4)(v), Mental Health Clubhouse - Annualized Standard Units: 1, 768
hours per FTE; Standard Percentage: 85 percent.
(V) For paragraph (4)(i), Day care; paragraph
(4)(j), Day Treatment; paragraph (4)(y), Prevention - Indicated; and paragraph
(4)(oo), Substance Abuse Outpatient Detoxification - Annualized Standard Units
to be established through negotiation between the department or Managing Entity
and the service provider; Standard Percentage: 90 percent.
b. Non-Direct Staff Hour - Annualized
Standard Units: 1, 430 hours per FTE; Standard Percentage: 68.75 percent,
except for paragraph (4)(k). Drop-in/Self help Centers - Annualized Standard
Units: To be established through negotiation between the department or Managing
Entity and the service provider; Standard Percentage: 100 percent.
c. Day - Annualized Standard Units: 365 Days
or 366 Days during Leap Year; Standard Percentage: 100 percent, except
paragraphs (4)(dd) - (gg). Residential I-IV; paragraphs(4)(ii) - (ll), Room and
Board with Supervision I-III Annualized Standard Units: 365 Days; Standard
Percentage: 85 percent.
d. Dosage -
Annualized Standard Units: To be established through negotiation between the
department or Managing Entity and the service provider; Standard Percentage:
100 percent.
4. Nothing
herein shall preclude the department or Managing Entity from using audited data
on actual expenditures to analyze the projected rates submitted by a
SAMH-Funded Entity.
(b)
For contracts and subcontracts under $200, 000 annually, in lieu of negotiating
rates under the provisions of paragraph (6)(a), above, the Managing Entity may
instead set a rate at a level not in excess of a region's average or median
rate negotiated under the provisions of paragraph (6)(a), for the same year. If
no such rate exists for a particular Covered Service, the Managing Entity may
set a rate not to exceed the SAMH-Funded Entity's established client
charges.
(7) Payment for Service.
(a) Eligibility for Payment.
1. A service provider shall invoice only for
Covered Services that:
a. Are within a
contractually specified Covered Service; and,
b. Have been delivered during the contract
period.
2. A service
provider shall not invoice for any Covered Services paid for under any other
contract or from any other source.
3. For the purposes of payment, the
department shall not be considered a liable third party payer for Medicaid or
other publically funded benefits assistance program. A Medicaid enrolled
Service Provider shall not bill the department for Medicaid covered services
provided to a Medicaid eligible recipient. A SAMH-Funded Entity shall not bill
the department for:
a. Any Covered Service
that is partially compensated by Medicaid, or another publically funded
benefits program source. This shall include any difference in a service
provider's rate for a Covered Service and any discount or contracted rate
payable by another source, or
b. An
individual's share of service cost, when that cost is reimbursable by Medicaid,
or another publically funded benefits program.
4. Nothing in this paragraph shall be
construed to prevent payment for Covered Services that are not covered by
Medicaid or another publically-funded benefits assistance program, or provided
to an individual who has depleted other fund sources.
(b) Financial Penalties. The department or a
Managing Entity shall apply the provisions of rule
65-29.001, F.A.C, if a service
provider fails to comply with an approved corrective action plan in response to
a finding of unacceptable performance, nonperformance, or noncompliance to the
terms and conditions of a contract or subcontract.
(c) The SAMH-Funded Entity's invoice packet
shall include a signed attestation by the fiscal agent identified in the
entity's contract or subcontract that, to the best of the fiscal agent's
knowledge at the time of invoice submission, no other payor source was
available or approved to reimburse the entity for the services submitted for
reimbursement.
(d) Upon
notification of overpayments by the department, an SAMH-Funded Entity shall
have thirty days to remit the amount of the overpayment to the
department.
(e) Service
Documentation.
1. Service providers shall
establish procedures for documenting and reporting service events in such a
manner as to provide a clear and distinguishable audit trail. Such procedures
shall ensure that documents and reports are complete and accurate, service
documentation requirements are met for each Covered Service, and the department
is not billed for unallowable units or more units than are eligible to be
paid.
2. If a service provider
fails to meet the individual eligibility and service delivery regulatory
requirements of a federal or state funding source provided by the department
and the service provider receives payment from the department for such service,
the amount of the payment shall be considered an overpayment and be remitted to
the department or offset by the service provider providing additional
contracted substance abuse or mental health services of comparable or more
value that comply with the individual eligibility and service delivery
regulatory requirements.
Rulemaking Authority 394.78(1), (5), 394.9082(3), 397.321(5), 402.73 FS. Law Implemented 394.74(2)(b), (3)(d), (e), (4), 394.77, 394.78(1), (5), 394.9082, 397.321(10), 402.73(1) FS.
New 7-1-03, Amended 12-14-03, 1-2-05, 7-27-14, 6-28-15, 4-27-16, 3-5-23.
Disclaimer: These regulations may not be the most recent version. Florida may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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