Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65E - Mental Health Program › Chapter 65E-11 - BEHAVIORAL HEALTH SERVICES › Section 65E-11.002 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
Definitions as used in Chapter 65E-11, F.A.C.
(1) "Alternative Services" means services
				other than those specified in Rule
				 65E-11.003, F.A.C., that a Lead
				Agency or a Provider of Behavioral Health Services and district deems necessary
				to meet the objectives outlined in a child's treatment plan.
(2) "Assessment" means the systematic
				collection and integrated review of individual-specific data and completion of
				evaluations for determining clinical eligibility and treatment
				planning.
(3) "Behavioral Health
				Interventions" means the prevention, diagnosis, and treatment of disabling
				mental and substance dependence disorders covered under the Title XXI part of
				the Florida KidCare Program, as described in Sections 409.810-.820,
				F.S.
(4) "Behavioral Health
				Liaison" means the primary person designated and employed by the Lead Agency to
				coordinate care between and among the various departments, agencies, providers,
				and families and to determine eligibility.
(5) "Behavioral Health Network" means the
				statewide network of Providers of Behavioral Health Services who serve
				non-Medicaid eligible children with mental or substance-related disorders who
				are determined eligible for the Title XXI part of the KidCare Program. This
				network includes providers who are managed behavioral health organizations,
				private and state funded mental health and substance-related disorders
				providers, and Lead Agencies. The Behavioral Health Network is administered by
				the Department of Children and Family Services, Children's Mental Health State
				Program Office to provide a comprehensive behavioral health benefits package
				for children with serious mental or substance-related disorders.
(6) "Behavioral Health Services" means those
				services, contingent on the child's presenting condition, that are provided to
				enrolled children in the Behavioral Health Network for the treatment of mental
				or substance-related disorders.
(7)
				"Behavioral Health Network Coordinator" means the department's designated
				representative for overseeing the enrollment and provision of care by a single
				entity or local alliance of Providers of Behavioral Health services who
				comprise a behavioral health care network.
(8) "Benefits Package" means the required
				benefits and Alternative Services described in Rule
				 65E-11.003, F.A.C., that are
				made available to each child upon enrollment into the Behavioral Health
				Network.
(9) "Child" means any
				individual five (5) years of age and not yet (19) years of age who is enrolled
				in the Behavioral Health Network.
(10) "Children's Medical Services Network"
				means a state wide managed care service system that includes health care
				providers as defined in Section
				 391.021, F.S.
(11) "Eligible" means a child that has been
				screened by the behavioral health liaison as meeting the Behavioral Health
				Network clinical and treatability criteria and by the Department for Title XXI
				financial eligibility criteria but is not yet enrolled in the program to
				receive Behavioral Health Network.
(12) "Emergency Behavioral Health Care" means
				those services necessary to stabilize a child who is experiencing an acute
				crisis attributable to his or her mental or substance-related disorder, and
				without care or treatment, there exists a substantial likelihood the child will
				cause serious bodily harm to himself or herself or others in the near future,
				as evidenced by recent behavior.
(13) "Enrollment" means a child is eligible
				for and receiving services in the Behavioral Health Network after an official
				acceptance into the Behavioral Health Network based on separate determinations
				of financial eligibility by the Department that the child is eligible for the
				Title XXI component of KidCare and that the child is clinically eligible for
				enrollment.
(14) "Enrollment Pool"
				means the total number of all children enrolled in a Behavioral Health Care
				Network and who are receiving Title XXI capitated behavioral health services
				during a specified contract period, where enrollment capacity is calculated as
				a separate calendar month per child.
(15) "Family" means the individual(s)
				consisting of parents(s), or adult caretaker(s) that reside with and have legal
				responsibility for the child.
(16)
				"Integrated Care System" means a comprehensive contracted program of services
				for children with special health care needs. This is the core service delivery
				structure of the Children's Medical Services Network.
(17) "Lead Agency" means a Provider of
				Behavioral Health Services who is the legal entity within a Behavioral Health
				Care Network and is responsible for the provision and coordination of medically
				necessary behavioral health services to children and enrolled in its Behavioral
				Health Care Network.
(18)
				"Medically Necessary Behavioral Health Services" means any behavioral health
				treatment and service necessary to prevent, diagnose, correct, or alleviate, or
				preclude deterioration of a condition that interferes with a child's ability to
				function in the home, school and community. Medically necessary behavioral
				health services shall be individualized and consistent with the symptoms,
				diagnosis, and treatment of the child's presenting condition; and shall be (1)
				provided in accordance with generally accepted professional practice standards;
				(2) shall not be primarily intended for the convenience of the child, the
				child's family, and the Provider of Behavioral Health Services; (3) shall be
				the most appropriate level of service for the diagnosis and treatment of the
				child's condition; and (4) shall be approved by the medical body or health care
				specialty involved in the child's treatment as effective, appropriate, and
				essential for the care and treatment of the child's condition.
(19) "Providers of Behavioral Health
				Services" means those managed behavioral health care organizations, or
				substance-related and treatment programs, or independent behavioral health
				providers, or subcontracted providers that directly provide behavioral health
				services to enrolled children and who also meet the minimal licensure and
				credentialing standards set forth in statutes and rules of the department or
				the Department of Health, Division of Medical Quality Assurance
,
pertinent to the treatment and prevention of mental and substance-related
				disorders.
(20) "Reverification"
				means the redetermination of a child's eligibility based on the criteria
				described in Rule  65E-11.004, F.A.C.
(21) "Risk" means the potential financial
				liability assumed by the Lead Agency for all behavioral health services
				included in the behavioral health benefit package, and non-direct client
				services specified in Rule
				 65E-11.003, F.A.C.
(22) "Routine Care" means Behavioral health
				services intended to maintain and improve the child's optimal level of
				functioning in the home, school, and community.
(23) "Rural" means an area which consist of a
				population density of 100 or fewer individuals per mile.
(24) "Screening" means the preliminary
				determination of a child's potential eligibility for behavioral health services
				from a Behavioral Health Care Provider based on the eligibility criteria
				described in Rule  65E-11.004, F.A.C.
(25) "Targeted Outreach" means the planned
				and coordinated efforts to communicate information about the Behavioral Health
				Network with an overall intent to increase awareness, participation, and
				enrollment in the program.
(26)
				"Treatment Plan" means that identifiable section of the medical record that
				depicts goals and objectives for the provision of services with specific
				treatment environments. The treatment plan shall be developed by a team
				consisting of individuals with experiences and competencies in the provision of
				behavioral health services to children as described in subsection
				 65E-11.002(10),
				F.A.C.; including if deemed appropriate by the family, the child and family or
				family representatives; and other agencies, providers or other
				persons.
(27) "Urgent Care" means
				those behavioral health services provided to children with mental or substance
				dependence disorders, whose presenting condition, although not
				life-threatening, could result in serious injury or disability unless
				behavioral health services is received.
Rulemaking Authority
					 409.8135(6) FS.
					 Law Implemented 409.8135
					 FS.
New 1-17-01, Amended
					 8-31-03.